Haematology and oncology: myelodysplastic syndrome: 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 and oncology: myelodysplastic syndrome

Sample item

A 72-year-old man has macrocytic anaemia that has not responded to vitamin B12 or folate, and normal levels of both. The smear shows neutrophils with hypolobated nuclei and poor granulation, and the marrow is hypercellular with abnormal maturation of all cell lines and ring sideroblasts. What is the diagnosis?

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

The answer and the reasoning

C. Myelodysplastic syndrome

Myelodysplastic syndromes are clonal stem cell disorders of older people, with cytopenias, dysplastic marrow and risk of progression to acute myeloid leukaemia. Pseudo-Pelger-Huet neutrophils and ring sideroblasts are typical findings.

Option by option

  • A. Megaloblastic anaemia

    Megaloblastic anaemia responds to B12 or folate and shows low levels of these vitamins.

  • B. Primary myelofibrosis

    Myelofibrosis presents with teardrop cells, marrow fibrosis and a dry tap with splenomegaly.

  • C. Myelodysplastic syndrome (correct)

    Correct. Refractory macrocytic anaemia with dysplasia in a hypercellular marrow is myelodysplasia.

  • D. Aplastic anaemia

    Aplastic anaemia has a hypocellular marrow without dysplasia.

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 C, Myelodysplastic syndrome. Myelodysplastic syndromes are clonal stem cell disorders of older people, with cytopenias, dysplastic marrow and risk of progression to acute myeloid leukaemia.

Why is "Megaloblastic anaemia" not the answer?

Megaloblastic anaemia responds to B12 or folate and shows low levels of these vitamins.

Why is "Primary myelofibrosis" not the answer?

Myelofibrosis presents with teardrop cells, marrow fibrosis and a dry tap with splenomegaly.

Why is "Aplastic anaemia" not the answer?

Aplastic anaemia has a hypocellular marrow without dysplasia.

What concept does this question test?

It tests Haematology and oncology: myelodysplastic syndrome in General Medicine. Pseudo-Pelger-Huet neutrophils and ring sideroblasts are typical findings.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: myelodysplastic syndrome?

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.