KMU Past Paper Practice

Question:

Bone-marrow examination in a 54-year-old patient with acute leukemia shows abnormal cells demonstrating both granulocytic and monocytic differentiation. Which FAB category best fits this pattern?

Options:

Correct Answer: M4 — Acute myelomonocytic leukemia

Explanation: FAB M4 shows differentiation along both granulocytic and monocytic pathways, distinguishing it from predominantly monocytic M5 disease.

Question:

A patient with acute myeloid leukemia has blasts showing differentiation toward platelet-producing cells. Which FAB subtype corresponds to this finding?

Options:

Correct Answer: M7

Explanation: FAB M7 is acute megakaryoblastic leukemia, in which the leukemic blasts demonstrate megakaryocytic differentiation.

Question:

A 66-year-old man has fatigue, bruising and anemia. His total leukocyte count is within the reference range, but bone marrow contains a large population of myeloid blasts. Which interpretation is most appropriate?

Options:

Correct Answer: AML can be present despite a normal total leukocyte count

Explanation: Peripheral leukocyte counts in AML may be increased, normal or reduced; marrow blast accumulation is therefore more important than the total count alone.

Question:

Morphology and lineage studies have established AML in a 49-year-old patient. Cytogenetic and molecular studies are then requested. What is their most important additional contribution?

Options:

Correct Answer: Define biologically important disease subtypes

Explanation: Cytogenetic and molecular abnormalities help classify AML into biologically meaningful subtypes after leukemia and lineage have been established.

Question:

Bone marrow from a patient with AML contains many myeloblasts, but a significant proportion of leukemic cells also mature toward later granulocytic forms. Which FAB category best fits this pattern?

Options:

Correct Answer: M2

Explanation: FAB M2 represents AML with maturation, whereas M1 is characterized by much less differentiation beyond the blast stage.

Question:

Cytogenetic analysis in a patient with a chronic myeloproliferative disorder demonstrates t(9;22). Which chromosomal structure is conventionally called the Philadelphia chromosome?

Options:

Correct Answer: Derivative chromosome 22

Explanation: The Philadelphia chromosome is the shortened derivative chromosome 22 produced by the reciprocal translocation between chromosomes 9 and 22.

Question:

A 45-year-old man has marked leukocytosis, splenomegaly and a blood film strongly suggestive of CML. Conventional chromosome analysis is inconclusive. Which study would most directly confirm the suspected disease-driving abnormality?

Options:

Correct Answer: FISH or molecular testing for BCR::ABL1

Explanation: Demonstration of the BCR::ABL1 fusion by FISH or molecular methods can confirm CML when conventional cytogenetic assessment is insufficient.

Question:

A patient with chronic-phase CML initially receives imatinib but develops intolerance while the disease remains suitable for molecularly targeted treatment. Which management principle is most appropriate?

Options:

Correct Answer: Use another BCR::ABL1 tyrosine-kinase inhibitor

Explanation: Other BCR::ABL1 inhibitors can be selected when imatinib is not tolerated or becomes unsuitable, while preserving targeted suppression of the leukemic driver.

Question:

Bone marrow is examined in a patient with chronic-phase CML who has marked peripheral leukocytosis. Which marrow pattern is most consistent with the disease at this stage?

Options:

Correct Answer: Marked granulocytic hyperplasia

Explanation: Chronic-phase CML produces a markedly hypercellular marrow dominated by expansion of the granulocytic series.

Question:

A 69-year-old woman has persistent macrocytic anemia and morphological dysplasia. Cytogenetic analysis identifies an isolated deletion involving the long arm of chromosome 5. Which MDS category best matches this finding?

Options:

Correct Answer: MDS with isolated del(5q)

Explanation: An isolated deletion of chromosome 5q defines an important MDS category and represents a clonal cytogenetic abnormality.

Question:

A 73-year-old man with a myelodysplastic syndrome has anemia with enlarged red cells. Bone marrow shows irregular erythroid precursors with disturbed development. Which process best explains these findings?

Options:

Correct Answer: Abnormal erythroid maturation

Explanation: Dysplastic erythropoiesis in MDS can produce macrocytic circulating red cells together with abnormal erythroid precursors in the marrow.

Question:

A patient with MDS has thrombocytopenia. Peripheral blood shows unusually large, poorly granulated platelets, while marrow examination demonstrates abnormal platelet-forming cells. Which pathological process is responsible?

Options:

Correct Answer: Megakaryocytic dysplasia

Explanation: MDS may produce structurally abnormal megakaryocytes and platelets, reflecting dysplastic maturation of the megakaryocytic lineage.

Question:

Persistent unexplained cytopenias and abnormal blood-cell morphology raise suspicion of MDS in a 71-year-old patient. Which set of features should be specifically assessed during marrow examination to support diagnosis and classification?

Options:

Correct Answer: Cellularity, dysplasia and blast proportion

Explanation: Marrow cellularity, the extent and lineages of dysplasia, and blast proportion are central to morphological assessment of suspected MDS.

Question:

A 64-year-old man with polycythemia vera develops recurrent attacks of acute joint pain due to urate crystal deposition. Which feature of his hematological disorder most directly contributes to this complication?

Options:

Correct Answer: Increased nucleic-acid breakdown from high blood-cell turnover

Explanation: Increased turnover of the expanded blood-cell mass raises purine breakdown and uric-acid production, predisposing to hyperuricemia and gout.

Question:

A patient with long-standing polycythemia vera later develops worsening anemia, increasing splenic enlargement and progressive fibrotic replacement of the bone marrow. Which change in the clinical course has occurred?

Options:

Correct Answer: Progression to marrow fibrosis

Explanation: Polycythemia vera may evolve over time into a fibrotic phase, producing worsening marrow function and increasing extramedullary hematopoiesis.

Question:

A 59-year-old man is being evaluated for persistent erythrocytosis. Which additional complete blood count pattern would more strongly suggest a clonal myeloproliferative process rather than an isolated increase in red-cell production?

Options:

Correct Answer: Leukocytosis with thrombocytosis

Explanation: Polycythemia vera arises from the myeloid stem-cell compartment, so granulocytes and platelets may increase along with red cells rather than erythrocytes increasing alone.

Question:

A patient receives filgrastim following myelosuppressive treatment. Which marrow response most directly accounts for the expected improvement in the circulating neutrophil count?

Options:

Correct Answer: Stimulation of neutrophil precursor proliferation and maturation

Explanation: Filgrastim acts as G-CSF, stimulating G-CSF receptors on neutrophil precursors and increasing their proliferation, maturation and marrow release.

Question:

A patient treated with G-CSF after chemotherapy shows rapid neutrophil recovery. Subsequent blood counts rise well beyond the intended range. Which pharmacological effect best explains this finding?

Options:

Correct Answer: Excessive stimulation of leukocyte production

Explanation: Because G-CSF drives granulocytic production, marked pharmacological stimulation can produce an excessive rise in circulating leukocytes.

Question:

A patient undergoing evaluation for an allergic disorder has a selective rise in one granulocyte population. Which leukocyte is most closely associated with this type of response?

Options:

Correct Answer: Eosinophil

Explanation: Eosinophils are granulocytes particularly associated with allergic responses and defense against parasitic infections.

Question:

During an inflammatory response, a circulating leukocyte leaves the bloodstream and enters tissue, where it differentiates into a macrophage. Which circulating cell is the immediate precursor?

Options:

Correct Answer: Monocyte

Explanation: Monocytes circulate in blood and can enter tissues, where they differentiate into macrophages that perform phagocytic and immune functions.