Neutropenia
Quiz by Sadeq K. Ali Al-Salait
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- Q1
Which factor must be considered in defining neutropenia in African-American populations?
Lower normal ANC range (1.0–1.5 × 10⁹/L)
Highet baseline ANC.
Reduced neutrophil function
Frequent congenital mutations in neutrophil maturation
Increased risk of autoimmune neutropenia
30s - Q2
Which is the most common cause of neutropenia in ambulatory adult patients?
Bone marrow failure syndromes
Drug-induced neutropenia
Congenital neutropenia
Autoimmune disorders
Viral infections
30s - Q3
Which of the following is NOT a common cause of neutropenia in neonates?
Congenital neutropenia
Autoimmune maternal antibody transfer
Maternal hypertension
Infection
Maternal iron deficiency
30s - Q4
Which molecular pathway is disrupted in Kostmann syndrome?
ELA2
LYST gene
JAK/STAT pathway
Fas-mediated apoptosis
30s - Q5
What is the primary defect in Chediak-Higashi syndrome?
Defective lysosomal trafficking
Hyperactivation of NK cells
Overexpression of CXCR4
Phagocytic dysfunction
Increased neutrophil lifespan
30s - Q6
Which bone marrow finding is characteristic of severe congenital neutropenia?
Abnormal granulation of granulocyte precursors
Maturation arrest at the promyelocyte stage
Marked eosinophilia
Absence of early precursors of granulocytes
Hypercellularity with erythroid predominance
30s - Q7
What is the most common infectious complication in severe neutropenia?
Tuberculosis
Meningitis
Gastrointestinal candidiasis
Bacterial sepsis, often gram-negative bacteremia
Viral pneumonia
30s - Q8
Which neutropenia-associated condition has the highest risk of transformation to myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML)?
Kostmann syndrome
Drug-induced neutropenia
Viral-induced neutropenia
Cyclic neutropenia
Autoimmune neutropenia
30s - Q9
A 35-year-old male presents with fever (39.5°C), rigors, and fatigue. CBC shows WBC: 1.2 × 10⁹/L, ANC: 0.3 × 10⁹/L, hemoglobin: 11.5 g/dL, platelets: 250 × 10⁹/L. He has been on methimazole for Graves’ disease for 3 weeks. What is the most appropriate next step?
Continue methimazole and monitor ANC
Discontinue methimazole immediately and start broad-spectrum IV antibiotics
Perform bone marrow biopsy urgently
Start G-CSF and observe
Prescribe antiviral therapy
30s - Q10
A 24-year-old female with a history of recurrent bacterial infections presents with neutropenia (ANC: 0.9 × 10⁹/L). She reports episodes of oral ulcers and fevers every 3 weeks since childhood. Her bone marrow biopsy shows normal cellularity. What is the most likely diagnosis?
Benign ethnic neutropenia
Cyclic neutropenia
Autoimmune neutropenia
Drug-induced agranulocytosis
Myelodysplastic syndrome
30s - Q11
A 60-year-old male with chronic lymphocytic leukemia (CLL) on ibrutinib presents with ANC 0.7 × 10⁹/L and no active infection. He has mild fatigue but no fever. What is the most appropriate management?
Perform a bone marrow biopsy immediately
Discontinue ibrutinib permanently
Start prophylactic G-CSF
Monitor ANC closely and continue ibrutinib unless ANC drops <0.5 × 10⁹/L
Start empiric antibiotics
30s - Q12
A 3-year-old boy presents with recurrent ear infections but no serious bacterial infections. His ANC is 0.5 × 10⁹/L. Anti-neutrophil antibodies are positive. Bone marrow biopsy shows normal myeloid maturation. What is the best initial treatment approach?
G-CSF
Bone marrow transplantation
IVIG therapy
Observation, as most cases resolve spontaneously
Immediate IV antibiotics
30s