Nokea
A 10 years old girl presented with fever and bruises for last 2 weeks. On examination she is pale; however there is no evidence of lymphadenopathy or hepatosplenomegaly. Her Hb is 6g/dl, TLC is 2700 and platelets are 90000. The most appropriate investigation to clinch the diagnosis is:
- A. Bone marrow aspiration
- B. Retics count
- C. Bleeding time
- D. PT and APTT
Correct Answer: A
Rationale: Bone marrow aspiration is essential to rule out conditions like aplastic anemia or leukemia, which could explain the symptoms and lab findings.
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Justine is admitted to the pediatric unit due to the occurrence of diabetic ketoacidosis signaling a new diagnosis of diabetes. The diabetes team explores the cause of the episode and take steps to prevent a recurrence. Diabetic ketoacidosis (DKA) results from an excessive accumulation of which of the following?
- A. Sodium bicarbonate from renal compensation
- B. Potassium from cell death
- C. Glucose from carbohydrate metabolism
- D. Ketone bodies from fat metabolism
Correct Answer: D
Rationale: Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when there is not enough insulin in the body. In the absence of sufficient insulin, the body is unable to use glucose for energy, leading to the breakdown of fats for fuel. This results in the excessive production of ketone bodies, specifically acetoacetate and beta-hydroxybutyrate. As the ketone bodies accumulate in the blood, they lower the blood pH, leading to acidosis. This is what causes the characteristic symptoms of DKA, such as fruity breath, deep rapid breathing, and abdominal pain. Therefore, the excessive accumulation of ketone bodies from fat metabolism is the primary cause of diabetic ketoacidosis.
Which type of leukemia has been MOST likely developed in a 2-year-old child with Down syndrome in the neonatal period?
- A. ALL
- B. CML
- C. AML M1
- D. AML M6
Correct Answer: D
Rationale: Transient myeloproliferative disorder in neonates with Down syndrome can evolve into AML M6.
Which of the ff is an assessment finding in a client with bonchiectasis?
- A. Same amount of sputum at all stages of the disease
- B. Non productive cough
- C. Expectoration of small amounts of sputum
- D. Worsening cough with position changes
Correct Answer: C
Rationale: Bronchiectasis is a condition characterized by the abnormal widening and thickening of the bronchial tubes, leading to a build-up of mucus. One of the common assessment findings in clients with bronchiectasis is the expectoration of small amounts of sputum. This is due to the increased mucus production and impaired clearance from the airways. The sputum may be foul-smelling and may contain pus or blood due to chronic infection and inflammation in the bronchial tubes.
Extraneural metastasis from primary brain tumors is MOST commonly likely to occur in which tumor?
- A. medulloblastoma
- B. primitive neuroectodermal tumor (PNET)
- C. ependymoma
- D. malignant glioma
Correct Answer: A
Rationale: Medulloblastoma is notorious for extraneural spread, particularly to bones and bone marrow.
The primary critical observation for Apgar scoring is the:
- A. Heart rate
- B. Respiratory rate
- C. Presence of meconium
- D. Evaluation of the Moro reflex
Correct Answer: A
Rationale: The primary critical observation for Apgar scoring is the heart rate. This is because the heart rate is vital for life and immediate assessment of the infant's heart rate provides crucial information about the baby's overall well-being and response to the birthing process. The Apgar score assesses five components: heart rate, respiratory effort, muscle tone, reflex irritability, and skin color. Among these components, the heart rate is considered the most critical because it directly reflects the infant's cardiovascular status and their ability to maintain adequate perfusion of vital organs. Therefore, for quick assessment and immediate intervention, the heart rate is prioritized as the primary observation in Apgar scoring.