LATEST PEDIATRIC HEMATOLOGY-ONCOLOGY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 3-year-old child presents with bruising,
petechiae, and pallor. Complete blood count (CBC)
shows hemoglobin 7 g/dL, platelets 20,000/μL, and
WBC 2,500/μL with 10% blasts. Bone marrow biopsy
shows 80% lymphoblasts (L1 morphology) that are
positive for CD10, CD19, and TdT. Cytogenetics show
hyperdiploidy (>50 chromosomes). What is the
prognosis for this leukemia?
A) Favorable prognosis (hyperdiploidy is a good risk
factor in B-ALL)
B) Poor prognosis (requires stem cell transplant)
C) Intermediate prognosis (requires intensified
chemotherapy)
D) Indeterminate (need molecular studies)
Correct answer: A
Rationale: Hyperdiploidy (>50 chromosomes) and
trisomies of chromosomes 4,10,17 confer a favorable
prognosis in pediatric B-ALL (5-year event-free
survival >90%). Low-risk features: age 1-9 years,
,WBC <50,000/μL, hyperdiploidy, t(12;21) ETV6-
RUNX1.
2. A 5-year-old boy presents with a 2-week history of
fever, bone pain (legs), and pallor. CBC: hemoglobin
6 g/dL, platelets 40,000/μL, WBC 1,800/μL with 15%
blasts. Bone marrow shows 85% blasts with Auer
rods. Blasts are positive for myeloperoxidase (MPO)
and CD13, CD33. Cytogenetics show
t(8;21)(q22;q22). What is the most likely diagnosis?
A) Acute myeloid leukemia (AML) with t(8;21)
(RUNX1-RUNX1T1)
B) Acute lymphoblastic leukemia (ALL) (Auer rods
are not seen in ALL)
C) Acute promyelocytic leukemia (APL) (t(15;17))
D) Juvenile myelomonocytic leukemia (JMML)
Correct answer: A
Rationale: t(8;21) is a favorable-risk AML (associated
with granulocytic differentiation, Auer rods). MPO
positivity confirms myeloid lineage. ALL (B) is MPO
negative. APL (C) has t(15;17) and promyelocytes.
3. A 6-year-old child with sickle cell disease (HbSS)
presents with fever (39.5°C), cough, and chest pain.
Oxygen saturation is 85% on room air. Chest X-ray
,shows a right lower lobe infiltrate. What is the most
appropriate next step?
A) Admit to hospital, start intravenous antibiotics
(ceftriaxone), pain control, incentive spirometry, and
consider exchange transfusion if worsening
B) Outpatient oral antibiotics (amoxicillin) and follow-
up
C) Exchange transfusion (immediate) (reserved for
severe acute chest syndrome, ACS)
D) Hydroxyurea (long-term) (not acute)
Correct answer: A
Rationale: Acute chest syndrome (ACS) is a leading
cause of death in sickle cell disease. Treatment: IV
antibiotics (cover encapsulated organisms and
atypical), pain control, oxygen, incentive spirometry,
and hydration. Exchange transfusion for severe ACS
(hypoxemia, rapid progression, pulmonary failure).
4. A 4-year-old child presents with a painless,
enlarging abdominal mass. CT shows a large,
heterogeneous renal mass with calcifications.
Nephrectomy shows a triphasic tumor (blastema,
stroma, epithelium) with favorable histology (no
anaplasia). What is the most likely diagnosis?
A) Wilms tumor (nephroblastoma)
, B) Neuroblastoma (adrenal, not renal)
C) Clear cell sarcoma of kidney
D) Mesoblastic nephroma (congenital)
Correct answer: A
Rationale: Wilms tumor is the most common renal
malignancy in children (peak age 2-5). Favorable
histology (no anaplasia) has excellent prognosis
(>90% survival). Staging and treatment with NWTS
(Children's Oncology Group, COG) protocols.
5. A 2-year-old child presents with proptosis (eye
bulging) and periorbital ecchymosis (raccoon eyes).
Urine catecholamines (VMA, HVA) are elevated.
Biopsy of an adrenal mass shows small round blue
cells with Homer-Wright rosettes. MYCN amplification
is detected. What is the prognostic significance?
A) Poor prognosis (high-risk neuroblastoma)
B) Good prognosis (favorable)
C) Intermediate prognosis (requires stem cell
transplant)
D) No prognostic significance
Correct answer: A
Rationale: MYCN amplification (>10 copies) is a poor
prognostic factor in neuroblastoma (high-risk). Other
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 3-year-old child presents with bruising,
petechiae, and pallor. Complete blood count (CBC)
shows hemoglobin 7 g/dL, platelets 20,000/μL, and
WBC 2,500/μL with 10% blasts. Bone marrow biopsy
shows 80% lymphoblasts (L1 morphology) that are
positive for CD10, CD19, and TdT. Cytogenetics show
hyperdiploidy (>50 chromosomes). What is the
prognosis for this leukemia?
A) Favorable prognosis (hyperdiploidy is a good risk
factor in B-ALL)
B) Poor prognosis (requires stem cell transplant)
C) Intermediate prognosis (requires intensified
chemotherapy)
D) Indeterminate (need molecular studies)
Correct answer: A
Rationale: Hyperdiploidy (>50 chromosomes) and
trisomies of chromosomes 4,10,17 confer a favorable
prognosis in pediatric B-ALL (5-year event-free
survival >90%). Low-risk features: age 1-9 years,
,WBC <50,000/μL, hyperdiploidy, t(12;21) ETV6-
RUNX1.
2. A 5-year-old boy presents with a 2-week history of
fever, bone pain (legs), and pallor. CBC: hemoglobin
6 g/dL, platelets 40,000/μL, WBC 1,800/μL with 15%
blasts. Bone marrow shows 85% blasts with Auer
rods. Blasts are positive for myeloperoxidase (MPO)
and CD13, CD33. Cytogenetics show
t(8;21)(q22;q22). What is the most likely diagnosis?
A) Acute myeloid leukemia (AML) with t(8;21)
(RUNX1-RUNX1T1)
B) Acute lymphoblastic leukemia (ALL) (Auer rods
are not seen in ALL)
C) Acute promyelocytic leukemia (APL) (t(15;17))
D) Juvenile myelomonocytic leukemia (JMML)
Correct answer: A
Rationale: t(8;21) is a favorable-risk AML (associated
with granulocytic differentiation, Auer rods). MPO
positivity confirms myeloid lineage. ALL (B) is MPO
negative. APL (C) has t(15;17) and promyelocytes.
3. A 6-year-old child with sickle cell disease (HbSS)
presents with fever (39.5°C), cough, and chest pain.
Oxygen saturation is 85% on room air. Chest X-ray
,shows a right lower lobe infiltrate. What is the most
appropriate next step?
A) Admit to hospital, start intravenous antibiotics
(ceftriaxone), pain control, incentive spirometry, and
consider exchange transfusion if worsening
B) Outpatient oral antibiotics (amoxicillin) and follow-
up
C) Exchange transfusion (immediate) (reserved for
severe acute chest syndrome, ACS)
D) Hydroxyurea (long-term) (not acute)
Correct answer: A
Rationale: Acute chest syndrome (ACS) is a leading
cause of death in sickle cell disease. Treatment: IV
antibiotics (cover encapsulated organisms and
atypical), pain control, oxygen, incentive spirometry,
and hydration. Exchange transfusion for severe ACS
(hypoxemia, rapid progression, pulmonary failure).
4. A 4-year-old child presents with a painless,
enlarging abdominal mass. CT shows a large,
heterogeneous renal mass with calcifications.
Nephrectomy shows a triphasic tumor (blastema,
stroma, epithelium) with favorable histology (no
anaplasia). What is the most likely diagnosis?
A) Wilms tumor (nephroblastoma)
, B) Neuroblastoma (adrenal, not renal)
C) Clear cell sarcoma of kidney
D) Mesoblastic nephroma (congenital)
Correct answer: A
Rationale: Wilms tumor is the most common renal
malignancy in children (peak age 2-5). Favorable
histology (no anaplasia) has excellent prognosis
(>90% survival). Staging and treatment with NWTS
(Children's Oncology Group, COG) protocols.
5. A 2-year-old child presents with proptosis (eye
bulging) and periorbital ecchymosis (raccoon eyes).
Urine catecholamines (VMA, HVA) are elevated.
Biopsy of an adrenal mass shows small round blue
cells with Homer-Wright rosettes. MYCN amplification
is detected. What is the prognostic significance?
A) Poor prognosis (high-risk neuroblastoma)
B) Good prognosis (favorable)
C) Intermediate prognosis (requires stem cell
transplant)
D) No prognostic significance
Correct answer: A
Rationale: MYCN amplification (>10 copies) is a poor
prognostic factor in neuroblastoma (high-risk). Other
