Leukaemias & Lymphomas

1.Define Leukaemia. Classify Acute Myeloblastic Leukaemia as per WHO classification. Describe the peripheral smear and bone marrow findings with illustrations in a case of Acute Myeloid Leukaemia

2.A 30-year-old female presented with history of easy fatiguability, weight loss, recurrent fever and gum bleeding. Clinical examination revealed severe pallor with hepatosplenomegaly. Blood routine examination showed Hb 8gm%, total count- 75000/mm3, platelet count 40000/mm3

• a) What is your provisional diagnosis
• b) Mention the classification systems of the disease and enlist the types
• c) Describe the peripheral smear and bone marrow findings of the disease

3.A 35 year old male complains of fever, fatigue for the past 15 days. He had bleeding gums for the past 3 days. He had severe bone pains also. His total white blood cell count was 1,23,000 cells/c.mm with myeloblasts of 69%.

• a) What is your provisional diagnosis.
• b) Describe the peripheral smear and bone marrow findings.
• c) What other investigations are to be done for classifying the disease and assessing the prognosis of the patient

4.Define and classify myeloproliferative neoplasms. Discuss the clinical features and laboratory diagnosis of chronic myeloid leukaemia

5.A 60-year-old male develops fatiguability, weakness, weight loss and a dragging sensation in the abdomen. Blood examination reveals a total count exceeding 100,000 cells /cu mm. O/E massive splenomegaly.

• a) What is your provisional diagnosis.
• b) Describe the peripheral smear and bone marrow findings.
• c) Describe the pathogenesis and the further tests to be done

6.A 60-year-old man presents to the medical OPD with complaints of easy fatiguability, bone pain and decreased urination. On examination, he has pallor. Systemic examination is normal. Hemogram shows Hb- 8gm%, TLC of 6500/mm3 and platelet count of 1,60,000/mm3. The differential leucocyte count is normal. Peripheral smear shows increase in Rouleaux formation. ESR is 110mm/first hour. Serum Creatinine of 3.8gm%. A bone marrow examination was ordered the next day.  What is the most likely possibility in such a situation  What are the findings expected in a bone marrow examination  What are the laboratory investigations you will do to arrive at a diagnosis and what are the expected results  What are the complications of this disease

7.Define acute leukemia. Classify acute myeloid leukemia. Indicate the importance of cytogenetics in acute myeloid leukemia. Draw the blood picture in acute promyelocytic leukemia

1.Hodgkin’s lymphoma

2.Classify Hodgkin Lymphoma. Describe the morphological features and immunohistochemical profile of Classical Hodgkin Lymphoma

3.What are the types of Leukemoid reaction. Discuss the causes

4.A two years old female child presented with pallor, growth retardation and history of repeated transfusions. There was malocclusion of jaws with skull X ray showing “hair on end appearance” and hepatosplenomegaly. Answer the following  What is your diagnosis  What is the etiopathogenesis of this condition  What are the peripheral smear findings  What are the bone marrow findings

5.A 60 year old male patient was brought to the hospital with history of weakness and lethargy since 6 months. On examination he had mild pallor and massive splenomegaly extending up to the umbilicus. He had no palpable lymph nodes. Lab reports showed a total WBC count of 1.5 lakh cells/ mm3.  What is your diagnosis  Discuss the lab diagnosis of this condition  Name the molecular test that you would do to confirm your diagnosis

6.A 14 years old boy presented with fever, cervical lymphadenopathy, rashes, mild hepatomegaly. No bleeding manifestation. TC: 20,000 cell/mm3; predominantly lymphocytes in peripheral blood. Answer the following: • What is your provisional diagnosis • What are the confirmatory tests • What is the complication • What is the etiologic agent

7.A 50 years old male presented with weakness, pallor and massive splenomegaly. Blood examination revealed marked increase in the total count. Answer the following: • What is the probable diagnosis. • What are the peripheral smear findings. • What is the genetic abnormality. • What are the different stages of disease progression

8.45 years old male presented with splenomegaly and anemia. His total WBC count was 1.5 lakhs per cu mm with myeloid precursors of all series in peripheral blood. Answer the following: • What is your diagnosis. • Describe the peripheral blood and bone marrow findings. • What is the cytogenetic abnormality

9.Five years old boy presented with recurrent fever, generalized lymphadenopathy, hepatosplenomegaly and severe anemia. His total WBC count was more than a lakh with numerous blasts. Answer the following: • What is your diagnosis. • Describe the types of blast with diagram. • What is the bone marrow picture in this condition

10.A 53 year old male presented with pain abdomen. Investigations: Hb 8g/dl TC 70,000/cmm DC N 55 L 10 myelocyte 15 metamyelo 10 band 1 eosino 6 baso 3 platelet count 5.8 lakh/cmm. Answer the following: • What is your diagnosis. • Describe the peripheral blood picture and bone marrow findings in this condition • Name the cytogenetic abnormality associated

1.Enlist two common indications and two absolute contraindications for bone marrow aspiration study

2.Leukemoid reactions

3.Laboratory Findings in Chronic myeloid leukemia

4.Aetiopathogenesis of Burkitt’s lymphoma and its morphology

5.Peripheral blood picture in acute myeloid leukemia

6.FAB classification of Acute Leukemia

7.Differential diagnosis of pancytopenia

8.Laboratory diagnosis of acute promyelocytic leukemia

9.Leucoerythroblastic blood picture – definition and causes

10.Lab investigations for diagnosis of acute leukemia

11.Peripheral smear findings in chronic lymphocytic leukemia

12.Staining of peripheral blood film

1.What is Reed Sternberg Cell

2.Two uses of buffy coat

3.Auer rods

4.Mott cell

5.Auer rods are seen in …………………

6.Classify Hodgkins lymphoma

7.Name two parasites seen in peripheral smear

8.Subtypes of Hodgkin’s lymphoma

9.Write the chromosomal abnormality in Chronic myeloid leukemia

10.Write two characteristic differences between Myeloblasts and Lymphoblasts

11.Cyclin D1 amplification is a feature of which lymphoma

12.Examples for Romanowsky stain

13.Starry sky appearance in Burkitt Lymphoma is due _______________

14.Hypersplenism

15.Philadelphia chromosome

1.Epstein Barr Virus is associated with the following cancers

• 1) Endometrial Carcinoma
• 2) Nasopharyngeal Carcinoma
• 3) Gastric carcinoma
• 4) Hodgkin’s Lymphoma
• a) 1, 2 and 3 are correct
• b) 2, 3 and 4 are correct
• c) 1, 3 and 4 are correct
• d) 1, 2 and 4 are correct

2.Identification of plasmodium falciparum in the peripheral smear include

• 1) Schizont forms
• 2) Small thin ring forms of the parasite inside the RBC
• 3) Banana shaped gametocytes
• 4) Multiple ring forms in a single RBC
• a) 1, 2 and 3 are correct
• b) 2, 3 and 4 are correct
• c) 1, 3 and 4 are correct
• d) 1, 2 and 4 are correct

3.Leukocyte alkaline phosphatase is markedly reduced in

• a) Acute Lymphoblastic Leukaemia
• b) Acute Myeloblastic Leukaemia
• c) Chronic Myeloid Leukaemia
• d) Chronic Lymphocytic Leukaemia

4.The most common morphology of red blood cells seen in the peripheral smear of the above case is

• a) Microcytes
• b) Schistocytes
• c) Drepanocytes
• d) Codocytes

5.Classical Hodgkin lymphoma subtypes are

• 1) Nodular lymphocyte predominant
• 2) Mixed cellularity
• 3) Nodular sclerosis
• 4) Lymphocyte depleted
• a) 1, 2, 3
• b) 2, 3, 4
• c) 3, 4, 1
• d) 1, 2, 4

6.Translocation seen in Burkitt’s lymphoma is

• a) t(8:14)
• b) t(9:22)
• c) t(14:18)
• d) t(15:17)