Nokea
A 14-year-old male patient is diagnosed with very high risk acute lymphoblastic leukemia and is likely going to require an allogeneic hematopoietic stem cell transplant to cure his leukemia. Prior to going to transplant, he is likely to require multiple blood transfusions. Which of the following products or component modifications is the best way to prevent him from developing alloimmunization due to anti-HLA antibodies prior to transplant?
- A. Frozen RBCs
- B. Volume-reduced blood products
- C. Irradiation of all blood products
- D. Leukoreduced blood products
Correct Answer: D
Rationale: The correct answer is D: Leukoreduced blood products. Leukoreduction removes white blood cells, which are a major source of HLA antigens that can trigger alloimmunization. By using leukoreduced blood products, the risk of developing anti-HLA antibodies is significantly reduced, thus minimizing the potential for alloimmunization prior to transplant.
A: Frozen RBCs - Freezing does not eliminate HLA antigens and does not prevent alloimmunization.
B: Volume-reduced blood products - Reducing volume does not impact HLA antigens and thus doesn't prevent alloimmunization.
C: Irradiation of all blood products - While irradiation prevents graft-versus-host disease, it does not directly prevent the development of anti-HLA antibodies.
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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.
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.
A 12-year-old patient has been referred to you following complete resection with clean margins of a high-grade malignant peripheral nerve sheath tumor of the shoulder region. The tumor measured approximately 4 cm in greatest dimension. A CT scan of the chest and a bone scan were within normal limits. The patient does not have evidence of neurofibromatosis type 1 (NF1). Which of the following treatment approaches would you recommend?
- A. Chemotherapy with doxorubicin and ifosfamide
- B. Radiotherapy
- C. Chemotherapy with doxorubicin and ifosfamide plus radiotherapy
- D. Observation
Correct Answer: D
Rationale: The correct answer is D: Observation. In this case, the patient has undergone complete resection of the tumor with clean margins and there is no evidence of metastasis or neurofibromatosis type 1. Given these factors, observation is the most appropriate approach as there is no indication for adjuvant chemotherapy or radiotherapy. Chemotherapy with doxorubicin and ifosfamide (Choice A) is typically reserved for cases with high-risk features such as incomplete resection or metastasis. Radiotherapy (Choice B) may be considered in certain cases, but in this scenario where surgery was curative and there is no evidence of spread, it is not necessary. Chemotherapy plus radiotherapy (Choice C) may be overly aggressive and carry unnecessary risks for a patient who has already had successful surgery. Thus, observation is the most appropriate approach in this situation.
A 5-year-old boy presents with a 3-week history of his right eye “not moving to the right side.†The remainder of his neurologic exam is normal with the exception of a weak gag. MRI of the brain reveals a diffusely infiltrative mass in the pons. If this patient were to undergo a stereotactic biopsy, what would be the most likely molecular finding?
- A. BRAFKIAA1549 fusion
- B. Trisomy 21
- C. H3 K27M mutation
- D. RELA fusion
Correct Answer: C
Rationale: The correct answer is C: H3 K27M mutation. In children with diffuse midline gliomas, the most common molecular finding is the H3 K27M mutation. This mutation is associated with a worse prognosis and is commonly found in tumors located in the pons, which is consistent with the MRI findings in this case.
Choice A (BRAFKIAA1549 fusion) is incorrect as this fusion is typically associated with pilocytic astrocytomas, which are low-grade tumors and not typically found in the pons.
Choice B (Trisomy 21) is incorrect as it is a chromosomal abnormality associated with Down syndrome, not a molecular finding in brain tumors.
Choice D (RELA fusion) is incorrect as this fusion is typically found in ependymomas, which are not typically located in the pons.
When should autologous hematopoietic stem cell transplantation be used, and what are the common cancers it is used for?
- A. It should be used when high dose therapy is needed to maximize response. Most common cancers it is used for include lymphoma, late relapse of acute lymphoblastic leukemia, neuroblastoma, and Ewing sarcoma.
- B. It should be used any time this approach can provide a meaningful survival benefit over chemotherapy. Most common cancers it is used for include neuroblastoma, responsive brain tumors in young children to avoid/minimize early radiation therapy, and relapsed lymphoma.
- C. It should be used for tumors in which a graft-versus-tumor effect does not occur. Most common cancers include neuroblastoma, lymphoma, selected brain tumors, rhabdomyosarcoma, and Ewing sarcoma with lung metastases.
- D. It should be used to avoid extensive treatment with chemotherapy and to shorten treatment. Most common cancers include neuroblastoma, relapsed Wilms' tumor, and selected brain tumors.
Correct Answer: B
Rationale: The correct answer is B because autologous hematopoietic stem cell transplantation should be used when it can provide a survival benefit over chemotherapy. This approach is particularly beneficial for certain cancers such as neuroblastoma and relapsed lymphoma.
- Choice A is incorrect because the indication for autologous transplantation is not solely based on the need for high-dose therapy, but rather on providing a meaningful survival benefit over chemotherapy. The listed cancers are not the most common ones treated with this approach.
- Choice C is incorrect because the graft-versus-tumor effect is actually desired in some cases of autologous transplantation, and the listed cancers are not the most common ones treated with this approach.
- Choice D is incorrect because the purpose of autologous transplantation is not to avoid extensive chemotherapy but to provide a survival benefit. The listed cancers are not the most common ones treated with this approach.