Welcome to Part 38 of our Free ASCP MLS Exam Practice Questions series. In this section, we cover White Blood Cell (WBC) Disorders, focusing on leukemias, lymphomas, and myeloproliferative diseases. These conditions are critical in hematology and are heavily emphasized on the ASCP MLS exam.
🔹 Topics Covered in This Part
- Normal WBC development and classification of leukocytes
- Reactive versus neoplastic WBC changes
- Acute and chronic leukemias (AML, ALL, CML, CLL)
- Lymphomas (Hodgkin and Non-Hodgkin)
- Myeloproliferative and myelodysplastic syndromes
- Laboratory diagnosis: morphology, cytochemistry, flow cytometry, molecular testing
60 MCQs (3221-3280):
📘 How to Use These Practice Questions
- This section is designed to test your knowledge of WBC pathology, diagnostic features, and lab correlations.
- Question numbering continues from the previous article — starting at Question 3321.
- Each MCQ set will be followed by answer keys with explanations to guide your review.
- The Philadelphia chromosome, formed by a translocation between chromosomes 9 and 22, is a classic finding in which disorder?
a) Acute Lymphocytic Leukemia (ALL)
b) Chronic Myelogenous Leukemia (CML)
c) Polycythemia Vera (PV)
d) Myelodysplastic Syndrome (MDS) - Which of the following is a significant feature of dyserythropoiesis in myelodysplastic syndromes?
a) Persistently increased M:E ratio
b) Marked thrombocytosis
c) Megaloblastoid erythropoiesis
d) Decreased ferritin levels - Auer rods, which are fused primary granules, are most likely present in which of the following?
a) Chronic Lymphocytic Leukemia (CLL)
b) Acute Myelogenous Leukemia (AML)
c) Hairy Cell Leukemia
d) Myelodysplastic Syndrome (MDS) - A patient’s peripheral blood smear shows many smudge cells. This finding is most characteristic of which condition?
a) Acute Myelogenous Leukemia (AML)
b) Chronic Myelogenous Leukemia (CML)
c) Chronic Lymphocytic Leukemia (CLL)
d) Infectious Mononucleosis - The malignant cells in Hairy Cell Leukemia typically express which of the following cell surface markers?
a) CD5
b) CD10
c) CD11c
d) CD3 - Which of the following is a category in the WHO classification of myelodysplastic syndromes/myeloproliferative neoplasms?
a) Acute Myelomonocytic Leukemia (AMML)
b) Chronic Myelogenous Leukemia (CML)
c) Juvenile Myelomonocytic Leukemia (JMML)
d) Refractory Anemia with Excess Blasts (RAEB) - The t(8;14) chromosomal translocation, which brings the c-myc gene near the immunoglobulin heavy chain gene, is most commonly associated with:
a) Burkitt Lymphoma
b) Acute Promyelocytic Leukemia
c) Follicular Lymphoma
d) Multiple Myeloma - A bone marrow examination showing sheets of immature plasma cells is most suggestive of:
a) Waldenström Macroglobulinemia
b) Multiple Myeloma
c) Hairy Cell Leukemia
d) Sézary Syndrome - Which of the following is a characteristic of Hodgkin Lymphoma?
a) High incidence of peripheral blood infiltration
b) Unpredictable lymph node involvement
c) Bimodal age distribution
d) Uniformly fatal outcome - The replacement of normal marrow precursor cells by an accumulation of blasts (>20%) is a hallmark of:
a) Chronic Lymphocytic Leukemia (CLL)
b) Myelodysplastic Syndromes (MDS)
c) Polycythemia Vera (PV)
d) Acute Myelogenous Leukemia (AML) - Terminal deoxynucleotidyl transferase (TdT) is a marker typically found on:
a) Mature T cells
b) Myeloblasts
c) Lymphoblasts
d) Plasma cells - Which of the following genetic alterations is associated with a favorable prognosis in pre-B-cell Acute Lymphoblastic Leukemia (ALL)?
a) t(9;22) – Philadelphia chromosome
b) t(4;11)
c) t(1;19)
d) t(12;21) - A peripheral blood finding of giant platelets and Döhle body-like inclusions in neutrophils is characteristic of:
a) May-Hegglin Anomaly
b) Chédiak-Higashi Syndrome
c) Alder-Reilly Anomaly
d) Pelger-Huët Anomaly - In Chronic Myelogenous Leukemia (CML), the myeloid to erythroid (M:E) ratio in the bone marrow is usually:
a) Normal
b) High
c) Low
d) Variable - Which of the following is a myeloproliferative neoplasm?
a) Refractory Anemia
b) Essential Thrombocythemia
c) Secondary Erythrocytosis
d) Chronic Myelomonocytic Leukemia (CMML) - The disease most closely associated with granulocyte hyposegmentation (bilobed nuclei) is:
a) May-Hegglin Anomaly
b) Chédiak-Higashi Syndrome
c) Alder-Reilly Anomaly
d) Pelger-Huët Anomaly - A patient with a history of leukemia presents with basophilia, thrombocytopenia, and 20% blasts in the peripheral blood. The Philadelphia chromosome is positive. This is most consistent with:
a) Acute Myelogenous Leukemia (AML)
b) Chronic Myelogenous Leukemia (CML) in blast transformation
c) Primary Myelofibrosis
d) Essential Thrombocythemia - Which of the following markers is typically expressed on neoplastic plasma cells in Multiple Myeloma?
a) CD7
b) CD19
c) CD138
d) CD3 - The leukemic phase of a T-cell lymphoma is often marked by the presence of which abnormal cell?
a) Reed-Sternberg Cell
b) Plasmacytoid Lymphocyte
c) Sézary Cell
d) Mantle Cell - Chronic Lymphocytic Leukemia (CLL) is defined as a(n):
a) Malignancy of the thymus
b) Accumulation of prolymphocytes
c) Accumulation of monoclonal B cells
d) Accumulation of hairy cells in the spleen - Disseminated intravascular coagulation (DIC) is a common presenting feature in which type of acute leukemia?
a) Acute Lymphoblastic Leukemia (ALL)
b) Acute Promyelocytic Leukemia (APL)
c) Acute Monocytic Leukemia
d) Acute Megakaryoblastic Leukemia - A useful chemical test for the diagnosis of Hairy Cell Leukemia is the:
a) Peroxidase test
b) Tartrate-resistant acid phosphatase (TRAP) test
c) Sudan black B test
d) Periodic acid-Schiff (PAS) test - Which of the following cell surface marker patterns is most consistent with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)?
a) CD5-/CD23-
b) CD5-/CD23+
c) CD5+/CD23-
d) CD5+/CD23+ - The V617F mutation in the JAK2 gene is most often associated with:
a) Chronic Myelogenous Leukemia (CML)
b) Polycythemia Vera (PV)
c) Acute Monocytic Leukemia
d) Myelodysplastic Syndrome (MDS) - A bone marrow showing foam cells with vacuolated cytoplasm containing sphingomyelin is most characteristic of:
a) Gaucher Disease
b) Multiple Myeloma
c) Niemann-Pick Disease
d) DiGuglielmo Disease - Which of the following is associated with Chédiak-Higashi syndrome?
a) Döhle bodies and giant platelets
b) A membrane defect of lysosomes
c) Two-lobed neutrophils
d) Mucopolysaccharidosis - The most common form of childhood leukemia is:
a) Acute Granulocytic Leukemia
b) Acute Lymphocytic Leukemia (ALL)
c) Acute Monocytic Leukemia
d) Chronic Granulocytic Leukemia - In the WHO classification, Acute Myelomonocytic Leukemia (AMML) would be classified under which category?
a) AML with recurrent cytogenetic changes
b) AML with myelodysplastic-related changes
c) AML, not otherwise specified (NOS)
d) Therapy-related AML - Which of the following disorders is characterized by the inability of neutrophils to kill phagocytized bacteria?
a) Chédiak-Higashi Syndrome
b) Chronic Granulomatous Disease (CGD)
c) Pelger-Huët Anomaly
d) Alder-Reilly Anomaly - A hypercellular bone marrow with a myeloid to erythroid (M:E) ratio of 6:1 is most commonly due to:
a) Lymphoid hyperplasia
b) Granulocytic hyperplasia
c) Normoblastic hyperplasia
d) Myeloid hypoplasia - Which of the following is the most common leukemia in adults?
a) Acute lymphoblastic leukemia (ALL)
b) Chronic lymphocytic leukemia (CLL)
c) Acute myeloid leukemia (AML)
d) Chronic myeloid leukemia (CML) - The presence of Auer rods in myeloblasts is diagnostic for:
a) ALL
b) AML
c) CLL
d) CML - Which cytogenetic abnormality is associated with chronic myeloid leukemia (CML)?
a) t(9;22) Philadelphia chromosome
b) t(8;14) Burkitt lymphoma
c) t(15;17) APL
d) t(11;14) Mantle cell lymphoma - A child presents with lymphoblasts in peripheral blood. The most likely diagnosis is:
a) AML
b) CLL
c) ALL
d) CML - Which cell marker is typically positive in CLL?
a) CD20
b) CD3
c) CD34
d) CD13 - The “smudge cell” on peripheral smear is characteristic of:
a) AML
b) CLL
c) ALL
d) Hodgkin lymphoma - The “starry sky” appearance in lymph node biopsy is seen in:
a) Hodgkin lymphoma
b) Burkitt lymphoma
c) Follicular lymphoma
d) Mantle cell lymphoma - Which cell type is Reed–Sternberg cell associated with?
a) AML
b) CLL
c) Hodgkin lymphoma
d) CML - In hairy cell leukemia, the characteristic positive marker is:
a) CD5
b) CD103
c) CD3
d) CD34 - Which type of leukemia is most often associated with Down syndrome in children?
a) CLL
b) AML (especially M7)
c) CML
d) Hairy cell leukemia - The chronic phase of CML is best monitored by measuring:
a) Hemoglobin level
b) LDH
c) BCR-ABL transcript by PCR
d) Serum ferritin - Which subtype of AML is associated with t(15;17) translocation?
a) AML-M2
b) Acute promyelocytic leukemia (APL, M3)
c) AML-M5
d) AML-M7 - A patient presents with lymphadenopathy and night sweats. Which test helps confirm Hodgkin lymphoma?
a) Peripheral smear
b) Reed–Sternberg cell biopsy
c) Flow cytometry of blood
d) Serum ferritin - Which condition is classified as a myeloproliferative disorder?
a) Follicular lymphoma
b) Polycythemia vera
c) Burkitt lymphoma
d) Hodgkin lymphoma - Which laboratory finding is most characteristic of polycythemia vera?
a) Decreased red cell mass
b) Increased red cell mass and hematocrit
c) Increased blasts in blood
d) Increased lymphocytes - The presence of “tear-drop” shaped RBCs (dacrocytes) is associated with:
a) AML
b) Myelofibrosis
c) CLL
d) ALL - Which lymphoma subtype commonly presents with painless lymphadenopathy and BCL2 mutation?
a) Burkitt lymphoma
b) Follicular lymphoma
c) Hodgkin lymphoma
d) T-cell lymphoma - Which finding is typical of essential thrombocythemia?
a) Increased platelet count
b) Decreased platelet count
c) Increased blasts
d) Increased RBC mass - Which virus is strongly associated with Burkitt lymphoma?
a) CMV
b) EBV
c) HPV
d) HIV - Which leukemia subtype often presents with gum hypertrophy and monoblast proliferation?
a) AML-M5
b) AML-M3
c) ALL
d) CLL - Which finding best distinguishes CML from a leukemoid reaction?
a) High WBC count
b) Increased basophils
c) Elevated ESR
d) Increased platelets - Which molecular mutation is most commonly seen in polycythemia vera?
a) JAK2 V617F
b) BCR-ABL
c) PML-RARA
d) MYC - Which lymphoma often presents in young adults with mediastinal mass and Reed–Sternberg cells?
a) Hodgkin lymphoma
b) Burkitt lymphoma
c) Follicular lymphoma
d) Mantle cell lymphoma - Which WBC disorder often transforms into acute leukemia if untreated?
a) CML
b) CLL
c) Polycythemia vera
d) Essential thrombocythemia - Which leukemia subtype shows TdT positivity in blasts?
a) AML
b) CLL
c) ALL
d) CML - Which clinical feature is most commonly seen in multiple myeloma?
a) Lytic bone lesions and hypercalcemia
b) Elevated RBC mass
c) Elevated WBC count
d) Increased platelet count - Rouleaux formation in peripheral smear is most associated with:
a) CML
b) Multiple myeloma
c) AML
d) Hodgkin lymphoma - Which lymphoma subtype has a translocation t(11;14)?
a) Burkitt lymphoma
b) Mantle cell lymphoma
c) Hodgkin lymphoma
d) Follicular lymphoma - Which WBC disorder is associated with increased plasma cells producing M protein?
a) Multiple myeloma
b) CLL
c) ALL
d) CML - Which of the following is NOT classified as a myeloproliferative disorder?
a) Polycythemia vera
b) Essential thrombocythemia
c) Primary myelofibrosis
d) Burkitt lymphoma
📌 How to Use This Practice Set
- Answer each question before checking the key.
- Focus on why the correct answer is right and the others are wrong.
- Use this set as timed practice to simulate the real exam environment.
Answer Key
Answer Key:
- b) Chronic Myelogenous Leukemia (CML)
- c) Megaloblastoid erythropoiesis
- b) Acute Myelogenous Leukemia (AML)
- c) Chronic Lymphocytic Leukemia (CLL)
- c) CD11c
- c) Juvenile Myelomonocytic Leukemia (JMML)
- a) Burkitt Lymphoma
- b) Multiple Myeloma
- c) Bimodal age distribution
- d) Acute Myelogenous Leukemia (AML)
- c) Lymphoblasts
- d) t(12;21)
- a) May-Hegglin Anomaly
- b) High
- b) Essential Thrombocythemia
- d) Pelger-Huët Anomaly
- b) Chronic Myelogenous Leukemia (CML) in blast transformation
- c) CD138
- c) Sézary Cell
- c) Accumulation of monoclonal B cells
- b) Acute Promyelocytic Leukemia (APL)
- b) Tartrate-resistant acid phosphatase (TRAP) test
- d) CD5+/CD23+
- b) Polycythemia Vera (PV)
- c) Niemann-Pick Disease
- b) A membrane defect of lysosomes
- b) Acute Lymphocytic Leukemia (ALL)
- c) AML, not otherwise specified (NOS)
- b) Chronic Granulomatous Disease (CGD)
- b) Granulocytic hyperplasia
- c) Acute myeloid leukemia (AML)
- b) AML
- a) t(9;22) Philadelphia chromosome
- c) ALL
- a) CD20
- b) CLL
- b) Burkitt lymphoma
- c) Hodgkin lymphoma
- b) CD103
- b) AML (especially M7)
- c) BCR-ABL transcript by PCR
- b) Acute promyelocytic leukemia (APL, M3)
- b) Reed–Sternberg cell biopsy
- b) Polycythemia vera
- b) Increased red cell mass and hematocrit
- b) Myelofibrosis
- b) Follicular lymphoma
- a) Increased platelet count
- b) EBV
- a) AML-M5
- b) Increased basophils
- a) JAK2 V617F
- a) Hodgkin lymphoma
- a) CML
- c) ALL
- a) Lytic bone lesions and hypercalcemia
- b) Multiple myeloma
- b) Mantle cell lymphoma
- a) Multiple myeloma
- d) Burkitt lymphoma
Top 8 Medical Laboratory Scientist (MLS) Exams:
Top 8 Medical Laboratory Scientist (MLS) Exams that are recognized globally and can help professionals validate their credentials and enhance their career opportunities:
1. ASCP – American Society for Clinical Pathology (USA)
- Exam Name: MLS(ASCP)
- Eligibility: Bachelor’s degree with clinical laboratory experience.
- Global Recognition: High
- Purpose: Certifies Medical Laboratory Scientists in the United States and internationally.
2. AMT – American Medical Technologists (USA)
- Exam Name: MLT(AMT) or MT(AMT)
- Eligibility: Academic and/or work experience in medical laboratory technology.
- Global Recognition: Moderate
- Purpose: Credentialing for medical technologists and technicians.
3. AIMS – Australian Institute of Medical and Clinical Scientists
- Exam Name: AIMS Certification Exam
- Eligibility: Assessment of qualifications and work experience.
- Recognition: Required for practice in Australia.
- Purpose: Certification and registration in Australia.
4. CSMLS – Canadian Society for Medical Laboratory Science
- Exam Name: CSMLS General or Subject-specific Exams
- Eligibility: Graduation from a CSMLS-accredited program or equivalent.
- Recognition: Canada
- Purpose: Entry-to-practice certification in Canada.
5. IBMS – Institute of Biomedical Science (UK)
- Exam Name: Registration and Specialist Portfolio Assessment
- Eligibility: Accredited degree and lab experience.
- Recognition: UK and some Commonwealth countries.
- Purpose: Biomedical Scientist registration with the HCPC (UK).
6. HAAD / DOH – Department of Health, Abu Dhabi (UAE)
- Exam Name: DOH/HAAD License Exam
- Eligibility: Degree in medical laboratory science and experience.
- Recognition: UAE (Abu Dhabi)
- Purpose: Licensure for medical laboratory practice in Abu Dhabi.
7. DHA – Dubai Health Authority (UAE)
- Exam Name: DHA License Exam for Medical Laboratory Technologists
- Eligibility: Relevant degree and experience.
- Recognition: Dubai, UAE
- Purpose: Professional license for clinical laboratory practice in Dubai.
8. MOH – Ministry of Health (Gulf Countries like UAE, Saudi Arabia, Kuwait)
- Exam Name: MOH License Exam
- Eligibility: BSc/Diploma in Medical Laboratory + experience.
- Recognition: Varies by country.
- Purpose: Required for practicing in public and private sector labs.
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