QUIZ: Acute and chronic leukaemia

🧬 Leukaemia Quiz: Pathophysiology and Clinical Patterns

Test your understanding of leukaemia subtypes, diagnostic markers, and disease progression. This quiz features five case-based questions focused on acute and chronic leukaemias, suitable for second-year medical students learning about haematological malignancy.

 

1. A 6-year-old boy presents with a 2-week history of fatigue, bruising, and intermittent fever. Examination reveals pallor, petechiae, and hepatosplenomegaly. FBC shows pancytopenia with circulating lymphoblasts.
Which of the following best explains the pathophysiology of this child's condition?

A. Overproduction of mature T-cells in the thymus
B. Infiltration of bone marrow by B-cell precursors
C. Autoimmune destruction of all three cell lines
D. Excessive erythropoietin stimulating marrow turnover
E. Failure of DNA repair in mature myeloid cells

2. A 55-year-old man is found to have a white cell count of 85 × 10⁹/L during a routine check-up. He is asymptomatic. Blood film shows mature and immature myeloid cells at various stages of differentiation.
What is the most likely molecular abnormality responsible for this disease?

A. BCL2 gene overexpression
B. FLT3 internal tandem duplication
C. Philadelphia chromosome translocation
D. JAK2 V617F mutation
E. TP53 loss-of-function mutation

3. A 68-year-old woman presents with progressive fatigue and frequent nosebleeds. FBC reveals anaemia, thrombocytopenia, and elevated WCC with myeloblasts. Bone marrow shows >20% blasts.
Which morphological feature is most characteristic of her condition?

A. Auer rods in the cytoplasm of blasts
B. Smudge cells on peripheral smear
C. Reed-Sternberg cells in lymph nodes
D. Rouleaux formation of red cells
E. Hypersegmented neutrophils

4. An 80-year-old man presents with mild fatigue and generalised lymphadenopathy. Bloods show lymphocytosis and normocytic anaemia. Flow cytometry reveals CD5+, CD19+, CD23+ B-cells.
Which of the following is a typical feature of CLL?

A. Blasts with t(15;17) translocation
B. Monoclonal B-cell population with smudge cells
C. Pelger-Huët anomaly in neutrophils
D. Bone pain with elevated serum calcium
E. Mediastinal mass on chest X-ray

5. A 58-year-old man with known CML presents with weight loss, night sweats, and increasing blasts in the peripheral blood. His WCC is 150 × 10⁹/L. Bone marrow shows >20% blasts.
Which term best describes his current disease phase?

A. Accelerated phase
B. Blast crisis
C. Chronic phase
D. Remission
E. Relapse

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Answer Explanations

1. Correct answer: B. Infiltration of bone marrow by B-cell precursors
In ALL, immature lymphoid progenitors (usually B-cell lineage) proliferate uncontrollably and infiltrate the bone marrow, crowding out normal haematopoiesis. This leads to anaemia, thrombocytopenia, and neutropenia. Option A is incorrect as T-cell ALL often presents with a mediastinal mass. Option C refers to rare causes of pancytopenia and would not explain blasts. Option D is not relevant. Option E relates more to myelodysplastic syndromes.

2. Correct answer: C. Philadelphia chromosome translocation
CML is caused by the t(9;22) translocation, creating the BCR-ABL fusion gene (Philadelphia chromosome), which encodes a constitutively active tyrosine kinase. This drives uncontrolled proliferation of myeloid cells. Other options relate to different haematological malignancies (BCL2: follicular lymphoma, FLT3: AML, JAK2: PV/ET, TP53: various cancers).

3. Correct answer: A. Auer rods in the cytoplasm of blasts
Auer rods are azurophilic needle-like inclusions seen in myeloblasts, particularly in AML. They are not found in lymphoid blasts. Smudge cells are a feature of CLL. Reed-Sternberg cells are found in Hodgkin lymphoma. Rouleaux occurs in plasma cell dyscrasias. Hypersegmented neutrophils are associated with B12/folate deficiency.

4. Correct answer: B. Monoclonal B-cell population with smudge cells
CLL features CD5+, CD19+, CD23+ monoclonal B-cells. Smudge cells are fragile lymphocytes that appear disrupted on smear. Option A (t15;17) is APL. Pelger-Huët anomaly is a benign neutrophil nuclear defect. Bone pain with hypercalcaemia suggests multiple myeloma. A mediastinal mass is seen in T-cell ALL or lymphoma.

5. Correct answer: B. Blast crisis
Blast crisis is defined as >20% blasts in blood or marrow and resembles acute leukaemia. It is the terminal phase of CML. Accelerated phase shows 10–19% blasts. Chronic phase is the initial presentation. Remission means disease activity is undetectable. Relapse refers to disease recurrence after remission, not phase progression.

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