Hematological Malignancies

Based on Davidson's Principles and Practice of Medicine, INI CET Exam Style

1.
A 55-year-old man presents with fatigue, night sweats, and splenomegaly. Peripheral
smear shows lymphocytosis with smudge cells. Which is the most likely diagnosis?
A. Acute lymphoblastic leukemia
B. Chronic lymphocytic leukemia
C. Hairy cell leukemia
D. Acute myeloid leukemia
Answer: B. Chronic lymphocytic leukemia
Explanation: Smudge cells (basket cells) are characteristic of CLL, along with
lymphocytosis and splenomegaly.

2.
A 35-year-old woman complains of bone pain and fatigue. Investigations reveal
hypercalcemia, anemia, and M-protein spike on serum electrophoresis. What is the
diagnosis?
A. Multiple myeloma
B. Acute myeloid leukemia
C. Chronic myeloid leukemia
D. Hodgkin lymphoma
Answer: A. Multiple myeloma
Explanation: Bone pain, hypercalcemia, anemia, and an M-protein spike are classic
features of multiple myeloma.

3.
Which of the following is a classical sign of hairy cell leukemia?
A. Dry tap on bone marrow aspiration
B. Reed-Sternberg cells
C. Auer rods
D. BCR-ABL translocation
Answer: A. Dry tap on bone marrow aspiration
Explanation: Hairy cell leukemia leads to marrow fibrosis, causing a dry tap.
4.
A 60-year-old male presents with generalized lymphadenopathy and pruritus. Biopsy
shows Reed-Sternberg cells. What is the most probable diagnosis?
A. Non-Hodgkin lymphoma
B. Hodgkin lymphoma
C. Acute lymphoblastic leukemia
D. Chronic myeloid leukemia
Answer: B. Hodgkin lymphoma
Explanation: Reed-Sternberg cells are pathognomonic for Hodgkin lymphoma,
commonly presenting with pruritus and lymphadenopathy.

5.
A patient diagnosed with acute promyelocytic leukemia is at high risk for which
complication during induction therapy?
A. Tumor lysis syndrome
B. Disseminated intravascular coagulation
C. Hypercalcemia
D. Pneumocystis infection
Answer: B. Disseminated intravascular coagulation
Explanation: APL (M3) is specifically prone to DIC due to procoagulant release from
granules.

6.
A 45-year-old patient on routine blood test is found to have elevated white cell count
with left shift and basophilia. A Philadelphia chromosome is detected. Diagnosis?
A. Chronic myeloid leukemia
B. Acute lymphoblastic leukemia
C. Myelodysplastic syndrome
D. Polycythemia vera
Answer: A. Chronic myeloid leukemia
Explanation: Basophilia and t(9;22) Philadelphia chromosome are diagnostic of CML.

7.
A 28-year-old woman presents with painless cervical lymphadenopathy, fever, and
weight loss. Biopsy reveals “owl’s eye” nuclei. What is this cell type?
A. Plasma cell
B. Reed-Sternberg cell
C. Langerhans cell
D. Blastic cell
Answer: B. Reed-Sternberg cell
Explanation: “Owl’s eye” nuclei are typical of Reed-Sternberg cells seen in Hodgkin
lymphoma.

8.
All are B symptoms of lymphoma, EXCEPT:
A. Fever
B. Night sweats
C. Weight loss
D. Pruritus
Answer: D. Pruritus
Explanation: Pruritus is common in lymphoma but is not a classic “B” symptom; the
triad includes fever, nightsweats, and weight loss.

9.
Which is the most common adult leukemia in Western countries?
A. AML
B. CLL
C. CML
D. ALL
Answer: B. CLL
Explanation: Chronic lymphocytic leukemia is the most common adult leukemia in the
West.

10.
A case of multiple myeloma is most likely to show which finding?
A. Decreased ESR
B. Renal failure
C. Lymphadenopathy
D. Jaundice
Answer: B. Renal failure
Explanation: Myeloma kidney due to light chain deposition leads to renal failure.

11.
What is NOT a typical feature of acute leukemia?
A. Thrombocytopenia
B. Organomegaly
C. Hypercalcemia
D. Blast cells in blood
Answer: C. Hypercalcemia
Explanation: Hypercalcemia is not a classic feature; other three are features of acute
leukemia.

12.
Which cytogenetic abnormality is associated with favorable prognosis in ALL?
A. t(12;21)
B. t(9;22)
C. t(4;11)
D. Monosomy 7
Answer: A. t(12;21)
Explanation: t(12;21) (ETV6-RUNX1) is associated with good prognosis in ALL.

13.
Auer rods are seen in:
A. Acute lymphoblastic leukemia
B. Chronic myeloid leukemia
C. Acute myeloid leukemia
D. Hairy cell leukemia
Answer: C. Acute myeloid leukemia
Explanation: Auer rods are pathognomonic for myeloid blasts in AML.

14.
Which lymphoma has strong association with EBV?
A. Follicular lymphoma
B. Diffuse large B-cell lymphoma
C. Burkitt lymphoma
D. Mantle cell lymphoma
Answer: C. Burkitt lymphoma
Explanation: Burkitt lymphoma, especially the endemic type, has strong association
with EBV.

15.
Which is the most common type of Hodgkin lymphoma?
A. Nodular sclerosis
B. Mixed cellularity
C. Lymphocyte-rich
D. Lymphocyte-depleted
Answer: A. Nodular sclerosis
Explanation: Nodular sclerosis is the most frequent variant, especially in young adults.

16.
A leukemia presenting with massive splenomegaly and "dry tap" due to marrow fibrosis
is:
A. Chronic myeloid leukemia
B. Hairy cell leukemia
C. Acute lymphoblastic leukemia
D. T-cell prolymphocytic leukemia
Answer: B. Hairy cell leukemia
Explanation: Fibrosis leads to dry tap; massive splenomegaly is classical.

17.
Which of the following is NOT a typical finding in chronic myeloid leukemia (CML)?
A. Basophilia
B. Increased LAP score
C. Philadelphia chromosome
D. Splenomegaly
Answer: B. Increased LAP score
Explanation: CML typically has a low leukocyte alkaline phosphatase score.

18.
Which leukemia is most strongly associated with Down’s syndrome?
A. ALL
B. CLL
C. AML (esp. M7)
D. CML
Answer: C. AML (esp. M7, megakaryoblastic type)
Explanation: Megakaryoblastic AML is common in children with Down syndrome.

19.
Which finding is characteristic of mantle cell lymphoma?
A. t(8;14)
B. Cyclin D1 positivity
C. BCL2 rearrangement
D. CD30 positivity
Answer: B. Cyclin D1 positivity
Explanation: Mantle cell lymphoma shows overexpression of cyclin D1 due to t(11;14).
20.
In acute lymphoblastic leukemia, which CNS complication is most common?
A. Meningitis
B. Intracerebral hemorrhage
C. Cranial nerve palsy
D. Leukemic infiltration
Answer: D. Leukemic infiltration
Explanation: CNS involvement by leukemic infiltration is common in ALL.

21.
A young male from Africa presents with rapidly growing jaw mass. Which feature is most
characteristic for the underlying tumor?
A. MYC translocation t(8;14)
B. BCR-ABL translocation
C. JAK2 mutation
D. BCL6 rearrangement
Answer: A. MYC translocation t(8;14)
Explanation: Endemic Burkitt lymphoma, commonly affecting the jaw, has t(8;14).

22.
A 45-year-old man presents with red, painful fingers after hot shower, splenomegaly,
and high hemoglobin. What mutation is associated?
A. JAK2 V617F
B. BCR-ABL
C. TP53
D. KRAS
Answer: A. JAK2 V617F
Explanation: Polycythemia vera is strongly associated with JAK2 V617F mutation.

23.
An elderly patient has anemia, rouleaux formation on peripheral smear, and lytic bone
lesions. What is the main pathophysiological process?
A. Overproduction of IgM
B. Plasma cell proliferation
C. Histamine release
D. Megakaryocyte infiltration
Answer: B. Plasma cell proliferation
Explanation: Plasma cell proliferation produces monoclonal immunoglobulin causing
clinical features.
24.
Which test is most sensitive for early detection of relapse in CML?
A. Cytogenetics
B. FISH
C. Reverse transcriptase PCR
D. Bone marrow biopsy
Answer: C. Reverse transcriptase PCR
Explanation: PCR detects BCR-ABL transcripts most sensitively.

25.
Which is a diagnostic marker of follicular lymphoma?
A. CD5
B. CD10
C. CD23
D. CD103
Answer: B. CD10
Explanation: Follicular lymphoma cells are typically CD10 positive.

26.
Auer rods are typical of which AML subtype?
A. M2
B. M3
C. M5
D. M7
Answer: B. M3 (Acute promyelocytic leukemia)
Explanation: Prominent Auer rods are seen in APL (M3).

27.
Tumor lysis syndrome is most likely with which hematological malignancy?
A. CLL
B. Follicular lymphoma
C. Burkitt lymphoma
D. Hairy cell leukemia
Answer: C. Burkitt lymphoma
Explanation: Highly proliferative tumors like Burkitt carry high risk, especially post-
chemotherapy.
28.
Which genetic event is associated with poor prognosis in ALL?
A. t(12;21)
B. Hyperdiploidy
C. t(9;22)
D. TEL-AML1 fusion
Answer: C. t(9;22)
Explanation: Philadelphia chromosome (t(9;22)) confers a poor prognosis in ALL.

29.
A patient with multiple myeloma is most likely to have which electrolyte abnormality?
A. Hypokalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypomagnesemia
Answer: C. Hypercalcemia
Explanation: Bone destruction by lytic lesions causes hypercalcemia in myeloma.

30.
Which marker is most specific for a diagnosis of ALL?
A. TdT
B. CD19
C. MPO
D. CD5
Answer: A. TdT
Explanation: Terminal deoxynucleotidyl transferase (TdT) is a marker of lymphoblasts in
ALL.

31.
Wine-colored (violaceous) skin lesions in a patient with AIDS and lymphadenopathy
most likely represent:
A. Burkitt lymphoma
B. Kaposi sarcoma
C. Mycosis fungoides
D. Sezary syndrome
Answer: B. Kaposi sarcoma
Explanation: Classic skin lesions and lymphadenopathy in immunocompromised
patients point to Kaposi sarcoma.
32.
Which clinical feature best differentiates CML from leukemoid reaction?
A. Splenomegaly
B. Presence of blast cells
C. Basophilia
D. Elevated total leukocyte count
Answer: C. Basophilia
Explanation: Basophilia is characteristic for CML, rarely seen in leukemoid reactions.

33.
Which is the most common leukemia of childhood?
A. CLL
B. AML
C. ALL
D. CML
Answer: C. ALL
Explanation: Acute lymphoblastic leukemia is the most common childhood leukemia.

34.
Which NHL subtype is the fastest growing?
A. Marginal zone lymphoma
B. Burkitt lymphoma
C. Follicular lymphoma
D. MALT lymphoma
Answer: B. Burkitt lymphoma
Explanation: Burkitt lymphoma has one of the highest proliferation rates among
tumors.

35.
Burning pain and erythromelalgia are hallmark features of:
A. Essential thrombocythemia
B. Polycythemia vera
C. Myelofibrosis
D. Acute leukemia
Answer: B. Polycythemia vera
Explanation: PV patients often complain of erythromelalgia—burning pain in
extremities.
36.
A 43-year-old man with lymphocytosis, severe anemia, and thrombocytopenia does
NOT require treatment if:
A. Bone marrow shows >30% lymphocytes
B. Peripheral WBC >100,000
C. Absence of symptoms
D. Splenomegaly present
Answer: C. Absence of symptoms
Explanation: Asymptomatic CLL is often observed without treatment.

37.
Auer rods are never seen in:
A. AML
B. CML in blast crisis
C. ALL
D. Acute promyelocytic leukemia
Answer: C. ALL
Explanation: Lymphoblasts never contain Auer rods.

38.
Which chromosomal translocation is characteristic for follicular lymphoma?
A. t(11;14)
B. t(14;18)
C. t(8;14)
D. t(15;17)
Answer: B. t(14;18)
Explanation: Follicular lymphoma is associated with t(14;18) leading to BCL2 activation.

39.
Pain in lymph node occurring after alcohol ingestion is characteristic of:
A. Hodgkin lymphoma
B. CLL
C. DLBCL
D. Mycosis fungoides
Answer: A. Hodgkin lymphoma
Explanation: This distinctive feature is found in Hodgkin lymphoma.
40.
Which clinical feature suggests transformation of CLL to aggressive lymphoma (Richter
transformation)?
A. Increasing spleen size
B. Rapidly enlarging lymph node
C. Rising lymphocyte count
D. Decreasing platelet count
Answer: B. Rapidly enlarging lymph node
Explanation: Richter’s transformation presents as sudden, rapidly growing nodes.

41.
Starry-sky appearance on lymph node biopsy is classic for:
A. Hodgkin lymphoma
B. Burkitt lymphoma
C. Follicular lymphoma
D. DLBCL
Answer: B. Burkitt lymphoma
Explanation: Benign macrophages among malignant cells give a “starry sky” pattern.

42.
First-line treatment for CML in chronic phase:
A. Hydroxyurea
B. Allogeneic stem cell transplant
C. Imatinib
D. Interferon alpha
Answer: C. Imatinib
Explanation: Imatinib, a tyrosine kinase inhibitor, targets BCR-ABL.

43.
Which of the following is a complication of treatment for Burkitt lymphoma?
A. Febrile neutropenia
B. Hypercalcemia
C. Tumor lysis syndrome
D. Ascites
Answer: C. Tumor lysis syndrome
Explanation: BL is rapidly growing and highly susceptibility to tumor lysis on
chemotherapy.
44.
Pseudo-Pelger-Huet cells are seen in:
A. ALL
B. Myelodysplastic syndrome
C. AML
D. CML
Answer: B. Myelodysplastic syndrome
Explanation: Abnormal neutrophils (hypolobated) are typical of MDS.

45.
Which of the following lymphomas is most likely to present with mediastinal mass in
young women?
A. Hodgkin lymphoma (Nodular sclerosis)
B. DLBCL
C. Burkitt lymphoma
D. Marginal zone lymphoma
Answer: A. Hodgkin lymphoma (Nodular sclerosis)
Explanation: NS subtype presents with mediastinal masses especially in young females.

46.
Primary characteristic of mycosis fungoides:
A. Reed-Sternberg cells
B. Cerebriform nuclei in T-cells
C. B-symptoms
D. Auer rods
Answer: B. Cerebriform nuclei in T-cells
Explanation: Sezary-Lutzner cells with cerebriform nuclei are seen in mycosis fungoides.

47.
Leukocyte alkaline phosphatase (LAP) score is elevated in:
A. CML
B. Leukemoid reaction
C. AML
D. ALL
Answer: B. Leukemoid reaction
Explanation: LAP is high in leukemoid reaction but low in CML.
48.
Basophils are most frequently increased in:
A. ALL
B. CLL
C. CML
D. Multiple myeloma
Answer: C. CML
Explanation: Basophilia is a distinguishing feature of CML.

49.
The most common cause of death in patients with acute leukemia is:
A. Bleeding
B. Infection
C. Renal failure
D. Cardiac arrhythmia
Answer: B. Infection
Explanation: Due to neutropenia, infections are the predominant cause of mortality in
acute leukemia.

50.
A 9-year-old boy develops gum hypertrophy, fever, and pallor. Peripheral smear shows
blasts with monocytic features. Likely diagnosis?
A. ALL
B. AML M5
C. CML
D. CLL
Answer: B. AML M5
Explanation: Monocytic AML presents with gum hyperplasia and monocytic
predominance.

51.
Which parameter is LEAST likely to be abnormal in early multiple myeloma?
A. Serum calcium
B. Serum albumin
C. Creatinine
D. Serum M-protein
Answer: B. Serum albumin
Explanation: Hypoalbuminemia is usually a late finding; M-protein, calcium and renal
parameters are affected earlier.
52.
The most likely cause of lymphadenopathy in a patient with chronic lymphocytic
leukemia is:
A. Thrombocytopenia
B. Lymphocyte accumulation
C. Eosinophilia
D. Neutropenia
Answer: B. Lymphocyte accumulation
Explanation: Lymphadenopathy results from infiltration and accumulation of neoplastic
lymphocytes.

53.
Which lymphoma subtype is associated with t(11;14)?
A. Mantle cell lymphoma
B. Burkitt lymphoma
C. Follicular lymphoma
D. DLBCL
Answer: A. Mantle cell lymphoma
Explanation: Mantle cell lymphoma: t(11;14) results in cyclin D1 overexpression.

54.
Bence Jones proteinuria is due to the presence of:
A. Kappa light chains
B. Alfa heavy chains
C. Lambda light chains
D. Both A & C
Answer: D. Both A & C
Explanation: Both kappa and lambda light chains can be detected as Bence Jones
proteins.

55.
A 66-year-old woman with CLL develops fever, cough, and infiltrates on chest X-ray.
Likely etiology?
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Pseudomonas
D. Cytomegalovirus
Answer: B. Streptococcus pneumoniae
Explanation: CLL causes hypogammaglobulinemia predisposing to encapsulated
bacteria.

56.
Characteristic clinical features of acute promyelocytic leukemia include all, EXCEPT:
A. DIC
B. Auer rods
C. Gum hypertrophy
D. t(15;17) translocation
Answer: C. Gum hypertrophy
Explanation: Gum hypertrophy is not typical; APL is notable for Auer rods, DIC and
t(15;17).

57.
Which marker is most commonly expressed in CLL?
A. CD3
B. CD19
C. CD5
D. Both B and C
Answer: D. Both B and C
Explanation: CLL is a B-cell malignancy (CD19+), but aberrantly co-expresses CD5.

58.
The best test to confirm diagnosis in suspected multiple myeloma:
A. Bone scan
B. Serum protein electrophoresis
C. Serum calcium
D. Renal biopsy
Answer: B. Serum protein electrophoresis
Explanation: M-protein (monoclonal spike) confirms the diagnosis.

59.
In which lymphoma is mediastinal mass (often with SVC syndrome) common in
adolescence?
A. Burkitt lymphoma
B. Lymphoblastic lymphoma
C. Mantle cell lymphoma
D. Marginal zone lymphoma
Answer: B. Lymphoblastic lymphoma
Explanation: T-cell lymphoblastic lymphoma often presents with a mediastinal mass in
young individuals.

60.
Which feature most reliably suggests transformation of follicular lymphoma to DLBCL?
A. Splenomegaly
B. Appearance of B symptoms
C. Rapid node enlargement
D. Decreased hemoglobin
Answer: C. Rapid node enlargement
Explanation: Sudden rapid growth of a node indicates transformation to high-grade
lymphoma.