Haematopathology: acute 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 · Haematopathology: acute leukaemia

Sample item

A 30-year-old woman has bruising, a prolonged PT and aPTT with low fibrinogen, and a marrow full of abnormal promyelocytes containing multiple Auer rods. Which translocation is expected and which drug is used?

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

The answer and the reasoning

D. t(15;17) PML-RARA, treated with all-trans retinoic acid

Acute promyelocytic leukaemia carries t(15;17), which fuses PML to the retinoic acid receptor alpha gene and blocks differentiation at the promyelocyte stage. Granules release procoagulants and cause DIC. All-trans retinoic acid with arsenic trioxide induces differentiation and gives excellent remission rates.

Option by option

  • A. t(8;21) RUNX1-RUNX1T1, treated with methotrexate

    t(8;21) is seen in AML with maturation but is not the promyelocytic form.

  • B. t(14;18) BCL2, treated with rituximab alone

    t(14;18) is seen in follicular lymphoma, not acute leukaemia.

  • C. t(9;22) BCR-ABL, treated with imatinib

    t(9;22) is typical of chronic myeloid leukaemia and is treated with tyrosine kinase inhibitors.

  • D. t(15;17) PML-RARA, treated with all-trans retinoic acid (correct)

    Correct. The translocation and the differentiating agent are specific to this leukaemia.

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 D, t(15;17) PML-RARA, treated with all-trans retinoic acid. Acute promyelocytic leukaemia carries t(15;17), which fuses PML to the retinoic acid receptor alpha gene and blocks differentiation at the promyelocyte stage.

Why is "t(8;21) RUNX1-RUNX1T1, treated with methotrexate" not the answer?

t(8;21) is seen in AML with maturation but is not the promyelocytic form.

Why is "t(14;18) BCL2, treated with rituximab alone" not the answer?

t(14;18) is seen in follicular lymphoma, not acute leukaemia.

Why is "t(9;22) BCR-ABL, treated with imatinib" not the answer?

t(9;22) is typical of chronic myeloid leukaemia and is treated with tyrosine kinase inhibitors.

What concept does this question test?

It tests Haematopathology: acute leukaemia in Pathology. Granules release procoagulants and cause DIC. All-trans retinoic acid with arsenic trioxide induces differentiation and gives excellent remission rates.

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 Haematopathology: acute 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.