Haematology: practice question

A Pathology 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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Pathology · Haematology

Sample item

A 70-year-old man has splenomegaly and a persistent absolute monocyte count of 3,000 per microlitre. The smear shows dysplastic neutrophils, blasts are 4%, and BCR-ABL1 is negative. What is the diagnosis?

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

The answer and the reasoning

A. Chronic myelomonocytic leukaemia

Chronic myelomonocytic leukaemia is an overlap of myelodysplasia and myeloproliferation, defined by sustained monocytosis above 1,000 per microlitre with dysplasia and fewer than 20% blasts.

Option by option

  • A. Chronic myelomonocytic leukaemia (correct)

    Correct. Persistent monocytosis with dysplasia and a low blast count in a BCR-ABL negative patient fits this overlap neoplasm.

  • B. Primary myelofibrosis

    Myelofibrosis shows teardrop cells and a leukoerythroblastic picture with marrow fibrosis, not monocytosis.

  • C. Acute monocytic leukaemia

    Acute monocytic leukaemia needs 20% or more blasts, and here blasts are only 4%.

  • D. Chronic myeloid leukaemia in chronic phase

    Chronic myeloid leukaemia shows basophilia and left-shifted granulocytes and is BCR-ABL1 positive.

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 Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Chronic myelomonocytic leukaemia. Chronic myelomonocytic leukaemia is an overlap of myelodysplasia and myeloproliferation, defined by sustained monocytosis above 1,000 per microlitre with dysplasia and fewer than 20% blasts.

Why is "Primary myelofibrosis" not the answer?

Myelofibrosis shows teardrop cells and a leukoerythroblastic picture with marrow fibrosis, not monocytosis.

Why is "Acute monocytic leukaemia" not the answer?

Acute monocytic leukaemia needs 20% or more blasts, and here blasts are only 4%.

Why is "Chronic myeloid leukaemia in chronic phase" not the answer?

Chronic myeloid leukaemia shows basophilia and left-shifted granulocytes and is BCR-ABL1 positive.

What concept does this question test?

It tests Haematology in Pathology. The correct option holds because: Correct. Persistent monocytosis with dysplasia and a low blast count in a BCR-ABL negative patient fits this overlap neoplasm.

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?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.