Haematology: 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

Sample item

A 45-year-old man has fatigue, a massive spleen, a total leukocyte count of 2,40,000 per microlitre with myelocytes and basophils, and a low leukocyte alkaline phosphatase score. Cytogenetics shows t(9;22). Which drug is the standard first-line treatment?

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

The answer and the reasoning

B. Imatinib

The picture is chronic myeloid leukaemia, driven by the BCR-ABL fusion tyrosine kinase from the Philadelphia chromosome. Imatinib inhibits this kinase, induces durable remission in chronic phase and has replaced older cytoreductive therapies as first-line treatment.

Option by option

  • A. Rituximab

    Rituximab targets CD20 on B cells and is used in lymphomas and chronic lymphocytic leukaemia.

  • B. Imatinib (correct)

    Correct. Imatinib is a BCR-ABL tyrosine kinase inhibitor and is standard first-line therapy.

  • C. Hydroxyurea as sole long-term therapy

    Hydroxyurea lowers the count but does not target the fusion gene or prevent progression, so it is only used for initial cytoreduction.

  • D. All-trans retinoic acid

    All-trans retinoic acid is used in acute promyelocytic leukaemia with t(15;17).

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Imatinib. The picture is chronic myeloid leukaemia, driven by the BCR-ABL fusion tyrosine kinase from the Philadelphia chromosome.

Why is "Rituximab" not the answer?

Rituximab targets CD20 on B cells and is used in lymphomas and chronic lymphocytic leukaemia.

Why is "Hydroxyurea as sole long-term therapy" not the answer?

Hydroxyurea lowers the count but does not target the fusion gene or prevent progression, so it is only used for initial cytoreduction.

Why is "All-trans retinoic acid" not the answer?

All-trans retinoic acid is used in acute promyelocytic leukaemia with t(15;17).

What concept does this question test?

It tests Haematology in General Medicine. Imatinib inhibits this kinase, induces durable remission in chronic phase and has replaced older cytoreductive therapies as first-line treatment.

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?

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.