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. DICER1 syndrome is associated with an increased risk of developing various tumors, including papillary thyroid cancer. This is due to the role of DICER1 gene mutation in dysregulating cell growth and division. Other choices like B: Medullary thyroid cancer, C: Pheochromocytoma, and D: Renal cell carcinoma are not typically associated with DICER1 syndrome. Medullary thyroid cancer is more commonly linked to RET gene mutations, pheochromocytoma to RET or SDHB/C/D gene mutations, and renal cell carcinoma to VHL gene mutations. Therefore, based on the genetic mechanism and known associations, papillary thyroid cancer is the most likely cancer this patient is predisposed to.
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A study is designed to investigate the rates of central line–associated blood stream infections (CLABSI) among pediatric hematology/oncology patients. Investigators wish to compare the length of stay (LOS) between subjects receiving three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]). It is discovered that LOS is not normally distributed. What is the appropriate test for comparing the LOS between patients receiving the three central line types?
- A. Student's t test
- B. ANOVA
- C. Wilcoxon-Mann-Whitney test
- D. Kruskal-Wallis test
Correct Answer: D
Rationale: The correct answer is D: Kruskal-Wallis test. This non-parametric test is used to compare the medians of three or more independent groups when the data is not normally distributed, as in this case with LOS. It is an extension of the Wilcoxon-Mann-Whitney test, which compares two groups. The Kruskal-Wallis test assesses whether the medians of the groups are equal or different by ranking all observations, calculating the sum of ranks for each group, and then comparing these sums. It is appropriate here because it allows for comparison of central line types without assuming normality. The other choices (A: Student's t test and B: ANOVA) require the data to be normally distributed, which is not the case in this scenario. Choice C: Wilcoxon-Mann-Whitney test is for comparing two groups, not three or more.
What are the six dimensions of quality care according to the Institute of Medicine?
- A. Safe, timely, effective, efficient, equitable, and person-centered
- B. Safe, transparent, effective, efficient, equitable, and person-centered
- C. Safe, timely, effective, low-cost, equitable, and person-centered
- D. Safe, timely, effective, efficient, cutting-edge, and person-centered
Correct Answer: A
Rationale: The correct answer is A: Safe, timely, effective, efficient, equitable, and person-centered. According to the Institute of Medicine, these six dimensions encompass quality care. Safety is essential to avoid harm. Timeliness ensures care is provided promptly. Effectiveness means care should be evidence-based and achieve desired outcomes. Efficiency aims to minimize waste. Equitability ensures fair and non-discriminatory care. Lastly, being person-centered emphasizes individual preferences and needs.
Summary:
Choice B is incorrect because transparency is not included in the six dimensions. Choice C is incorrect as low-cost is not a primary dimension of quality care. Choice D is incorrect as it includes cutting-edge, which is not one of the six dimensions outlined by the Institute of Medicine.
A 20-month-old otherwise healthy male presents late for his 18-month well child check. During his first year of life, he took iron-fortified formula and had a point-of-care hemoglobin (Hgb) of 12 g/dL at his 1-year well child check. His mother reports that he is a picky eater but loves milk and has recently become obsessive about chewing the corners of his cardboard books. Physical examination is normal except for a flow murmur. Which combination of laboratory test results listed below would most likely characterize this patient?
- A. Hgb 8.7 g/dL, mean corpuscular volume (MCV) 60 fL, serum ferritin 2 ng/mL
- B. Hgb 12.0 g/dL, MCV 80 fL, serum ferritin 30 ng/mL
- C. Hgb 9.2 g/dL, MCV 60 fL, serum ferritin 30 ng/mL
- D. Hgb 11.2 g/dL, MCV 90 fL, serum ferritin 7 ng/mL
Correct Answer: A
Rationale: The correct answer is A because it reflects iron deficiency anemia in a 20-month-old child who is a picky eater and has pica behavior. The low hemoglobin level of 8.7 g/dL indicates anemia. The MCV of 60 fL suggests microcytic anemia, typical of iron deficiency. The serum ferritin level of 2 ng/mL confirms low iron stores.
Choice B is incorrect as the hemoglobin level is normal, MCV is higher, and serum ferritin is not indicative of iron deficiency anemia.
Choice C is incorrect as the hemoglobin level is higher, and the MCV is not consistent with iron deficiency anemia.
Choice D is incorrect as the hemoglobin level is higher, MCV is too high for iron deficiency anemia, and the serum ferritin level does not support iron deficiency.
Graft versus host disease is a complication of transfusion in patients of bone marrow transplantation. This can be best avoided by
- A. Transfusion of packed cells
- B. Irradiating the blood components before transfusion
- C. Transfusing fresh whole blood
- D. Replacement by crystalloids
Correct Answer: B
Rationale: The correct answer is B: Irradiating the blood components before transfusion. Graft versus host disease occurs when donor T-cells attack the recipient's tissues in bone marrow transplant patients. Irradiating blood components helps to deactivate T-cells in the donor blood, preventing them from attacking the recipient's tissues. Transfusion of packed cells (A) or fresh whole blood (C) does not address the issue of T-cell activation. Replacement by crystalloids (D) is not a solution for preventing graft versus host disease.
After receiving a diagnosis of acute lymphocytic leukemia, a patient is visibly distraught, stating, 'I have no idea where to go from here.' How should the nurse prepare to meet this patient's psychosocial needs?
- A. Assess the patient's previous experience with the health care system.
- B. Reassure the patient that treatment will be challenging but successful.
- C. Assess the patient's specific needs for education and support.
- D. Identify the patient's plan of medical care.
Correct Answer: C
Rationale: Rationale: Choice C is correct because assessing the patient's specific needs for education and support is crucial in addressing psychosocial needs. By understanding the patient's knowledge gaps and support requirements, the nurse can provide tailored information and resources to help the patient cope effectively. This empowers the patient to make informed decisions and feel supported throughout the treatment process.
Incorrect Choices:
A: Assessing the patient's previous experience with the health care system may provide some insight but does not directly address the current psychosocial needs.
B: Reassuring the patient about treatment success is important but may not adequately address the patient's immediate distress and uncertainty.
D: Identifying the patient's plan of medical care is important but focuses more on the medical aspect rather than psychosocial support and education.