Haematology: chronic myeloid leukaemia: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematology: chronic myeloid leukaemia

Sample item

A 45-year-old man has massive splenomegaly and a total leukocyte count of 240,000/microlitre with myelocytes, metamyelocytes and basophilia. The leukocyte alkaline phosphatase score on a blood film is very low. What does this result help to distinguish?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Chronic myeloid leukaemia from a leukaemoid reaction

The LAP score is low in CML and high in a leukaemoid reaction, infection and polycythaemia vera. The diagnosis is confirmed by t(9;22) or BCR-ABL1. Basophilia and splenomegaly support CML.

Option by option

  • A. Acute from chronic lymphoid leukaemia

    LAP does not discriminate between acute and chronic lymphoid leukaemia.

  • B. Hairy cell from prolymphocytic leukaemia

    Hairy cell leukaemia is identified by TRAP, CD25, CD103 and BRAF V600E, not LAP.

  • C. Chronic myeloid leukaemia from a leukaemoid reaction (correct)

    Correct. A low LAP score favours CML over a reactive leukaemoid response.

  • D. Iron deficiency from thalassaemia

    LAP has no role in separating iron deficiency from thalassaemia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Chronic myeloid leukaemia from a leukaemoid reaction. The LAP score is low in CML and high in a leukaemoid reaction, infection and polycythaemia vera.

Why is "Acute from chronic lymphoid leukaemia" not the answer?

LAP does not discriminate between acute and chronic lymphoid leukaemia.

Why is "Hairy cell from prolymphocytic leukaemia" not the answer?

Hairy cell leukaemia is identified by TRAP, CD25, CD103 and BRAF V600E, not LAP.

Why is "Iron deficiency from thalassaemia" not the answer?

LAP has no role in separating iron deficiency from thalassaemia.

What concept does this question test?

It tests Haematology: chronic myeloid leukaemia in Pathology. The diagnosis is confirmed by t(9;22) or BCR-ABL1. Basophilia and splenomegaly support CML.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: chronic myeloid leukaemia?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.