Nokea
A 9-year-old boy presents to the emergency department with emesis and headache of 3 weeks' duration. MRI reveals a large heterogeneous mass in the cerebellum. He undergoes a resection, and the pathology is most consistent with a classic medulloblastoma. Which of the following findings would classify the patient as a high-risk medulloblastoma?
- A. Elevated serum and CSF AFP and beta-HCG tumor markers
- B. WNT subgrouping on molecular classification
- C. A presurgical spine MRI that reveals bulky tumor in the spine
- D. A postoperative brain MRI with no signs of residual tumor
Correct Answer: C
Rationale: The correct answer is C. A presurgical spine MRI revealing bulky tumor in the spine classifies the patient as high-risk due to leptomeningeal spread. This indicates dissemination of the tumor cells beyond the primary site, leading to a poorer prognosis. Choice A is incorrect as AFP and beta-HCG markers are associated with germ cell tumors, not medulloblastomas. Choice B is incorrect as WNT subgrouping is associated with better outcomes. Choice D is incorrect because the absence of residual tumor postoperatively does not necessarily indicate high-risk disease.
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Which of the following is not the criteria in the international prognostic index for non Hodgkin's lymphoma?
- A. Number of extranodal sites
- B. LDH level
- C. Lymphocyte count
- D. Performance status
Correct Answer: C
Rationale: The correct answer is C: Lymphocyte count. The International Prognostic Index (IPI) for non-Hodgkin's lymphoma includes factors such as age, number of extranodal sites, LDH level, performance status, and stage. Lymphocyte count is not a specific criteria in the IPI. This index is used to predict the outcome of patients with aggressive lymphomas. A higher score indicates a worse prognosis. A low lymphocyte count is not a consistent prognostic factor for non-Hodgkin's lymphoma, unlike the other factors listed. Therefore, choice C is not a criteria in the IPI, making it the correct answer.
A 4-year-old boy is pale with intermittent jaundice and splenomegaly. Laboratory results are as follows: RBC 4.85 M/mcL (N); Hgb 8.6 g/dL (L); Hct 25.8% (L); MCV 81.6 (N); MCHC 38% (H); RDW 20% (H); Retic 7% (H). What are the two best tests to distinguish autoimmune hemolytic anemia from hereditary spherocytosis?
- A. Free erythrocyte protoporphyrin and IgG levels
- B. Hemoglobin electrophoresis and direct antiglobulin test (DAT)
- C. Lactate dehydrogenase (LDH) and modified Russell viper venom test
- D. Red cell distribution width (RDW) and mean corpuscular hemoglobin concentration (MCHC)
Correct Answer: E
Rationale: As the correct answer is not provided, I'll provide a step-by-step rationale for each choice:
A: Free erythrocyte protoporphyrin and IgG levels are not specific tests for distinguishing between autoimmune hemolytic anemia and hereditary spherocytosis.
B: Hemoglobin electrophoresis and direct antiglobulin test (DAT) can help differentiate between these two conditions as autoimmune hemolytic anemia is associated with a positive DAT, while hereditary spherocytosis typically has a negative DAT.
C: Lactate dehydrogenase (LDH) and modified Russell viper venom test are not specific tests for distinguishing between autoimmune hemolytic anemia and hereditary spherocytosis.
D: Red cell distribution width (RDW) and mean corpuscular hemoglobin concentration (MCHC) are not typically used to distinguish between autoimmune hemolytic anemia and hereditary spherocytosis.
Therefore, the best tests
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 it seems like there might be a mistake in the question as there is no option "E" provided. Could you please provide the correct answer choice so that I can give you a step-by-step rationale for why that answer is correct?
A patient who is suspected of having acute viral hemorrhagic fever reveals history of tick bite. Which of the following is the most possible causative agent?
- A. Hantavirus
- B. Rift Valley virus
- C. Crimean Congo virus
- D. Marburg virus
Correct Answer: C
Rationale: The correct answer is C: Crimean Congo virus. This is because Crimean Congo virus is a tick-borne virus known to cause acute viral hemorrhagic fever. Tick bite history increases suspicion for this virus. A: Hantavirus is transmitted through rodent feces and urine. B: Rift Valley virus is transmitted through mosquito bites. D: Marburg virus is transmitted through contact with infected animals.
A patient is being prepared to receive a prescribed blood transfusion. What is the best way that the LPN can assist the health team to prevent a transfusion reaction?
- A. Monitor vital signs every 15 minutes.
- B. Warm blood to 98.6°F (37°C) before infusion.
- C. Administer diphenhydramine (Benadryl) before the infusion.
- D. Assist the registered nurse (RN) to identify correctly the patient and the blood product.
Correct Answer: D
Rationale: The correct answer is D: Assist the registered nurse (RN) to identify correctly the patient and the blood product. This is crucial to prevent transfusion reactions as it ensures the right blood is given to the right patient. Misidentification can lead to severe complications. Monitoring vital signs (A) is important but doesn't directly prevent transfusion reactions. Warming blood (B) may improve patient comfort but doesn't prevent reactions. Administering diphenhydramine (C) is not a standard pre-transfusion medication and should not be given without specific orders. Identifying the patient and blood product correctly is the best way to prevent transfusion reactions.