MCQs on Leukemia – AMC Wise

Written by Dr. Daniel Fraser (MBBS, FRACP) – Physician

Question 1

A 48-year-old man presents with fatigue, recurrent infections, and gum bleeding for 3 weeks. Physical examination reveals pallor and petechiae. His complete blood count shows Hb 85 g/L, platelet count 25 × 10⁹/L, and WBC 3 × 10⁹/L. Peripheral blood smear reveals numerous myeloblasts with occasional Auer rods. Bone marrow biopsy confirms hypercellularity with >25% blasts.

Which of the following is the most likely diagnosis?

A) Acute lymphoblastic leukemia
B) Chronic myeloid leukemia
C) Acute myeloid leukemia
D) Aplastic anemia
E) Myelodysplastic syndrome

Correct Answer: C) Acute myeloid leukemia

Explanation:

Acute myeloid leukemia (AML) is characterized by the proliferation of immature myeloid cells (myeloblasts) in the bone marrow, leading to pancytopenia. Clinical features include fatigue, bleeding, and infections. The presence of Auer rods in blasts is highly suggestive of AML.

ALL is more common in children and typically involves lymphoblasts. CML presents with elevated WBC and more mature granulocytes. Aplastic anemia involves pancytopenia without blasts. Myelodysplastic syndromes can show dysplastic cells but usually have <20% blasts unless transformed to AML.

The combination of pancytopenia, high blast count, and Auer rods confirms acute myeloid leukemia.

Question 2

A 6-year-old boy is brought to the emergency department with lethargy, fever, and leg pain for the past week. His parents report he has been bruising easily. Examination reveals pallor, petechiae, and tender long bones. Blood tests show Hb 78 g/L, platelet count 30 × 10⁹/L, and WBC 40 × 10⁹/L. Peripheral smear shows numerous lymphoblasts.

Which of the following is the most likely diagnosis?

A) Acute lymphoblastic leukemia
B) Acute myeloid leukemia
C) Chronic lymphocytic leukemia
D) Idiopathic thrombocytopenic purpura
E) Ewing sarcoma

Correct Answer: A) Acute lymphoblastic leukemia

Explanation:

Acute lymphoblastic leukemia (ALL) is the most common cancer in children. It typically presents with fever, fatigue, bleeding tendencies, bone pain, and signs of marrow failure (anemia, thrombocytopenia, neutropenia). The presence of lymphoblasts on blood smear supports the diagnosis.

AML is more common in adults. CLL occurs almost exclusively in older adults. ITP causes thrombocytopenia but not leukocytosis or blasts. Ewing sarcoma can present with bone pain but does not cause marrow infiltration with blasts.

This child’s presentation is classic for acute lymphoblastic leukemia.

Question 3

A 72-year-old man is referred to the clinic after routine blood tests reveal a white blood cell count of 85 × 10⁹/L. He is asymptomatic but has noticed some painless swelling in his neck. Examination reveals cervical and axillary lymphadenopathy. Peripheral blood smear shows numerous small mature lymphocytes with some smudge cells. Flow cytometry confirms a monoclonal B-cell population expressing CD5 and CD23.

Which of the following is the most likely diagnosis?

A) Chronic lymphocytic leukemia
B) Acute lymphoblastic leukemia
C) Chronic myeloid leukemia
D) Follicular lymphoma
E) Hairy cell leukemia

Correct Answer: A) Chronic lymphocytic leukemia

Explanation:

Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults, typically affecting elderly men. It is characterized by an elevated lymphocyte count with small mature lymphocytes, smudge cells on peripheral smear, and monoclonal B-cells expressing CD5 and CD23.

Unlike ALL, the lymphocytes are mature. CML presents with elevated granulocytes, not lymphocytes. Follicular lymphoma often presents with painless lymphadenopathy but does not cause marked lymphocytosis or smudge cells. Hairy cell leukemia shows “hairy”-appearing cells and pancytopenia, not lymphocytosis.

The combination of marked lymphocytosis, smudge cells, and immunophenotyping is diagnostic of CLL.

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6. Hematology Module

6.1 Anemia

6.2 Thrombocytopenia

6.3 Thromboembolism

6.4 Anti-Coagulation

6.5 Lymphomas

6.6 Other Hematological Disorders

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