ATI Hematologic System Test

ATI Hematologic System Test Related

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A 7-year-old boy presents with recent onset of vomiting and lethargy. Blood smear shows increased neutrophils with a left shift and 8% abnormal cells. Bone marrow contains 60% of the same cells. Flow cytometry shows that the cells are TdT–, CD10+, CD19+, CD20+, sIg+. What is the most likely diagnosis?

  • A. Burkitt leukemia/lymphoma
  • B. B-cell acute lymphoblastic leukemia (ALL)
  • C. T-cell ALL
  • D. Hematogones
Correct Answer: A

Rationale: The correct answer is A: Burkitt leukemia/lymphoma. The key features in the case are increased neutrophils with a left shift, presence of abnormal cells in blood and bone marrow, and flow cytometry showing TdT–, CD10+, CD19+, CD20+, sIg+. These findings are consistent with Burkitt leukemia/lymphoma, a highly aggressive B-cell neoplasm. The presence of CD10, CD19, and CD20, along with sIg positivity, points towards a B-cell origin. Additionally, the characteristic translocation t(8;14) involving c-Myc oncogene is commonly seen in Burkitt lymphoma. The absence of TdT expression rules out T-cell ALL (Choice C). Hematogones (Choice D) are normal precursor B-cells found in bone marrow, but they do not typically present with the clinical features described. B-cell ALL (Choice B) lacks the specific features seen in this case

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An oncology nurse recognizes a patient's risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the patient's plan of care? Select all that apply.

  • A. Monitoring the patient's electrolyte levels
  • B. Monitoring the patient's hepatic function
  • C. Measuring the patient's weight on a daily basis
  • D. Measuring and recording the patient's intake and output
Correct Answer: B

Rationale: The correct answer is B: Monitoring the patient's hepatic function. In leukemia treatment, the patient may undergo chemotherapy which can affect liver function, leading to fluid imbalance. By monitoring hepatic function, the nurse can assess the liver's ability to maintain fluid balance.

A: Monitoring electrolyte levels is important for fluid balance but may not directly assess the liver's role in maintaining balance.
C: Measuring weight daily is crucial for monitoring fluid status but does not directly assess liver function.
D: Measuring and recording intake and output is essential for assessing fluid balance but does not directly evaluate hepatic function.

The main vector transmitting malaria in Sabah is Anopheles balabacensis. This vector breeds in

  • A. Artificial containers in urban centres
  • B. Drains
  • C. Temporary collecting of water in jungles
  • D. Rock pools in control areas
Correct Answer: C

Rationale: The correct answer is C because Anopheles balabacensis, the main vector transmitting malaria in Sabah, breeds in temporary water collections in jungles. This is supported by research showing that this mosquito species prefers breeding in natural habitats like jungle pools. Choices A, B, and D are incorrect because Anopheles balabacensis is not typically found breeding in artificial containers in urban centers, drains, or rock pools in control areas. These habitats do not provide the specific environmental conditions required for the breeding and survival of this particular mosquito species.

Which of the following moves furthest to the anode on cellulose acetate electrophoresis of normal haemoglobin at pH 8.6?

  • A. Haemoglobin A
  • B. Haemoglobin D
  • C. Haemoglobin A2
  • D. Haemoglobin S
Correct Answer: A

Rationale: 1. In cellulose acetate electrophoresis at pH 8.6, proteins migrate based on their net charge.
2. Haemoglobin A migrates furthest to the anode as it has the highest net negative charge among the options.
3. Haemoglobin D, A2, and S have different charges compared to Haemoglobin A.
4. Haemoglobin D and A2 have lower net negative charges, so they migrate less than Haemoglobin A.
5. Haemoglobin S has a different charge distribution due to a mutation, causing it to migrate differently than Haemoglobin A.

Splenectomy is curative in:

  • A. G6PD def.
  • B. ITP
  • C. thalassemia
  • D. hereditary spherocytosis
Correct Answer: D

Rationale: The correct answer is D: hereditary spherocytosis. Splenectomy is curative in hereditary spherocytosis because the spleen is responsible for the destruction of the abnormal spherocytes in this condition. Removing the spleen eliminates the primary site of red blood cell destruction, leading to an improvement in anemia and other symptoms.

Incorrect choices:
A: Splenectomy is contraindicated in G6PD deficiency as it can worsen hemolysis by increasing the workload on other organs.
B: Splenectomy can be beneficial in ITP to increase platelet counts but is not curative as the underlying autoimmune process persists.
C: Splenectomy is not curative in thalassemia as it does not address the underlying genetic defect causing abnormal hemoglobin synthesis.

A 14-year-old boy presents with cough, shortness of breath, and difficulty lying down. His face and neck swell when his arms are raised. Chest x-ray reveals a large mediastinal mass. A tissue diagnosis is desired. A biopsy is performed with local anesthesia because the anesthesiologist thinks that the patient has a very high general anesthesia risk. Which of the following findings does not make general anesthesia unsafe?

  • A. Tumor diameter greater than 45% of transthoracic diameter
  • B. Tracheal cross-sectional area less than 50% of predicted
  • C. Peak expiratory flow rate less than 50% of predicted
  • D. A malignancy of hematopoietic origin
Correct Answer: D

Rationale: The correct answer is D. A malignancy of hematopoietic origin does not inherently make general anesthesia unsafe. This is because anesthesia risk is typically influenced by factors such as airway patency, respiratory function, and cardiac status. Choices A, B, and C all indicate potential complications that could make general anesthesia unsafe, such as airway obstruction due to a large mediastinal mass (A), compromised tracheal cross-sectional area (B), and impaired respiratory function (C). These factors would necessitate careful consideration and potential modifications in the anesthesia plan to ensure patient safety.

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