Oncology: acute promyelocytic leukaemia: 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 · Oncology: acute promyelocytic leukaemia

Sample item

A 35-year-old woman has one week of fatigue and bruising. White cells are 3,000 per microlitre, platelets 18,000 and haemoglobin 7 g/dL. PT and aPTT are prolonged with fibrinogen of 90 mg/dL, and the film shows abnormal promyelocytes with multiple Auer rods. What should be done immediately?

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

The answer and the reasoning

D. Start all-trans retinoic acid at once with coagulopathy support, without waiting for cytogenetics

This is acute promyelocytic leukaemia, AML with t(15;17) producing the PML-RARA fusion, which has a high risk of fatal haemorrhage from DIC and hyperfibrinolysis. Treatment with ATRA, usually with arsenic trioxide, is a medical emergency and starts on clinical suspicion because ATRA induces differentiation and rapidly corrects the coagulopathy.

Option by option

  • A. Wait for confirmation of t(15;17) before starting any drug

    Delay for genetic confirmation exposes the patient to fatal bleeding.

  • B. Start standard induction chemotherapy and avoid retinoids

    Chemotherapy alone worsens the DIC; ATRA is the key to rapid control.

  • C. Give a heparin infusion for the coagulopathy

    Heparin increases bleeding risk and is not standard.

  • D. Start all-trans retinoic acid at once with coagulopathy support, without waiting for cytogenetics (correct)

    Correct. ATRA is started on suspicion because early deaths are from haemorrhage.

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, Start all-trans retinoic acid at once with coagulopathy support, without waiting for cytogenetics. This is acute promyelocytic leukaemia, AML with t(15;17) producing the PML-RARA fusion, which has a high risk of fatal haemorrhage from DIC and hyperfibrinolysis.

Why is "Wait for confirmation of t(15;17) before starting any drug" not the answer?

Delay for genetic confirmation exposes the patient to fatal bleeding.

Why is "Start standard induction chemotherapy and avoid retinoids" not the answer?

Chemotherapy alone worsens the DIC; ATRA is the key to rapid control.

Why is "Give a heparin infusion for the coagulopathy" not the answer?

Heparin increases bleeding risk and is not standard.

What concept does this question test?

It tests Oncology: acute promyelocytic leukaemia in General Medicine. Treatment with ATRA, usually with arsenic trioxide, is a medical emergency and starts on clinical suspicion because ATRA induces differentiation and rapidly corrects the coagulopathy.

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 Oncology: acute promyelocytic leukaemia?

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.