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85 Cards in this Set
- Front
- Back
Which of the following hematologic diseases are considered to be Myeloproliferative disorders?
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1)Chronic Myelocytic leukemia
2) Polycythemia vera 3) Idiopathic myelofibrosis 4) Essential thrombocythemia *5) All of the above |
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Acute myeloproliferative disorders (MPD) include all of the following except
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1) Erythroleukemia
*2) Polycythemia vera 3) Acute myeloblastic leukemia 4) Acute Promyelocytic leukemia |
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Leukemia is defined as
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A malignant disease of hematopoietic tissue, characterized by replacement of normal bone marrow elements with abnormal (neoplastic) blood cells
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Leukemia of the myeloid lineage may include
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1) Granulocytic leukemia
2) Monocytic leukemia 3) Megakaryocytic leukemia *4) All of the above |
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What is the ratio of development of leukemia in adults versus children?
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10:1
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What clinical features suggests a chronic leukemia?
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Insidious clinical onset
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Five to 10% of cases of AML (acute myeloblastic leukemia) are preceded by a recognizable "preleukemic" __________ syndrome.
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Myelodysplastic
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A 35-year-old man presents with anemia, neutropenia, thrombocytopenia, myeloblasts with the presence of Auer rods and 1-2 distinct nucleoli and promyelocytes. Cytochemistry examination demonstrates peroxidase and Sudan black positive and TdT negative. This hematologic picture is consistent with
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AML (acute myeloblastic leukemia)
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A 5-year-old girl presents with anemia, neutropenia, thrombocytopenia, lymphoblasts and prolymphocytes. Cytochemical examination shows peroxidase and Sudan black negative, and a positive for TdT. This hematologic picture is consistent with
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ALL (acute lymphoblastic leukemia)
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When a leukemia is suspected in a patient, what laboratory test should be required for the initial diagnosis?
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1) CBC, differential, platelet count
2) Cytochemical stains 3) Immunologic surface markers *4) All of the above |
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The presence of Auer rods in the cytoplasm of cells rules out __________.
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ALL (acute lymphoblastic leukemia)
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A positive myeloperoxidase or Sudan black B stain indicates __________ differentiation.
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Myeloid
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A positive nonspecific esterase stain indicates __________ differentiation.
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Monocytic
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The cytochemical reactions are performed by applying staining techniques to __________ smears.
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1) Peripheral blood
2) Bone marrow 3) Touch preparation *4) All of the above |
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The Sudan black B (SBB) stain is the most sensitive stain for granulocytic precursors with a staining pattern which parallels the __________ stain.
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Myeloperoxidase
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Which cytochemical stain more specific than sudan black B stain should be recommended for granulocytic differentiation?
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Myeloperoxidase
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The alpha-naphthyl butyrate stain is used to identify __________ cells.
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Monocytic
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A strong periodic acid-Schiff (PAS) reaction supports the diagnosis of __________.
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Erythroleukemia
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Which of cytochemical stain differentiates AML from ALL?
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Myeloperoxidase
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In immunologic surface marker studies, __________ are used to detect markers associated with cell lineage and maturation stage.
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Antibodies
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Cytoplasmic marker studies are useful in assessing cell linege in
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ALL
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During bacterial infection the granulocyte-to-erythroid ratio can increase due to __________ production.
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Increased granulocyte
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What should be suspected when the left shift is seen in the presence of low leukocyte counts with 70% neutrophils?
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Septicemia
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Morphological features that can be clinically sensitive to the presence of severe infections include:
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1) Toxic granulation
2) Vacuolated cytoplasm 3) Döhle bodies *4) All of the above |
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Döhle bodies consist of __________.
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Endoplastic reticulum
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Neutropenia is produced by:
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1) Decrease in production by the bone marrow
2) Impaired release from the marrow into the blood 3) Maldistribution resulting in pseudoneutropenia *4) All of the above |
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Newborns who are afflicted with a bacterial infection will develop severe neutropenia because of:
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The neutrophil storage pool being depleted in the bone marrow
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Acquired neutropenia as a component of pancytopenia occurs in patients who have bone marrow failure due to:
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1) Toxic injury
2) Malignant cell invasion 3) Aplastic anemia *4) All of the above |
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A rare autosomal recessive congenital disorder that features partial albinism, mild bleeding tendencies, and giant lysosomal granules in blood and tissue cell is known as ____________.
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Chédiak-Higashi disease
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Myeloperoxidase is present in the primary granules of __________.
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1) Neutrophils
2) Eosinophils 3) Monocytes/macrophages *4) All of the above |
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The susceptibility to infections in Chédiak-Higashi disease is due to:
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1) Abnormal distribution of lysosomal enzymes
2) Impaired chemotaxis 3) Neutropenia *4) All of the above |
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What X-linked recessive disease is characterized by a granuloma formation as a result of the inability of neutrophils, monocytes, and eosinophils to kill microorganisms following normal engulfment?
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Chronic granulomatous disease
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A patient with leukemia demonstrated bilobed neutrophils on a peripheral blood smear. These are often called:
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Pseudo-Pelger-Huet neutrophils
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__________, seen in association with mucopolysaccharidosis, has characteristic dark staining and coarse cytoplasmic granules in the cytoplasm of neutrophils, lymphocytes, and monocytes.
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Alder's anomaly
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Which qualitative WBC disorder demonstrates blue-staining cytoplasmic inclusions in neutrophils that resemble Döhle bodies?
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May-Hegglin anomaly
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Which of the following morphologies differentiates reactive lymphocyte from monocytes?
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Increased patchy basophilic cytoplasm
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Reactive lymphocytes in infectious mononucleosis represent:
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T lymphocytes responding to infection
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Additional serologic findings may be required to distringuish EBV infection from which other viral infections?
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1) Hepatitis
2) Cytomegalovirus 3) Rubella *4) All of the above |
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A patient presents with absolute lymphocytosis with 12% reactive lymphocytes on the peripheral blood smear. The heterophils antibody test is negative. What more specific antibody test should be performed?
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IgM-EBV (Epstein-Barr virus)
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What other laboratory tests have significant correlation with infectious mononucleosis?
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1) ALT (alanine transferase)
2) AST 3) Bilirubin *4) All of the above |
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TdT (terminal deoxynucleotidyl transferase) is found in 90% of acute __________ leukemia.
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Lymphoblastic
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In performing surface marker analysis for FAB (French-American-British) classification M4 and M5, monoclonal antibodies specific for __________ cells would be detected by flow cytometry.
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Monocytic
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Which FAB (French-American-British) classification demonstrates at least 3% positivity with peroxidase or Sudan black, < 20% positivity with nonspecific esterase, and contains primarily myeloblasts with distinct nucleoli?
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M1
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This acute leukemia contains primarily abnormal promyelocytes with heavy granulation, and the presence of Auer rods is abundant. The cells react near 100% with Sudan black and peroxidase; however, the reaction is negative for non-specific esterase. DIC is frequently associated with this disorder. What is the FAB (French-American-British) classification?
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M3
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The most common acute leukemia FAB classification diagnosed is __________.
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M2
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What definitive laboratory findings in acute myelomonocytic leukemia aid in the differentiation of M4 and M2?
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Increased serum lysozyme level
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Chronic lymphocytic leukemia (CLL) is included in a general category of conditions known as the __________ disorders.
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Lymphoproliferative
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In chronic lymphocytic leukemia (CLL) there is a malignant proliferation of which cell?
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B lymphocytes
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Suppression of all classes of immunoglobulin is evident in CLL (chronic lymphocytic leukemia) resulting in:
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Autoimmune disease
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The laboratory test for detecting minimal residual disease in patients who have previously been treated for CLL but currently lack histopathelogic evidence of relapse is the:
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PCR
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A cell that could suggest that lymphocytes in CLL are not normal is a:
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Smudge cell
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All of the following are features of CLL (chronic lymphocytic leukemia) except:
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1) Monoclonality
*2) Polyclonality 3) Hypogammaglobulinemia 4) Autoimmune disease |
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The final diagnosis of any lymphoproliferative disorder encompasses clinical data obtained from __________ analysis.
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1) Morphologic
2) Histologic 3) Immunologic *4) All of the above |
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CLL (chronic lymphocytic leukemia) has been known to occur simultaneously with what hematologic disorder?
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Acute myeloblastic leukemia (AML)
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Clinical features of CLL (chronic lymphocytic leukemia) include all of the following except:
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Splenomegaly
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What definitive factors differentiate prolymphocytic leukemia (PL) from CLL?
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Extreme leukocytosis (>100 x 10 /L) and splenomegaly without lymphadenopathy
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What is characteristic morphology for Sézary cells?
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Dark-staining hyperchromatic nuclear chromatin with numerous folds
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Other names for chronic myelogenous leukemia include:
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Chronic granulocytic leukemia
and Chronic myeloid leukemia |
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CML (chronic myelocytic leukemia) is characterized by examining the production of __________ and their precursors.
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Granulocytes
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Which phase of CML (chronic myelocytic leukemia) carries the worst prognosis and is generally unresponsive to treatment?
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Blast crisis
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Which cell types contain the Ph chromosome in patients with CML (chronic myelocytic leukemia)?
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1) Neutrophil
2) Monocyte 3) Erythrocyte 4) Platelet *5) All of the above |
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In CML (chronic myelocytic leukemia) the term maturation arrest refer to the:
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Absence of cellular differentiation beyond the blast or promyelocyte stage
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Which of the following hematologic diseases are considered to be chronic myeloproliferative disorders?
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1) Chronic myelocytic leukemia
2) Polycythemia vera 3) Idiopathic myelofibrosis 4) Essential thrombocythemia *5) All of the above |
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Which myeloproliferative disorder is characterized by fibrosis of the marrow, extramedullary hematopoiesis of the spleen or liver, leukoerythroblastosis, and teardrop poikilocytosis?
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Idiopathic myelofibrosis
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Factors that have been implicated in stimulating fibroblast proliferation in myelofibrosis include:
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Release of PDGF (platelet derived growth factor)
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What is/are the strongest differentiating feature(s) that distinguish CML (chronic myelocytic leukemia) from IMF (idiopathic myelofibrosis)?
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Decreased LAP (leukocyte alkaline phosphatase)
and Presence of Philadelphia chromosome |
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What is the etiology of polycythemia vera?
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Clonal hematologic malignancy of bone marrow
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A patient presents with an HCT of 55%, elevated red cell mass, normal arterial oxygen saturation, elevated LAP (leukocyte alkaline phosphatase) score, and thrombocytosis. What is the most probable cause of these laboratory findings?
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Polycythemia vera
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The fundamental characteristic of MDS is:
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Peripheral blood cytopenia and bone marrow hypercellularity
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The following morphologies are characteristic of dyserythropoiesis in MDS (myelodysplastic syndrome):
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Basophilic stippling and Normochromic, normocytic red cells
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What specific features are characteristic of dysgranulopoiesis morphology in MDS (myelodysplastic syndrome)?
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Hypersegmentation in bone marrow
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What specific features are characteristic of dysmegakaryocytopoiesis morphology in MDS (myelodysplastic syndrome)?
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Micromegakaryocytes
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What type of MDS (myelodysplastic syndrome) demonstrates a mild decreased WBC (3.9 x 10/L), increased erythropoiesis and normal numbers of blast cells in the marrow, and < 15% sideroblasts?
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Refractory anemia (RA)
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Which of the following is the most significant prognostic indicator in MDS (myelodysplastic syndrome)
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Percentage of bone marrow blasts
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In calculating the percentage of myeloblasts in the bone marrow, the following data is given. Erythroid nuclear precursors (E) = 65%, myeloblasts = 14%, other cells = 21%. Based on these numbers, what is the percentage of myeloblasts by FAB classification?
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40%
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Wright's stains of peripheral blood smears from some patients with myeloma are bluish. This coloration is due to increased background staining of the high level of __________ in the plasma portion of the blood.
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Immunoglobulin
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Which laboratory test(s) should be ordered to evaluate a patient suspected of having plasma cell disorder?
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1) SPEP (serum protein electrophoresis)
2) Calcium 3) BUN (blood urea nitrogen) 4) ESR (erythrocyte sedimentation) *5) All of the above |
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A 63-year-old black man presents with an elevated ESR, 10-30% plasma cells in the bone marrow, M-spike by SPEP (serum protein electrophoresis), and 4.0 g/dl of serum IgG by radial diffusion. What plasma cell disorder is implicated?
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Multiple myeloma
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In multiple myeloma, a plasma cell will sometimes contain clumps of aggregated immunoglobulin that stain red with Wright-Giemsa stain. These aggregates are referred to as:
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Russell bodies
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How does osteoclast activating factor (OAF) produced by malignant plasma cells influence disease in multiple myeloma?
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1) Induces overactivity of osteoclasts
2) Induces bone reabsorption 3) Produces lytic bone lesion 4) Increases calcium *5) All of the above |
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What multiple myeloma manifestation describes the formation of abnormal proteins in organ systems due to deposition of immunoglobulin light chains leading to kidney and renal dysfunction?
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Amyloidosis
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Neurologic manifestations such as blurred vision, headaches, and episodes of consfusion occur in patients with Waldenstrom's macroglobulinemia due to __________.
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Hyperviscosity syndrome
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The morphologic hallmark of Hodgkin's lymphoma is a peculiar cell called the __________cell.
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Reed-Sternberg
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The most frequently occurring subtype of Hodgkin's lymphoma is:
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Nodular sclerosing Hodgkin's lymphoma
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What following cell types are commonly found in mixed cellularity Hodgkin's disease?
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1) Lymphocytes
2) Histiocytes 3) Plasma cells 4) Reed-Sternberg cells *5) All of the above |