Deck 20: Chronic Lymphocytic Leukemia and Related Lymphoproliferative Disorders

Question 1

All of the following are features of CLL except:

A) Monoclonality
B) Polyclonality
C) Hypogammaglobulinemia
D) Autoimmune disease
E) None of the above

Answer 1

Polyclonality

Question 2

The final diagnosis of any lymphoproliferative disorder encompasses clinical data obtained from __________ analysis.

A) Morphologic
B) Histologic
C) Immunologic
D) All of the above
E) None of the above

Answer 2

All of the above

Question 3

What age group does CLL primarily affect?

A) 4-20 years
B) 20-40 years
C) >50 years
D) 1-5 years
E) None of the above

Answer 3

>50 years

Question 4

Diagnosis of CLL can be confirmed immunologically by the use of monoclonal antibodies that detect __________ antigens.

A) Cluster differentiation (CD)
B) Chromosome designation
C) Cytoplasmic differentiation
D) Leukocyte differentiation
E) None of the above

Question 5

Clinical features of CLL include all of the following except:

A) Absolute lymphocytosis
B) Splenomegaly
C) Axial lymphadenopathy
D) Thrombocytosis
E) None of the above

Question 6

What is the classification of anemia in CLL?

A) Macrocytic/hyperchromic
B) Normocytic/normochromic
C) Microcytic/hypochromic
D) Microcytic/normochromic
E) None of the above

Question 7

A cell that could suggest that lymphocytes in CLL are not normal is a:

A) Smudge cell
B) Lymphoblast
C) Monoblast
D) All of the above
E) None of the above

Question 8

CLL has been known to occur simultaneously with what hematologic disorder?

A) Acute myeloblastic leukemia (AML)
B) Acute lymphocytic leukemia (ALL)
C) Non-Hodgkin's lymphoma
D) Hairy cell leukemia
E) None of the above

Question 9

The laboratory test for detecting minimal residual disease in patients who have previously been treated for CLL but currently lack histopathologic evidence of relapse is the:

A) Polymerase chain reaction (PCR)
B) Complete blood count (CBC) and differential
C) Electrophoresis
D) All of the above
E) None of the above

Question 10

In CLL, all of the following might result from the autoimmune phenomenon except:

A) Thalassemia
B) Autoimmune hemolytic anemia
C) Idiopathic thrombocytopenic purpura (ITP)
D) Immune neutropenia
E) None of the above

Question 11

What is meant by monoclonality?

A) Presence of kappa and lambda chains
B) Presence of either kappa or lambda light chains
C) Absence of kappa and lambda light chains
D) Presence of epsilon chain
E) None of the above

Question 12

Which morphologic factors distinguish the lymphocytes of CLL from normal mature lymphocytes?

A) Nucleoli
B) N/C ratio
C) Exaggerated nuclear chromatin
D) Secondary granules
E) None of the above

Question 13

Required hematologic findings for a diagnosis of CLL include:

A) 5000/µL lymphocytes in the peripheral blood
B) 30% lymphocytosis in bone marrow
C) Normocytic/hypochromic anemia
D) A and B
E) A and C

Question 14

What are the consequences of the accumulation of the lymphocytes in the peripheral blood and bone marrow in a patient with CLL?

A) Neutropenia
B) Anemia
C) Thrombocytopenia
D) All of the above
E) None of the above

Question 15

Autoimmune hemolytic anemia in CLL is characterized by the following:

A) A positive direct Coombs' test
B) An increased indirect serum bilirubin
C) Reticulocytosis
D) All of the above
E) None of the above

Question 16

In CLL there is a malignant proliferation of which cell?

A) B lymphocytes
B) T lymphocytes
C) Natural killer (NK) lymphocytes
D) Null lymphocytes
E) None of the above

Question 17

Immune dysfunction within proliferating B cells of CLL is indicated by:

A) Monoclonal gammopathy
B) Hypogammaglobulinemia
C) Hypergammaglobulinemia
D) All of the above
E) None of the above

Question 18

Which immunologic technique is helpful in detecting very small numbers of malignant cells or amplifying gene rearrangements in malignant clones?

A) Monoclonal antibodies
B) Polyclonal antibodies
C) PCR technology
D) DNA probe
E) None of the above

Question 19

Suppression of all classes of immunoglobulin is evident in CLL, resulting in:

A) Hypergammaglobulinemia
B) Decreased susceptibility to infections
C) Autoimmune disease
D) Hypothyroidism
E) None of the above

Question 20

The demonstration of SIg (surface immunoglobulin) is the classic marker for __________.

A) T cells
B) B cells
C) Null cells
D) NK cells
E) None of the above

Question 21

The following is true regarding hairy cell leukemia:

A) Pancytopenia is a common finding
B) Lymphocytes appear as hair-like cytoplasmic projections
C) Alkaline phosphatase is not inhibited by tartrate-resistant acid phosphatase (TRAP) reaction
D) A and B
E) A, B, and C

Question 22

The most common chromosomal abnormality in B-CLL (B lymphocytes) is an extra chromosome called __________.

A) Inversion 12
B) Trisomy 12
C) Trisomy 7
D) Inversion 7
E) None of the above

Question 23

What is characteristic morphology for Sézary cells?

A) Dark-staining hyperchromatic nuclear chromatin with numerous folds
B) Light-staining hyperchromatic nuclear chromatin with numerous folds
C) Dark-staining hypochromatic nuclear chromatin with many clumps
D) Light-staining hypochromatic nuclear chromatin with numerous grooves
E) None of the above

Question 24

Atypical lymphocytes in reactive lymphocytosis are a proliferation of which type of cell?

A) T cell
B) B cell
C) NK cell
D) Null cell
E) None of the above

Question 25

What definitive factor differentiates prolymphocytic leukemia (PL) from CLL?

A) Extreme leukocytosis (>100  10/L)
B) Splenomegaly without lymphadenopathy
C) Presence of prolymphocytes
D) A and B
E) B and C

Question 26

The most common etiologic agent for reactive lymphocytosis is:

A) Viral
B) Bacterial
C) Fungal
D) Unknown
E) None of the above

Question 27

The leukemia phase of cutaneous T-cell lymphoma, mycosis fungoides, is called __________.

A) Hunter's syndrome
B) Hairy cell leukemia
C) Sézary syndrome
D) Idiopathic myelofibrosis
E) None of the above

Question 28

Well-differentiated lymphocytic leukemia is a diffuse non-Hodgkin's lymphoma that is characterized by neoplastic transformation of __________.

A) T lymphocytes
B) B lymphocytes
C) NK cells
D) Null cells
E) None of the above

Question 29

Which may be used to differentiate CLL from ALL?

A) Age of patient
B) Nuclear chromatin pattern
C) Presence of nucleoli
D) All of the above
E) None of the above