KMU Past Paper Practice

Question:

A 38-year-old man has a total leukocyte count that is only mildly reduced. His differential count, however, shows a marked reduction in neutrophils. He has recently developed recurrent oral ulceration and fever. Which laboratory value best reflects his risk of serious infection?

Options:

Correct Answer: Absolute neutrophil count

Explanation: Infection risk in leukopenia depends particularly on the number of circulating neutrophils, so the absolute neutrophil count is more informative than the total leukocyte count alone.

Question:

A 55-year-old woman presents with high fever, productive cough and focal chest signs. CBC shows neutrophilic leukocytosis. The peripheral blood film demonstrates predominantly mature neutrophils with band forms and prominent toxic changes. Which interpretation best fits these findings?

Options:

Correct Answer: Strong reactive inflammatory response

Explanation: Neutrophilia with band forms and toxic morphological changes in a patient with clear bacterial infection supports an intense reactive marrow response rather than leukemia.

Question:

An 11-year-old child is recovering from a febrile upper respiratory illness. CBC shows mild leukocytosis with lymphocyte predominance. The blood film shows atypical lymphocytes, while hemoglobin and platelets are normal. There is no hepatosplenomegaly. Which interpretation is most appropriate?

Options:

Correct Answer: Reactive lymphocyte response to viral illness

Explanation: Atypical lymphocytes can accompany viral illness, especially when other blood-cell lines are preserved and there are no clinical features suggesting marrow infiltration.

Question:

A 46-year-old woman has persistent leukopenia with mild anemia. She has no recent infection and is not taking marrow-suppressing medication. The peripheral film shows abnormal maturation and dysplastic neutrophil morphology. What is the most appropriate interpretation?

Options:

Correct Answer: Abnormal marrow production requiring evaluation

Explanation: Persistent cytopenia combined with dysplastic white-cell morphology suggests disturbed marrow production and warrants further hematological assessment.

Question:

A patient presents with fatigue, recurrent infections and easy bruising. CBC demonstrates pancytopenia. The reticulocyte response is markedly reduced. Which process does this finding most strongly support?

Options:

Correct Answer: Reduced bone-marrow blood-cell production

Explanation: A poor reticulocyte response indicates that the marrow is not adequately increasing red-cell production and supports a hypoproliferative marrow process.

Question:

A 29-year-old patient with pancytopenia is initially suspected to have aplastic anemia. Examination, however, reveals marked splenomegaly and generalized lymphadenopathy. What is the most appropriate interpretation of these examination findings?

Options:

Correct Answer: They suggest reconsidering an infiltrative or hematological disorder

Explanation: Significant lymphadenopathy and splenomegaly are not typical of classical aplastic anemia and should prompt reconsideration of leukemia or another infiltrative disorder.

Question:

A 6-year-old child had leukopenia during a viral illness. Six weeks later the leukopenia persists, and the child now has bruising, cervical lymphadenopathy and splenomegaly. What is the most appropriate next clinical approach?

Options:

Correct Answer: Broaden evaluation for an underlying marrow disorder

Explanation: Persistent leukopenia plus bruising, lymphadenopathy and splenomegaly is no longer compatible with an uncomplicated transient post-viral change.

Question:

A 31-year-old man develops neutrophilic leukocytosis shortly after major surgery. He is afebrile, has no localizing infective symptoms, and the film shows mature neutrophils without abnormal cells. The leukocyte count begins to fall over the next day. What is the most likely explanation?

Options:

Correct Answer: Physiological stress-related leukocytosis

Explanation: Surgery and acute physiological stress can produce transient neutrophilic leukocytosis, particularly when there are no abnormal cells or clinical signs of infection.

Question:

A 17-year-old patient with recurrent wheeze and an itchy allergic rash is found to have leukocytosis. The differential count shows a marked increase in one white-cell population, while the blood film shows mature cells without blasts. Which diagnostic direction is most appropriate?

Options:

Correct Answer: Allergic, parasitic or drug-related process

Explanation: Eosinophilia in an appropriate clinical setting directs the differential toward allergic, parasitic and selected drug-related causes rather than a leukemic process.

Question:

A patient with a prolonged inflammatory illness has persistent mild leukocytosis. The differential count shows isolated monocytosis, with mature morphology and no anemia or thrombocytopenia. Which interpretation is most appropriate?

Options:

Correct Answer: Chronic inflammatory or infectious response

Explanation: Monocytosis may accompany chronic inflammatory or infectious conditions, especially when cell morphology is mature and other blood-cell lines remain preserved.

Question:

A 50-year-old patient is referred for unexplained persistent leukocytosis. There is no obvious focus of infection. Which combination of examination findings would most strongly increase concern for an underlying hematological malignancy?

Options:

Correct Answer: Pallor, bruising, lymphadenopathy and splenomegaly

Explanation: Cytopenia-related signs together with lymph-node and splenic enlargement suggest marrow or lymphoid disease rather than a simple reactive leukocytosis.

Question:

An 8-year-old child with acute leukemia has marked lymphadenopathy, hepatosplenomegaly and persistent limb pain. These features cannot be explained solely by anemia, neutropenia or thrombocytopenia. Which pathological process best accounts for them?

Options:

Correct Answer: Infiltration of tissues by leukemic cells

Explanation: Leukemic cells may infiltrate lymph nodes, liver, spleen and bone, producing organ enlargement and bone or limb pain in addition to marrow-failure manifestations.

Question:

A patient receiving treatment for acute leukemia has severe symptomatic anemia with marked fatigue, dyspnea and tachycardia. There is no major active bleeding and the platelet count is adequate. Which supportive management principle is most appropriate?

Options:

Correct Answer: Appropriate red-cell supportive therapy

Explanation: Supportive care during acute leukemia treatment includes red-cell support when clinically indicated for significant symptomatic anemia while definitive therapy continues.

Question:

A patient with chronic myeloid leukemia initially responds to a tyrosine-kinase inhibitor. Several months later, his symptoms return and blood counts progressively worsen despite confirmed adherence. What is the most appropriate management principle?

Options:

Correct Answer: Arrange specialist reassessment for resistance or progression

Explanation: Loss of clinical or hematological response despite adherence suggests inadequate disease control and requires specialist reassessment of resistance, progression and alternative therapy.

Question:

A 70-year-old patient with CLL develops clinically significant progressive disease and now requires active treatment. Which broad therapeutic approach may appropriately form part of modern hematology-directed management?

Options:

Correct Answer: Targeted or antibody-based anti-leukemic therapy

Explanation: When CLL becomes clinically significant, hematology-directed treatment may include targeted agents and antibody-based approaches selected according to patient and disease factors.

Question:

The parents of a child with ALL are worried that the child’s younger sibling may “catch” leukemia through close contact at home. Which counselling response is most appropriate?

Options:

Correct Answer: Explain that leukemia is not contagious through ordinary family contact

Explanation: ALL is not an infectious disease and is not transmitted between family members; infection precautions relate to protecting the immunocompromised child, not preventing spread of leukemia.

Question:

A 10-year-old child receiving prolonged treatment for ALL feels increasingly isolated because of missed school and reduced contact with friends. The child is currently clinically stable. Which counselling principle is most appropriate?

Options:

Correct Answer: Support schooling, emotional wellbeing and normal routines when safe

Explanation: Family-centred ALL care should support education, emotional health and age-appropriate routines whenever these can be maintained safely during treatment.

Question:

Parents of a child newly diagnosed with ALL ask for an exact prediction of the child’s outcome before treatment-response data are available. Which counselling approach is most appropriate?

Options:

Correct Answer: Explain that outlook depends on biological risk and response to therapy

Explanation: Many children with ALL respond well, but an individual prognosis should be discussed using the child’s biological risk features and observed treatment response.

Question:

The parent of a child receiving treatment for ALL asks whether the child’s usual vaccination schedule should continue unchanged during chemotherapy. Which advice best reflects appropriate counselling?

Options:

Correct Answer: Follow the treating team’s advice on vaccination timing and safety

Explanation: Vaccination planning during leukemia treatment depends on the child’s immune status and treatment phase, so families should follow individualized advice from the oncology team.

Question:

A patient with chronic myeloid leukemia develops advanced disease despite appropriate targeted therapy. The hematology team is considering treatment beyond drug adjustment because disease control remains poor. Which intervention may be appropriate in a selected resistant or advanced case?

Options:

Correct Answer: Hematopoietic stem-cell transplantation

Explanation: Stem-cell transplantation remains an important option for selected patients with resistant or advanced CML when adequate control cannot be achieved with targeted therapy.