ATI Hematologic System Test

ATI Hematologic System Test Related

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A leukemia investigator plans to obtain bone marrow under general anesthesia to measure minimal residual disease (MRD) and to see if this time point can predict early relapse. The specimen will be obtained at a time point when otherwise no bone marrow would be sampled. The results are not shared with the treating oncologist, and no therapeutic interventions are decided or based on the results. Which of the following statements is most accurate about this intervention?

  • A. It constitutes a minimal-risk procedure because bone marrow assessments are considered routine for patients diagnosed with acute lymphoblastic leukemia.
  • B. It constitutes a minimal-risk procedure because it is a single additional procedure being performed during the course of treatment.
  • C. It constitutes a greater than minimal-risk procedure because it is being done under general anesthesia.
  • D. It is justifiable because future patients may benefit from knowledge gained by the research.
Correct Answer: C

Rationale: The correct answer is C because obtaining bone marrow under general anesthesia carries inherent risks that make it greater than minimal-risk. Here's a step-by-step rationale:
1. General anesthesia poses risks such as allergic reactions, breathing problems, and potential complications, making the procedure more than minimal-risk.
2. Even though bone marrow assessments are routine for leukemia patients, the use of general anesthesia elevates the risk level.
3. The fact that the results are not shared with the treating oncologist and no therapeutic interventions are based on them indicates that the procedure is solely for research purposes, emphasizing the risk-benefit analysis.
4. Choice A is incorrect because the use of general anesthesia increases the procedure's risk level beyond routine.
5. Choice B is incorrect as the focus should be on the inherent risks of general anesthesia, not just the number of procedures performed.
6. Choice D is irrelevant to the risk assessment of the specific procedure and does not address the immediate safety concerns associated with general anesthesia.

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You are discussing prognosis with the mother of a patient with stage 3, group III rhabdomyosarcoma. Which of the following is the most unfavorable primary site?

  • A. Extremity
  • B. Prostate
  • C. Infratemporal fossa
  • D. Neck
Correct Answer: A

Rationale: The correct answer is A: Extremity. Rhabdomyosarcoma has a better prognosis when located in the extremities compared to other sites due to easier surgical resection and less risk of metastasis. Prostate (B) is less common in children and has a poorer prognosis. Infratemporal fossa (C) and neck (D) sites have a higher risk of local invasion and metastasis, leading to a worse prognosis compared to extremity sites.

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 this case, the key features to consider are the patient's age (9 months old), large liver mass with lung metastases, and elevated alpha-fetoprotein level. Small cell undifferentiated hepatoblastoma is commonly seen in infants, presents as a large liver mass, and frequently metastasizes to the lungs. The alpha-fetoprotein level in this case is also elevated, which is typical for hepatoblastoma. Pure fetal histology hepatoblastoma (A) is less common in older infants, and the presence of lung metastases is not typical. Embryonal sarcoma (B) typically presents as a solitary mass without metastases. Fibrolamellar hepatocellular carcinoma (C) is rare in infants and does not typically present with elevated alpha-fetoprotein levels. Thus, based on the clinical presentation and imaging findings, small cell undifferentiated hepatob

A 2-month-old infant is brought to your clinic with an extensive scaly rash on the scalp, which has been biopsied and shown to be Langerhans cell histiocytosis (LCH). You want to determine whether this patient has skin-only LCH or involvement of any of the 'high-risk' organs. The child has a normal CBC; normal liver enzymes and bilirubin; and a normal skeletal survey, skull films, and chest X ray. What other screening test will be important for finding involvement of a high-risk organ?

  • A. Reticulocyte count
  • B. Erythrocyte sedimentation rate
  • C. Alkaline phosphatase
  • D. Serum albumin and total protein
Correct Answer: D

Rationale: The correct answer is D: Serum albumin and total protein. In Langerhans cell histiocytosis (LCH), involvement of high-risk organs like the liver, spleen, and bone marrow can occur. Serum albumin and total protein levels can indicate liver involvement as hypoalbuminemia and hypoproteinemia can be seen in liver dysfunction. The other choices, A (Reticulocyte count), B (Erythrocyte sedimentation rate), and C (Alkaline phosphatase) are not specific for evaluating high-risk organ involvement in LCH. Reticulocyte count is related to red blood cell production, ESR is a nonspecific marker of inflammation, and alkaline phosphatase is commonly elevated in various conditions, not specific for high-risk organ involvement in LCH.

The nurse is staying with a patient who has been started on a blood transfusion. Which assessment should the nurse perform during a blood product infusion to detect a reaction?

  • A. Vital signs
  • B. Skin turgor
  • C. Bowel sounds
  • D. Pupil reactivity
Correct Answer: A

Rationale: The correct answer is A: Vital signs. During a blood transfusion, the nurse should monitor the patient's vital signs regularly to detect any signs of a transfusion reaction, such as fever, chills, rash, or hypotension. Vital signs provide crucial information about the patient's overall condition and can help the nurse identify and respond promptly to any adverse reactions. Skin turgor (B), bowel sounds (C), and pupil reactivity (D) are not directly related to monitoring for transfusion reactions and are not sensitive indicators of an adverse reaction during a blood transfusion. Monitoring vital signs is essential for patient safety and early detection of any complications during the transfusion process.

Increase serum iron:-decrease IBC a feature of:

  • A. Hookworm infestation
  • B. sideroblastic an.
  • C. alcoholic liver dis.
  • D. th.major
Correct Answer: B

Rationale: The correct answer is B: sideroblastic anemia. In sideroblastic anemia, there is impaired heme synthesis leading to the accumulation of iron in the mitochondria of red blood cell precursors. This results in increased serum iron levels due to the release of iron from the mitochondria. Decreased Iron Binding Capacity (IBC) occurs as a compensatory mechanism due to the increased serum iron levels.

Choice A, hookworm infestation, would typically result in iron deficiency anemia with decreased serum iron levels and normal to increased IBC. Choice C, alcoholic liver disease, is associated with decreased serum iron levels and normal to increased IBC due to impaired iron metabolism. Choice D, thalassemia major, presents with normal to decreased serum iron levels and normal to increased IBC due to ineffective erythropoiesis.

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