Anatomy of Hematologic System

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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.

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Waldeyer's ring does not include:

  • A. faucal tonsils
  • B. submandibular glands
  • C. adenoids
  • D. lingual tonsils
Correct Answer: B

Rationale: The correct answer is B: submandibular glands. Waldeyer's ring consists of the pharyngeal tonsil (adenoids), tubal tonsils, palatine tonsils (faucal tonsils), and lingual tonsils. The submandibular glands are salivary glands located outside of Waldeyer's ring. The other choices are incorrect because they are all part of Waldeyer's ring, which is a ring of lymphoid tissue located in the pharynx.

Cooley's anemia is:

  • A. Sickle cell an.
  • B. thalassemia major
  • C. high ESR
  • D. aplastic an.
Correct Answer: B

Rationale: Step 1: Cooley's anemia is another term for thalassemia major, a genetic disorder affecting hemoglobin production.
Step 2: Thalassemia major results in severe anemia due to the body's inability to produce enough functional hemoglobin.
Step 3: Sickle cell anemia (Choice A) is a different genetic disorder characterized by abnormal hemoglobin shape.
Step 4: High ESR (Choice C) is a non-specific marker of inflammation, not specific to Cooley's anemia.
Step 5: Aplastic anemia (Choice D) is a condition where the bone marrow does not produce enough blood cells, not specific to Cooley's anemia.

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.

A peripheral blood smear showing increase in numbers of neutrophils, band cells, basophils, eosinophils, and platelets is most suggestive

  • A. Acute myeloid leukemia
  • B. Acute lymphoid leukemia
  • C. Chronic myelocytic leukemia
  • D. Chronic lymphocytic leukemia
Correct Answer: C

Rationale: Rationale: A peripheral blood smear showing an increase in neutrophils, basophils, eosinophils, and platelets is indicative of Chronic Myelocytic Leukemia (CML). Neutrophils, basophils, and eosinophils are myeloid lineage cells typically elevated in CML. The presence of increased platelets is also common in CML due to the overproduction of cells in the bone marrow.

Summary of other choices:
A: Acute myeloid leukemia - Typically presents with a predominance of immature myeloid cells like blasts, rather than an increase in mature myeloid cells.
B: Acute lymphoid leukemia - Primarily involves lymphoid lineage cells, not myeloid cells as seen in the blood smear.
D: Chronic lymphocytic leukemia - Characterized by an increase in mature lymphocytes, not myeloid cells like neutrophils, basophils, and eosinophils.

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, an iron supplement, commonly causes constipation due to its effects on the digestive system. Iron slows down bowel movements, leading to constipation. Monitoring for constipation is crucial to ensure the client's comfort and prevent complications.

Phlebitis (choice A) is not a common adverse effect of ferrous sulfate administration. Dark, tarry stools (choice B) can indicate gastrointestinal bleeding but are not directly related to iron supplementation. Orange-colored stools (choice C) are not a typical side effect of ferrous sulfate and are more commonly associated with certain foods or medications.

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