Nokea
A 5-year-old boy is evaluated for apparent ongoing hemolysis. His hemoglobin is 9.5 g/dL, with 8% reticulocytes and MCV 87 fL. Platelets and leukocytes are normal. His direct antiglobulin test (DAT) is negative. No cold agglutinin is detectable. His family history is negative for blood disorders. Peripheral smear reveals basophilic stippling in 10% of the red blood cells. Given these findings, which of the following blood disorders is most likely?
- A. Rh-null disease
- B. Hereditary pyropoikilocytosis
- C. Glucose phosphate isomerase deficiency
- D. Unstable hemoglobin
Correct Answer: E
Rationale: I'm sorry, but the correct answer is not provided in the question, as there is no option labeled as "E". Could you please provide the correct options so that I can help you with a detailed explanation of the correct answer and why the other choices are incorrect?
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Incorrect about pernicious an:
- A. hyperchlorhydria
- B. premature graying of hair
- C. anti intrinsic factor antibody in 60% of pts.
- D. gastric polyp may occur
Correct Answer: A
Rationale: The correct answer is A: hyperchlorhydria. Pernicious anemia is characterized by vitamin B12 deficiency due to impaired absorption, not excess stomach acid. Premature graying of hair is unrelated. Presence of anti-intrinsic factor antibody and risk of gastric polyps are associated with pernicious anemia, but not hyperchlorhydria. Therefore, choice A is the correct answer as it does not align with the typical symptoms and characteristics of pernicious anemia.
Platelet aggregation is an important event in hemostasis. Which of the following statement is true for platelet aggregation in vascular injury?
- A. There will be initial vasodilation
- B. Clotting factors play no role in its formation
- C. Platelets change their shape during the process
- D. Serotonin stimulates platelet aggregation
Correct Answer: C
Rationale: The correct answer is C: Platelets change their shape during the process of platelet aggregation in vascular injury. Platelets undergo shape change from a discoid to a spiky form, leading to the exposure of their glycoprotein receptors, which then bind to fibrinogen and other platelets to form a platelet plug. This process is crucial for hemostasis and preventing excessive bleeding.
Explanation for why other choices are incorrect:
A: There will be initial vasodilation - Vasodilation is not a direct result of platelet aggregation but rather an initial response to vascular injury to increase blood flow to the area.
B: Clotting factors play no role in its formation - Clotting factors are essential for the later stages of hemostasis, but platelet aggregation is primarily driven by platelet activation and shape change.
D: Serotonin stimulates platelet aggregation - While serotonin is released from platelets upon activation, it does not directly stimulate platelet aggregation.
An 8-year-old girl presents with National Cancer Institute (NCI) Standard Risk acute pre-B-cell acute lymphoblastic leukemia. Her family history is significant for her mother having been diagnosed with breast cancer at age 34 years and a maternal uncle who developed osteosarcoma as a teenager. What cytogenetic abnormality is most likely to be detected in this patient?
- A. t(1;19)
- B. CRLF2 rearrangement with a JAK2 mutation
- C. KMT24 rearrangement
- D. Hypodiploidy with a modal chromosome number of 34
Correct Answer: D
Rationale: The correct answer is D, Hypodiploidy with a modal chromosome number of 34. In pediatric pre-B-cell acute lymphoblastic leukemia, hypodiploidy with fewer than 44 chromosomes is associated with a poor prognosis. This cytogenetic abnormality is commonly seen in cases of NCI Standard Risk acute pre-B-cell ALL.
A: t(1;19) is typically associated with T-cell ALL, not pre-B-cell ALL.
B: CRLF2 rearrangement with a JAK2 mutation is more commonly seen in high-risk B-cell ALL.
C: KMT24 rearrangement is not a recognized cytogenetic abnormality in ALL.
In summary, the presence of hypodiploidy with a modal chromosome number of 34 is the most likely cytogenetic abnormality in this patient based on her clinical presentation and family history.
A client is having a radioisotopic imaging scan. What action by the nurse is most important?
- A. Assess the client for shellfish allergies.
- B. Place the client on radiation precautions.
- C. Sedate the client before the scan.
- D. Teach the client about the procedure.
Correct Answer: D
Rationale: The correct answer is D because educating the client about the procedure is crucial for informed consent, reducing anxiety, and promoting cooperation during the scan. This empowers the client to understand what to expect and how to prepare. Assessing for shellfish allergies (A) is not directly related to the scan. Placing the client on radiation precautions (B) is unnecessary as the exposure is minimal, and sedating the client (C) should only be considered if medically indicated, not as a routine practice.
Dengue is a common vector-borne disease prevalent in tropical countries. Which of the following statement is true for dengue fever?
- A. It is caused by a DNA virus
- B. The vector once infected with the virus remains infective for life
- C. The vector prefers polluted water for propagation
- D. Joint symptoms are commoner in dengue fever compared to chikungunya
Correct Answer: B
Rationale: The correct answer is B because the Aedes mosquito, the vector for dengue fever, remains infective for life once it is infected with the dengue virus. This is due to the virus establishing a lifelong infection in the mosquito's salivary glands. The other choices are incorrect because: A) Dengue is caused by an RNA virus, not a DNA virus. C) The Aedes mosquito prefers clean, stagnant water for breeding, not polluted water. D) Joint symptoms are commoner in chikungunya, not dengue fever.