Haematology and oncology: leukaemoid reaction versus CML: practice question

A General Medicine 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.

Try it

General Medicine · Haematology and oncology: leukaemoid reaction versus CML

Sample item

A 35-year-old man with a large abscess has a leucocyte count of 60,000 per microlitre with neutrophilia, left shift, toxic granulation and Dohle bodies. Which finding favours a leukaemoid reaction over chronic myeloid leukaemia?

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

The answer and the reasoning

D. High leucocyte alkaline phosphatase score

In reactive neutrophilia the neutrophils are mature and rich in alkaline phosphatase, so the score is high. In CML the score is low, and basophilia, a myelocyte bulge and BCR-ABL1 are present.

Option by option

  • A. Absolute basophilia on the blood film

    Basophilia is typical of CML.

  • B. Prominent eosinophilia with myelocytes

    Eosinophilia and basophilia with myelocytes are features of the chronic phase of CML.

  • C. Philadelphia chromosome on cytogenetic analysis

    The Philadelphia chromosome confirms CML.

  • D. High leucocyte alkaline phosphatase score (correct)

    Correct. A high LAP score indicates reactive rather than neoplastic neutrophils.

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, High leucocyte alkaline phosphatase score. In reactive neutrophilia the neutrophils are mature and rich in alkaline phosphatase, so the score is high.

Why is "Absolute basophilia on the blood film" not the answer?

Basophilia is typical of CML.

Why is "Prominent eosinophilia with myelocytes" not the answer?

Eosinophilia and basophilia with myelocytes are features of the chronic phase of CML.

Why is "Philadelphia chromosome on cytogenetic analysis" not the answer?

The Philadelphia chromosome confirms CML.

What concept does this question test?

It tests Haematology and oncology: leukaemoid reaction versus CML in General Medicine. In CML the score is low, and basophilia, a myelocyte bulge and BCR-ABL1 are present.

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 and oncology: leukaemoid reaction versus CML?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.