Nokea
A 16-year-old female presents to the emergency room with a new complaint of chest pain. When performing a review of systems and physical examination, which of the following would substantially decrease your suspicion for a diagnosis of pulmonary embolism?
- A. Cough
- B. Fever
- C. Rib tenderness
- D. Shortness of breath
Correct Answer: C
Rationale: The correct answer is C: Rib tenderness. Rib tenderness would decrease suspicion for pulmonary embolism because it suggests a musculoskeletal origin of chest pain rather than a vascular one. Pulmonary embolism typically presents with symptoms such as shortness of breath, pleuritic chest pain, and sometimes cough, but rib tenderness is not a common finding in this condition. Fever is non-specific and can be present in various conditions, including pulmonary embolism. Shortness of breath is a key symptom of pulmonary embolism and would increase suspicion for this diagnosis.
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A nurse is caring for a client who has chronic stable angina. The nurse should identify that which of the following drugs inhibits the action of adenosine diphosphate receptors (ADP) on platelets and can be prescribed to reduce the client's risk for myocardial infarction?
- A. Clopidogrel
- B. Heparin
- C. Warfarin
- D. Alteplase
Correct Answer: A
Rationale: 1. Clopidogrel inhibits ADP receptors on platelets, reducing platelet aggregation and clot formation.
2. By reducing platelet aggregation, clopidogrel decreases the risk of myocardial infarction in patients with chronic stable angina.
3. Heparin acts by inhibiting thrombin and factor Xa, not ADP receptors.
4. Warfarin inhibits vitamin K-dependent clotting factors, not ADP receptors.
5. Alteplase is a thrombolytic agent that dissolves blood clots, not an ADP receptor inhibitor.
Several gene mutations have been associated with juvenile myelomonocytic leukemia (JMML), and they may or may not have prognostic implications. A gene expression–based classification system has been found to be an independent predictor of clinical outcome in these patients. What is the disease signature that predicts a poor outcome?
- A. Tyrosine kinase inhibitors
- B. Acute myeloid leukemia–like
- C. Chronic myeloid leukemia-like
- D. BRAF pathway abnormalities
Correct Answer: B
Rationale: The correct answer is B: Acute myeloid leukemia-like. In JMML, a disease signature resembling acute myeloid leukemia (AML) has been associated with a poor outcome. This signature includes features such as increased blasts, abnormal karyotypes, and mutations in genes like NRAS and KRAS. AML-like JMML cases often have aggressive disease progression and poorer response to treatment. Tyrosine kinase inhibitors (choice A) are not typically used in JMML treatment. Chronic myeloid leukemia-like (choice C) is not associated with a poor outcome in JMML. BRAF pathway abnormalities (choice D) may be present in some cases of JMML but are not the primary disease signature predicting poor outcomes.
An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem?
- A. Hodgkin disease
- B. Non-Hodgkin Lymphoma
- C. Multiple Myeloma
- D. Acute Thrombocytopenia
Correct Answer: C
Rationale: The correct answer is C: Multiple Myeloma. In this case, the patient's age, symptoms of fatigue, back, and rib pain without recent injuries are indicative of multiple myeloma. This condition is a type of cancer that affects plasma cells in the bone marrow, leading to bone pain and fatigue. Hodgkin disease and Non-Hodgkin Lymphoma typically present with lymph node enlargement rather than back and rib pain. Acute Thrombocytopenia would present with symptoms related to low platelet levels such as bleeding tendencies, not back and rib pain.
Plat. Transfusion is not indicated in:
- A. aplastic an.
- B. uraemia with bleeding
- C. DIC
- D. immunogenic thrombocytopenia
Correct Answer: D
Rationale: The correct answer is D: immunogenic thrombocytopenia. Platelet transfusion is not indicated in immunogenic thrombocytopenia because it involves antibodies attacking platelets, which would render transfused platelets ineffective. Platelet transfusion is indicated in aplastic anemia (A) to increase platelet count, in uremia with bleeding (B) to replace dysfunctional platelets, and in DIC (C) to help manage severe bleeding. In summary, platelet transfusion is contraindicated in immunogenic thrombocytopenia due to ineffective platelet response.
According to the FAB classification, the L2 stage is characterized by:
- A. Large heterogenous blasts with prominent nucleoli
- B. Small homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- C. Large homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- D. Large blasts with basophilic vacuolated cytoplasm
Correct Answer: C
Rationale: The correct answer is C because according to the FAB classification, the L2 stage is characterized by large homogenous blasts with scanty nucleoli and a higher nucleus to cytoplasm ratio. This stage represents acute lymphoblastic leukemia with a high risk of relapse. Choice A is incorrect as it describes the L1 stage. Choice B is incorrect as it describes the L3 stage. Choice D is incorrect as it does not accurately describe the characteristics of the L2 stage.