Systemic paediatrics: acute promyelocytic leukaemia: practice question

A Pediatrics 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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Pediatrics · Systemic paediatrics: acute promyelocytic leukaemia

Sample item

A 6-year-old has bleeding gums and purpura. The blood count shows pancytopenia with abnormal promyelocytes containing multiple bundles of Auer rods. PT and aPTT are prolonged and fibrinogen is low. Which drug should be started immediately with supportive care?

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

The answer and the reasoning

D. All-trans retinoic acid

The picture is acute promyelocytic leukaemia with DIC, with t(15;17) producing PML-RARA. All-trans retinoic acid induces differentiation, reduces the coagulopathy and is started on suspicion, usually with arsenic trioxide or chemotherapy.

Option by option

  • A. Imatinib mesylate

    Imatinib targets BCR-ABL in chronic myeloid leukaemia and Philadelphia-positive ALL.

  • B. Intrathecal methotrexate

    Intrathecal methotrexate is for central nervous system prophylaxis in lymphoblastic leukaemia.

  • C. Rituximab

    Rituximab targets CD20 on B cells and has no role in this myeloid leukaemia.

  • D. All-trans retinoic acid (correct)

    Correct. All-trans retinoic acid induces differentiation and corrects the coagulopathy of this leukaemia.

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 Pediatrics question

What is the answer to this Pediatrics question?

The best answer is D, All-trans retinoic acid. The picture is acute promyelocytic leukaemia with DIC, with t(15;17) producing PML-RARA.

Why is "Imatinib mesylate" not the answer?

Imatinib targets BCR-ABL in chronic myeloid leukaemia and Philadelphia-positive ALL.

Why is "Intrathecal methotrexate" not the answer?

Intrathecal methotrexate is for central nervous system prophylaxis in lymphoblastic leukaemia.

Why is "Rituximab" not the answer?

Rituximab targets CD20 on B cells and has no role in this myeloid leukaemia.

What concept does this question test?

It tests Systemic paediatrics: acute promyelocytic leukaemia in Pediatrics. All-trans retinoic acid induces differentiation, reduces the coagulopathy and is started on suspicion, usually with arsenic trioxide or chemotherapy.

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 Systemic paediatrics: acute promyelocytic leukaemia?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics 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.