Haematology: essential thrombocythaemia and myelofibrosis: 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.

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General Medicine · Haematology: essential thrombocythaemia and myelofibrosis

Sample item

A patient has massive splenomegaly, teardrop red cells, leucoerythroblastic smear and a dry tap on bone marrow aspiration. What is the diagnosis?

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

The answer and the reasoning

D. Primary myelofibrosis

Primary myelofibrosis shows marrow fibrosis causing dry tap, teardrop poikilocytes and extramedullary haematopoiesis with massive splenomegaly. JAK2, CALR and MPL mutations are found. Essential thrombocythaemia is dominated by high platelet counts with the same driver mutations.

Option by option

  • A. Hairy cell leukaemia

    Hairy cell leukaemia shows hairy lymphocytes and may give dry tap but without leucoerythroblastic picture.

  • B. Essential thrombocythaemia

    Essential thrombocythaemia has isolated thrombocytosis.

  • C. Chronic lymphocytic leukaemia

    CLL shows smudge cells and lymphocytosis.

  • D. Primary myelofibrosis (correct)

    Correct. Teardrop cells, dry tap and splenomegaly define myelofibrosis.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Primary myelofibrosis. Primary myelofibrosis shows marrow fibrosis causing dry tap, teardrop poikilocytes and extramedullary haematopoiesis with massive splenomegaly.

Why is "Hairy cell leukaemia" not the answer?

Hairy cell leukaemia shows hairy lymphocytes and may give dry tap but without leucoerythroblastic picture.

Why is "Essential thrombocythaemia" not the answer?

Essential thrombocythaemia has isolated thrombocytosis.

Why is "Chronic lymphocytic leukaemia" not the answer?

CLL shows smudge cells and lymphocytosis.

What concept does this question test?

It tests Haematology: essential thrombocythaemia and myelofibrosis in General Medicine. JAK2, CALR and MPL mutations are found. Essential thrombocythaemia is dominated by high platelet counts with the same driver mutations.

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: essential thrombocythaemia and myelofibrosis?

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.