Nokea
A peripheral blood smear showing increase in numbers of neutrophils, band cells, basophils, eosinophils, and platelets is most suggestive
- A. Acute myeloid leukemia
- B. Acute lymphoid leukemia
- C. Chronic myelocytic leukemia
- D. Chronic lymphocytic leukemia
Correct Answer: C
Rationale: Rationale: A peripheral blood smear showing an increase in neutrophils, basophils, eosinophils, and platelets is indicative of Chronic Myelocytic Leukemia (CML). Neutrophils, basophils, and eosinophils are myeloid lineage cells typically elevated in CML. The presence of increased platelets is also common in CML due to the overproduction of cells in the bone marrow.
Summary of other choices:
A: Acute myeloid leukemia - Typically presents with a predominance of immature myeloid cells like blasts, rather than an increase in mature myeloid cells.
B: Acute lymphoid leukemia - Primarily involves lymphoid lineage cells, not myeloid cells as seen in the blood smear.
D: Chronic lymphocytic leukemia - Characterized by an increase in mature lymphocytes, not myeloid cells like neutrophils, basophils, and eosinophils.
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A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?
- A. Give two more courses of intensification chemotherapy.
- B. Perform an autologous hematopoietic stem cell transplant (HSCT).
- C. Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
- D. Give one more course of intensification chemotherapy and then 1 year of maintenance chemotherapy.
Correct Answer: C
Rationale: The correct answer is C because the patient is in morphologic remission and MRD-negative after the second course of treatment. Given her high-risk AML and lack of HLA-matched siblings, a matched unrelated donor HSCT offers the best chance for long-term remission. Autologous HSCT (choice B) would risk reintroducing leukemic cells. Giving more courses of intensification chemotherapy alone (choice A) may not eradicate the disease. Maintenance chemotherapy alone (choice D) is not sufficient for high-risk AML. Therefore, choice C is the best option for maximizing the chances of a favorable outcome in this case.
Artemisinin and its derivatives are used in the treatment of severe forms of chloroquine-resistant falciparum because they have:
- A. Rapid gametocidal activity
- B. The ability to prevent further development of hypnozoites
- C. Rapid sporontocidal activity
- D. Rapid schizonticidal activity
Correct Answer: D
Rationale: The correct answer is D: Rapid schizonticidal activity. Artemisinin and its derivatives target the asexual stage of the malaria parasite's life cycle, specifically the schizont stage. By quickly destroying the schizonts, they effectively kill the parasites in the blood, leading to a rapid reduction in parasite load and alleviating symptoms. The other choices are incorrect because A (Rapid gametocidal activity) targets sexual stage parasites, B (Ability to prevent further development of hypnozoites) refers to relapse prevention in Plasmodium vivax and Plasmodium ovale infections, and C (Rapid sporontocidal activity) targets the mosquito stage of the parasite's life cycle.
A 4-year-old girl with a history of recurrent epistaxis and easy bruising is referred to you for evaluation. She is found to have a prolonged PTT and a factor VIII level that is less than 1%. Both parents have a history of excessive bleeding. She is admitted with a severe episode of epistaxis, and your colleague orders 40 IU/kg of recombinant factor VIII. Her epistaxis resolves initially but within an hour starts again at the same severity as before. What is the best next step?
- A. Infuse a von Willebrand factor concentrate.
- B. Give another dose of recombinant factor VIII concentrate.
- C. Call otorhinolaryngology to pack her nose.
- D. Check for a factor VIII inhibitor.
Correct Answer: A
Rationale: The correct answer is A: Infuse a von Willebrand factor concentrate. In this case, the 4-year-old girl with a factor VIII deficiency did not respond to recombinant factor VIII, suggesting a possible von Willebrand disease (vWD) as well. Infusing von Willebrand factor concentrate can help address the underlying vWD component, which is necessary for adequate hemostasis. Option B is incorrect because giving another dose of recombinant factor VIII won't address the potential vWD deficiency. Option C is not the best next step as packing the nose does not address the underlying bleeding disorder. Option D is not the immediate next step as checking for a factor VIII inhibitor is important but can be done after addressing the acute bleeding episode with appropriate therapy.
What are the six dimensions of quality care according to the Institute of Medicine?
- A. Safe, timely, effective, efficient, equitable, and person-centered
- B. Safe, transparent, effective, efficient, equitable, and person-centered
- C. Safe, timely, effective, low-cost, equitable, and person-centered
- D. Safe, timely, effective, efficient, cutting-edge, and person-centered
Correct Answer: A
Rationale: The correct answer is A: Safe, timely, effective, efficient, equitable, and person-centered. According to the Institute of Medicine, these six dimensions encompass quality care. Safety is essential to avoid harm. Timeliness ensures care is provided promptly. Effectiveness means care should be evidence-based and achieve desired outcomes. Efficiency aims to minimize waste. Equitability ensures fair and non-discriminatory care. Lastly, being person-centered emphasizes individual preferences and needs.
Summary:
Choice B is incorrect because transparency is not included in the six dimensions. Choice C is incorrect as low-cost is not a primary dimension of quality care. Choice D is incorrect as it includes cutting-edge, which is not one of the six dimensions outlined by the Institute of Medicine.
You have a new patient consult in clinic this morning. The referral packet includes the newborn screen report, which is flagged abnormal hemoglobinopathy screen, F, A, Bart's, refer to hematology, and a complete blood count done at 4 years of age with a hemoglobin of 10 g/dL and an MCV of 68. The pediatrician has informed the parents the child has some form of alpha thalassemia. The older brother had the same newborn screen results but had a normal complete blood count when checked. The mother wants to know why her second child has an abnormal complete blood count when she and her husband do not have any blood problems. How would you respond to the child's mother?
- A. The mother and father are both silent carriers and each passed a deleted alpha globin allele to their child. The child inherited a trans-deletion genotype alpha thalassemia trait.
- B. The mother has cis deletion alpha thalassemia and the father has no alpha globin deletion, giving the child alpha thalassemia trait.
- C. Neither parent has an alpha globin deletion; this was a new spontaneous mutation causing alpha thalassemia in the child.
- D. Both parents carry cis deletions in the alpha globin gene cluster.
Correct Answer: A
Rationale: The correct answer is A because both parents are silent carriers, each passing a deleted alpha globin allele to their child, resulting in a trans-deletion genotype alpha thalassemia trait. This explanation aligns with the child's abnormal complete blood count and the family history.
Choice B is incorrect because it states that the mother has cis deletion alpha thalassemia, which is not supported by the information provided.
Choice C is incorrect as it suggests a new spontaneous mutation causing alpha thalassemia in the child, which is not consistent with the genetic inheritance pattern described.
Choice D is incorrect because it claims both parents carry cis deletions in the alpha globin gene cluster, which contradicts the scenario where the parents are silent carriers.