Nokea
Which of the following requires IL-2 and IL-4 in the conversion of unilineage progenitor cell into mature circulating cell?
- A. Neutrophil
- B. Eosinophil
- C. Basophil
- D. B lymphocyte
Correct Answer: D
Rationale: The correct answer is D: B lymphocyte. IL-2 and IL-4 are essential for the differentiation of B lymphocytes from unilineage progenitor cells into mature circulating cells. IL-2 is crucial for B cell proliferation and survival, while IL-4 is required for B cell activation and class switching. Neutrophils do not require IL-2 and IL-4 for differentiation. Eosinophils are primarily influenced by IL-5. Basophils are influenced by IL-3 and IL-5. Therefore, B lymphocytes are the only cell type among the choices that specifically requires IL-2 and IL-4 for their maturation.
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Thrombocytopenia is absent in:
- A. DIC
- B. Wiskott Aldrich syndrome
- C. Henoch Schonlein purpura
- D. myelosclerosis
Correct Answer: C
Rationale: Thrombocytopenia is absent in Henoch Schonlein purpura because it primarily involves vasculitis, not platelet destruction or consumption. In DIC (A), there is widespread activation of coagulation leading to thrombocytopenia. Wiskott Aldrich syndrome (B) is characterized by low platelet counts due to defective platelet function. Myelosclerosis (D) is a bone marrow disorder causing decreased platelet production, leading to thrombocytopenia.
C6PD reflect false normal report in:
- A. iron def .an.
- B. hypoplastic an.
- C. hairy cell leuk.
- D. shortly after haemolysis
Correct Answer: D
Rationale: The correct answer is D because individuals with G6PD deficiency can have normal enzyme levels shortly after a hemolytic episode due to the body replenishing the enzyme. Choice A, iron deficiency anemia, is unrelated to G6PD deficiency. Choice B, hypoplastic anemia, does not affect enzyme levels. Choice C, hairy cell leukemia, is not typically associated with false-normal G6PD levels. Therefore, the correct answer is D as it reflects the transient nature of G6PD levels post-hemolysis.
The nurse is staying with a patient who has been started on a blood transfusion. Which assessment should the nurse perform during a blood product infusion to detect a reaction?
- A. Vital signs
- B. Skin turgor
- C. Bowel sounds
- D. Pupil reactivity
Correct Answer: A
Rationale: Correct Answer: A (Vital signs)
Rationale: Monitoring vital signs during a blood transfusion is crucial to detect any adverse reactions promptly. Changes in blood pressure, pulse rate, temperature, and respiratory rate can indicate a potential reaction. By assessing vital signs, the nurse can intervene promptly if there is any sign of an adverse reaction, such as fever, hypotension, tachycardia, or shortness of breath.
Summary of Incorrect Choices:
B: Skin turgor is not directly related to detecting a reaction during a blood transfusion.
C: Bowel sounds are not indicative of a reaction during a blood transfusion.
D: Pupil reactivity is not relevant for monitoring during a blood transfusion.
A 13-year-old Hispanic girl is found to have a WBC count of 6,500/mm3 with 40% Auer rod–containing granular blasts that, by flow cytometry, express very bright CD33 but are negative for human leukocyte antigen–DR isotype (HLA-DR). She is oozing blood around her peripheral IV site. Coagulation studies reveal an international normalized ratio (INR) of 3.4, a fibrinogen of 170, and a markedly elevated D-dimer. Marrow aspirate shows nearly 90% blasts with a similar morphology. You send the marrow to the fluorescence in situ hybridization (FISH) lab and request STAT testing for the most likely recurrent genetic abnormality based on the clinical presentation. How do you plan to initiate therapy?
- A. Perform a lumbar puncture to determine leukemic involvement, then proceed with induction chemotherapy.
- B. Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.
- C. Start dexamethasone and hydroxyurea immediately while aggressively managing coagulopathy with blood product support.
- D. Start induction chemotherapy, obtain HLA typing, and start a donor search because of the poor prognosis associated with this leukemic phenotype.
Correct Answer: B
Rationale: The correct answer is B: Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support. The patient's presentation is consistent with acute promyelocytic leukemia (APL), indicated by the presence of Auer rod-containing blasts, very bright CD33 expression, and coagulopathy (elevated INR, low fibrinogen, elevated D-dimer). APL is associated with a specific genetic abnormality involving the PML-RARA fusion gene. ATRA is the mainstay of induction therapy for APL as it induces differentiation of leukemic promyelocytes. Aggressive management of coagulopathy is crucial to prevent life-threatening bleeding complications.
Incorrect answers:
A: Performing a lumbar puncture is not necessary at this stage as the patient's symptoms and laboratory findings point towards APL, not central nervous system involvement.
C: Dexamethasone and hydroxyurea are not
Which of the following alters the function of thrombin from a procoagulant protein to one that downregulates the formation of fibrinogen?
- A. Protein C
- B. Protein S
- C. Antithrombin
- D. Thrombomodulin
Correct Answer: D
Rationale: Thrombomodulin alters thrombin's function by binding to it and activating protein C. Activated protein C then inhibits factors Va and VIIIa, which are essential for the formation of fibrinogen. Protein C (choice A) also inhibits coagulation, but it doesn't directly alter thrombin's function. Protein S (choice B) enhances protein C's activity but doesn't directly affect thrombin. Antithrombin (choice C) inhibits thrombin and other coagulation factors, but it doesn't specifically alter thrombin's function to downregulate fibrinogen formation.