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A patient is presented with weakness of legs, arms, trunk, tingling and numbness that progressively worsens. Peripheral blood smear shows macrocytic anemia. Which of the following is not the factor causing this condition?
- A. Chronic atrophic gastritis
- B. Ileal resection
- C. Tapeworm infestation
- D. Alcoholism
Correct Answer: C
Rationale: The correct answer is C: Tapeworm infestation. The symptoms described suggest vitamin B12 deficiency, which can lead to macrocytic anemia. Chronic atrophic gastritis can cause decreased intrinsic factor production, leading to impaired B12 absorption. Ileal resection can also affect B12 absorption as it is the site where B12 is absorbed. Alcoholism can lead to poor dietary intake and impaired B12 absorption. However, tapeworm infestation does not directly affect B12 absorption and would not be a likely cause of the described symptoms.
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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
A study is designed to investigate the rates of central line–associated blood stream infections among pediatric hematology/oncology patients. Three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]) were included in the study. What data structure is central line type?
- A. Continuous
- B. Dichotomous
- C. Nominal
- D. Ordinal
Correct Answer: C
Rationale: The correct answer is C: Nominal. The central line types in this study (port, PICC, TEC) are categorical and do not have a natural order or ranking. They are simply names or labels representing different types of central lines. This makes them fall under the nominal data structure category. Continuous data (choice A) would involve measurements with infinite possible values. Dichotomous data (choice B) would have only two categories. Ordinal data (choice D) would imply a natural ranking or order among the categories, which is not applicable in this context.
A study is designed to investigate the rates of central line–associated blood stream infections among pediatric hematology/oncology patients. Three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]) were included in the study. What data structure is central line type?
- A. Continuous
- B. Dichotomous
- C. Nominal
- D. Ordinal
Correct Answer: C
Rationale: The correct answer is C: Nominal. Central line type is a nominal data structure because it represents categories without any inherent order or ranking. In this study, the central line types (port, PICC, TEC) are distinct categories with no numerical significance or order. They are simply different types of central lines used for medical purposes. Continuous (A) data involves numerical values with infinite possibilities, which is not the case here. Dichotomous (B) data consists of only two categories, while in this study there are three central line types. Ordinal (D) data involves categories with a specific order or ranking, which is not applicable to central line types as they do not have a natural order.
A nurse is caring for four clients. After reviewing today's laboratory results, which client should the nurse see first?
- A. Client with an international normalized ratio of 2.8
- B. Client with a platelet count of 128000/mm³
- C. Client with a prothrombin time (PT) of 28 seconds
- D. Client with a red blood cell count of 5.1 million/L
Correct Answer: C
Rationale: The correct answer is C because a prothrombin time (PT) of 28 seconds indicates a prolonged clotting time, putting the client at risk for bleeding. This requires immediate assessment and intervention to prevent complications.
Choice A (INR of 2.8) is within the therapeutic range for clients on anticoagulant therapy, so it does not require immediate attention.
Choice B (platelet count of 128000/mm³) is low but not critically low enough to warrant immediate action unless there are signs of active bleeding.
Choice D (red blood cell count of 5.1 million/L) is within normal limits and does not indicate an urgent issue.
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