Haematology: myelodysplastic syndrome with del(5q): 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: myelodysplastic syndrome with del(5q)

Sample item

A 70-year-old woman has macrocytic anaemia (Hb 8 g/dL) and thrombocytosis. B12 and folate are normal. The smear shows macro-ovalocytes, the marrow is hypercellular with hypolobulated megakaryocytes, blasts are 3%, and cytogenetics shows an isolated deletion of 5q. Which drug is most appropriate?

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

The answer and the reasoning

C. Lenalidomide

Myelodysplastic syndrome with isolated del(5q) causes macrocytic anaemia, often with a normal or high platelet count and hypolobulated megakaryocytes. Lenalidomide produces transfusion independence in many patients. Haploinsufficiency of genes on 5q, such as RPS14, underlies the phenotype.

Option by option

  • A. Cyanocobalamin

    Vitamin B12 does not help, since the level is normal and the anaemia is dysplastic.

  • B. All-trans retinoic acid

    All-trans retinoic acid treats acute promyelocytic leukaemia with t(15;17).

  • C. Lenalidomide (correct)

    Lenalidomide targets the del(5q) clone and reduces transfusion need.

  • D. Imatinib

    Imatinib inhibits BCR-ABL in CML and has no role here.

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, Lenalidomide. Myelodysplastic syndrome with isolated del(5q) causes macrocytic anaemia, often with a normal or high platelet count and hypolobulated megakaryocytes.

Why is "Cyanocobalamin" not the answer?

Vitamin B12 does not help, since the level is normal and the anaemia is dysplastic.

Why is "All-trans retinoic acid" not the answer?

All-trans retinoic acid treats acute promyelocytic leukaemia with t(15;17).

Why is "Imatinib" not the answer?

Imatinib inhibits BCR-ABL in CML and has no role here.

What concept does this question test?

It tests Haematology: myelodysplastic syndrome with del(5q) in Pathology. Lenalidomide produces transfusion independence in many patients. Haploinsufficiency of genes on 5q, such as RPS14, underlies the phenotype.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: myelodysplastic syndrome with del(5q)?

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.