Nokea
A 10-year-old girl is a long-term survivor of type II pleuropulmonary blastoma (PPB). You suspect she has a cancer predisposition syndrome and perform genetic testing, which confirms she has DICER1 syndrome. Which other cancer is she predisposed to?
- A. Papillary thyroid cancer
- B. Medullary thyroid cancer
- C. Pheochromocytoma
- D. Renal cell carcinoma
Correct Answer: A
Rationale: The correct answer is A: Papillary thyroid cancer. Individuals with DICER1 syndrome are at increased risk for developing various tumors, including papillary thyroid cancer. This is due to the role of DICER1 gene in regulating cell growth and division. The other choices, B (medullary thyroid cancer), C (pheochromocytoma), and D (renal cell carcinoma), are not typically associated with DICER1 syndrome. Medullary thyroid cancer is commonly linked to RET gene mutations, pheochromocytoma to genes such as SDHB, SDHD, and VHL, and renal cell carcinoma to mutations in genes like VHL and MET.
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A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding?
- A. Hematocrit of 35%
- B. Hemoglobin of 11.8 g/dL
- C. Platelet count of 400000/L
- D. White blood cell (WBC) count of 2800/L
Correct Answer: D
Rationale: The correct answer is D: White blood cell (WBC) count of 2800/L. A low WBC count (leukopenia) in an older patient can indicate an impaired immune system, making them vulnerable to infections. This is concerning as older adults have a weakened immune response. A: Hematocrit of 35% is within the normal range. B: Hemoglobin of 11.8 g/dL is slightly low but not a major concern as long as it's not significantly lower. C: Platelet count of 400000/L is within the normal range and not typically a cause for concern.
A nurse is monitoring a client following ferrous sulfate administration. The nurse should monitor the client for which of the following adverse effects?
- A. Phlebitis
- B. Dark
- C. orange-colored stools
- D. Constipation
Correct Answer: D
Rationale: The correct answer is D: Constipation. Ferrous sulfate is an iron supplement commonly associated with gastrointestinal side effects, including constipation. Iron can cause constipation by slowing down bowel movements. Phlebitis (A) is inflammation of a vein and is not a common adverse effect of ferrous sulfate. Dark (B) or orange-colored stools (C) are expected side effects of iron supplements due to the change in color caused by the iron, but they are not harmful. Constipation (D) is the most concerning adverse effect to monitor for as it can lead to discomfort and potential complications if left untreated.
An infant is born with a 7 cm × 6 cm lesion over the upper extremity from the elbow to the shoulder. The lesion is indurated and purpuric, with some petechiae around the edges. No other areas of petechiae are noted on the skin. The infant is doing well without other systemic problems. i were 9 and 9. You are called by the pediatric nurse practitioner to the NICU. What is the most appropriate next step?
- A. Do nothing because the infant is doing well and had good Apgars.
- B. Obtain an ultrasound for more information about the lesion.
- C. Obtain an MRI to assess the extent of the lesion.
- D. Obtain labs, including a CBC with platelet count and fibrinogen.
Correct Answer: D
Rationale: The correct next step is D: Obtain labs, including a CBC with platelet count and fibrinogen. This is the most appropriate action because the infant presents with an indurated and purpuric lesion with petechiae, suggesting a possible coagulation disorder. Labs can help assess for any underlying hematologic abnormalities.
Choice A is incorrect because it is important to investigate further given the concerning presentation.
Choice B is not the best next step as an ultrasound would not provide information on the hematologic status.
Choice C is also not the best option as an MRI is not typically used to assess coagulation disorders.
You are seeing a 13-year-old boy with fatigue, weight loss, night sweats, and splenomegaly. Peripheral blood shows anemia, thrombocytosis, and leukocytosis (300,000/mm3). What is this patient's most likely diagnosis?
- A. Leukemoid reaction
- B. Acute lymphoblastic leukemia (ALL)
- C. Chronic myeloid leukemia (CML)
- D. Juvenile myelomonocytic leukemia (JMML)
Correct Answer: C
Rationale: The most likely diagnosis for this 13-year-old boy presenting with fatigue, weight loss, night sweats, splenomegaly, anemia, thrombocytosis, leukocytosis (300,000/mm3) is Chronic Myeloid Leukemia (CML).
1. Presence of anemia, thrombocytosis, and leukocytosis is characteristic of CML.
2. CML typically presents with splenomegaly.
3. Age of onset (13 years) is within the typical range for CML.
4. The Philadelphia chromosome (t(9;22)) is present in most cases of CML, aiding in diagnosis.
5. Leukemoid reaction (A) is a reactive increase in white blood cells, not a primary neoplastic disorder.
6. Acute lymphoblastic leukemia (ALL) (B) typically presents with bone pain, lymphadenopathy, and CNS symptoms in children.
7
Artemisinin and its derivatives are used in the treatment of severe forms of chloroquine-resistant falciparum because they have:
- A. Rapid gametocidal activity
- B. The ability to prevent further development of hypnozoites
- C. Rapid sporontocidal activity
- D. Rapid schizonticidal activity
Correct Answer: D
Rationale: The correct answer is D: Rapid schizonticidal activity. Artemisinin and its derivatives target the asexual stage of the malaria parasite's life cycle, specifically the schizont stage. By quickly destroying the schizonts, they effectively kill the parasites in the blood, leading to a rapid reduction in parasite load and alleviating symptoms. The other choices are incorrect because A (Rapid gametocidal activity) targets sexual stage parasites, B (Ability to prevent further development of hypnozoites) refers to relapse prevention in Plasmodium vivax and Plasmodium ovale infections, and C (Rapid sporontocidal activity) targets the mosquito stage of the parasite's life cycle.