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. This diagnosis is supported by the presence of abnormal cells that are CD10+, CD19+, CD20+, sIg+, which are characteristic of Burkitt lymphoma. The absence of TdT– indicates that it is not T-cell ALL. B-cell ALL would typically show TdT positivity. Hematogones are immature B-cell precursors commonly seen in the bone marrow of healthy children and do not typically present with the described clinical picture. The high percentage of abnormal cells in both blood and bone marrow, along with the specific immunophenotype, point towards Burkitt leukemia/lymphoma.

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Thrombocytopenia is absent in:

  • A. DIC
  • B. Wiskott Aldrich syndrome
  • C. Henoch Schonlein purpura
  • D. myelosclerosis
Correct Answer: C

Rationale: Thrombocytopenia is absent in Henoch Schonlein purpura because it primarily involves vasculitis, not platelet destruction or consumption. In DIC (A), there is widespread activation of coagulation leading to thrombocytopenia. Wiskott Aldrich syndrome (B) is characterized by low platelet counts due to defective platelet function. Myelosclerosis (D) is a bone marrow disorder causing decreased platelet production, leading to thrombocytopenia.

A 9-month-old boy has been referred to you for the evaluation of an enlarged abdomen. Imaging studies show a large liver mass (PRETEXT III). Alfa-fetoprotein is 98 ng/mL, and a CT scan of the lungs show bilateral lung metastases. A needle biopsy is performed, and you are planning to review the specimen with the pathologist. Which of the following diagnoses are you suspecting?

  • A. Pure fetal histology hepatoblastoma
  • B. Embryonal sarcoma of the liver
  • C. Fibrolamellar hepatocellular carcinoma
  • D. Small cell undifferentiated hepatoblastoma
Correct Answer: D

Rationale: The correct answer is D: Small cell undifferentiated hepatoblastoma. In hepatoblastoma, the presence of lung metastases indicates a high-risk tumor. The small cell undifferentiated subtype is more aggressive with a poorer prognosis compared to other subtypes. The AFP level is lower than typically seen in hepatoblastoma, but still within the range for this diagnosis. Pure fetal histology hepatoblastoma (choice A) is less common and usually associated with a better prognosis. Embryonal sarcoma of the liver (choice B) is a distinct entity with different histological features. Fibrolamellar hepatocellular carcinoma (choice C) typically occurs in older children and has a different imaging appearance.

Basophilic stippling is classically seen in:

  • A. CML
  • B. myelosclerosis
  • C. chronic lead poisoning
  • D. iron def anemia
Correct Answer: C

Rationale: Basophilic stippling is caused by the presence of ribosomal RNA in red blood cells, which is a characteristic finding in chronic lead poisoning. Lead inhibits enzymes involved in heme synthesis, leading to accumulation of ribosomal RNA. In CML, there is an increase in immature white blood cells, not red blood cells. Myelosclerosis is associated with bone marrow fibrosis, not basophilic stippling. Iron deficiency anemia presents with microcytic, hypochromic red blood cells, not basophilic stippling.

When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered?

  • A. Platelet count
  • B. Neutrophil count
  • C. White blood cell count
  • D. Hemoglobin (Hgb) level
Correct Answer: D

Rationale: The correct answer is D: Hemoglobin (Hgb) level. Pallor of the skin and nail beds indicates possible anemia, which is a decrease in red blood cells or hemoglobin. Checking the hemoglobin level will confirm if the patient is anemic. Platelet count (A) assesses for clotting ability, not anemia. Neutrophil count (B) and White blood cell count (C) are indicators of infection or inflammation, not anemia. Therefore, ensuring the hemoglobin level has been ordered is crucial for assessing the patient's pallor.

A nurse is caring for a client who has renal failure and is receiving epoetin. The nurse should monitor the client for which of the following adverse effects?

  • A. Hypertension
  • B. Muscle pain
  • C. Edema
  • D. Dry mouth
Correct Answer: A

Rationale: The correct answer is A: Hypertension. Epoetin stimulates red blood cell production, increasing blood volume and potentially leading to hypertension. This adverse effect is known as hypertensive crisis. Muscle pain (B), edema (C), and dry mouth (D) are not typically associated with epoetin therapy for renal failure. Thus, they are incorrect choices.

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