Nokea
A laboratory finding of aplastic anaemia
- A. Pancytopaenia
- B. Erythrocytosis
- C. Bone marrow hypercellularity
- D. Reticulocytosis
Correct Answer: A
Rationale: Rationale:
1. Aplastic anemia is characterized by bone marrow failure, leading to decreased production of all blood cell types.
2. Pancytopenia refers to low levels of red blood cells, white blood cells, and platelets, consistent with aplastic anemia.
3. Erythrocytosis is an increase in red blood cell count, contradictory to the reduced production in aplastic anemia.
4. Bone marrow hypercellularity indicates increased cellularity, opposite to the hypocellularity seen in aplastic anemia.
5. Reticulocytosis is an elevated number of immature red blood cells, which is not typically seen in the context of bone marrow failure in aplastic anemia.
Summary:
A is correct as it aligns with the characteristic pancytopenia in aplastic anemia. B, C, and D are incorrect due to their inconsistency with the pathophysiology of the condition.
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A 14-year-old Syrian male with beta thalassemia major has relocated to your community as a refugee. He has been receiving chronic transfusion therapy in Turkey for the past 3 years. On his first visit, you notice that his height is below the fifth percentile. He has skin discoloration and hepatosplenomegaly. His mother reports they have not had regular access to chelation therapy. Laboratory testing shows a serum ferritin of 6,200 ng/mL. A cardiac MRI shows grossly normal cardiac function but a T2* value of 9 ms. What is the most likely cause of his short stature?
- A. Lack of regular blood transfusion causing growth failure
- B. Cirrhosis and liver failure
- C. Ineffective erythropoiesis and chronic anemia
- D. Growth hormone deficiency due to iron deposition in the pituitary
Correct Answer: D
Rationale: The correct answer is D: Growth hormone deficiency due to iron deposition in the pituitary. Iron deposition in the pituitary gland can lead to impaired production and secretion of growth hormone, resulting in short stature. This is a known complication of beta thalassemia major. The patient's elevated serum ferritin levels and T2* value of 9 ms indicate iron overload, which can cause damage to organs including the pituitary gland. Choices A, B, and C are incorrect because the patient's growth failure is primarily due to the impact of iron deposition on the pituitary gland rather than lack of transfusion, cirrhosis, or ineffective erythropoiesis. Regular chelation therapy is essential to prevent iron overload and its complications in patients with beta thalassemia major.
In the laboratory diagnosis of leishmaniasis, the expected parasite stage in vitro is
- A. Amastigote
- B. Promastigote
- C. Trypomastigote
- D. Schizont
Correct Answer: B
Rationale: The correct answer is B: Promastigote. In the laboratory diagnosis of leishmaniasis, the expected parasite stage in vitro is the promastigote form. This is because the promastigote form is the stage of the parasite that lives in the sandfly vector and is transmitted to humans, causing infection. In vitro, the promastigote form can be cultured and studied for diagnostic purposes.
Incorrect choices:
A: Amastigote - This is the intracellular form of the parasite found in mammalian hosts and not typically used for laboratory diagnosis.
C: Trypomastigote - This form is typically associated with Trypanosoma species, not Leishmania.
D: Schizont - This term is used for malaria parasites, not Leishmania parasites.
In summary, the promastigote form is the most relevant stage for laboratory diagnosis of leishmaniasis due to its presence in the sandfly vector and its ability to
A 3-month-old female presents to the emergency room with vomiting and abdominal distension. She has a left-side abdominal mass, and an abdominal ultrasound confirms an 8-cm mass arising from the left kidney. Liver lesions are also noted. Nephrectomy is performed and reveals a histologic diagnosis of malignant rhabdoid tumor of the kidney (MRTK). Which of the following is not a true statement about the management of this patient?
- A. Most patients with rhabdoid tumor of the kidney present in infancy.
- B. Most patients with rhabdoid tumor of the kidney present with metastatic (stage III or IV) disease.
- C. She has an excellent prognosis with surgery, chemotherapy, and radiation.
- D. Germline testing for SMARCB1/INI1 mutation on chromosome 22 is recommended, with brain MRI every 3 months until she is 5 years old, if testing is germline positive for SMARCB1/INI1.
Correct Answer: C
Rationale: The correct answer is C: She has an excellent prognosis with surgery, chemotherapy, and radiation.
Rationale:
1. Malignant rhabdoid tumor of the kidney (MRTK) is an aggressive cancer with poor prognosis.
2. Even with aggressive treatment, including surgery, chemotherapy, and radiation, the prognosis is generally poor due to high rates of recurrence and metastasis.
3. Therefore, stating that the patient has an excellent prognosis with the mentioned treatments is not true.
Summary of other choices:
A: Most patients with rhabdoid tumor of the kidney present in infancy - True, MRTK commonly presents in infancy.
B: Most patients with rhabdoid tumor of the kidney present with metastatic (stage III or IV) disease - True, MRTK often presents with metastatic disease.
D: Germline testing for SMARCB1/INI1 mutation on chromosome 22 is recommended, with brain MRI every 3 months until she is
Sickle cell an. Is not complicated by:
- A. papillary necrosis
- B. pancreatitis
- C. osteomyelitis
- D. CHF
Correct Answer: B
Rationale: Step-by-step rationale for choice B (pancreatitis) being correct:
1. Sickle cell anemia primarily affects red blood cells, leading to vaso-occlusive crises.
2. Pancreatitis is not a known complication of sickle cell anemia.
3. Complications of sickle cell anemia commonly involve organs affected by sickling, such as the bones (osteomyelitis), kidneys (papillary necrosis), and heart (CHF).
Summary:
A: Papillary necrosis - Correct, as it can affect the kidneys in sickle cell anemia.
B: Pancreatitis - Correct, as it is not a typical complication of sickle cell anemia.
C: Osteomyelitis - Incorrect, as it can affect the bones in sickle cell anemia.
D: CHF - Incorrect, as it can affect the heart in sickle cell anemia.
A patient receiving blood begins complaining of severe chest pain and a feeling of warmth. What should the nurse do first?
- A. Call the physician.
- B. Administer diuretics as ordered.
- C. Discontinue the blood transfusion.
- D. Assess vital signs and cardiovascular status.
Correct Answer: C
Rationale: The correct first action is to discontinue the blood transfusion (Choice C). This is because the patient's symptoms of severe chest pain and warmth suggest a possible transfusion reaction, which can be life-threatening. By stopping the transfusion, the nurse can prevent further harm to the patient. Calling the physician (Choice A) can be done after stopping the transfusion. Administering diuretics (Choice B) without knowing the cause of symptoms can exacerbate the situation. Assessing vital signs and cardiovascular status (Choice D) is important but should come after stopping the transfusion to prioritize patient safety.