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: Step-by-step rationale:
1. Increased neutrophils, band cells, basophils, and platelets suggest myeloproliferative disorder.
2. Presence of eosinophils indicates a chronic phase as seen in chronic myelocytic leukemia.
3. Chronic myelocytic leukemia commonly presents with increased granulocytes and platelets.
Summary:
- A: Acute myeloid leukemia is characterized by blast cells, not mature granulocytes.
- B: Acute lymphoid leukemia primarily affects lymphocytes, not myeloid cells.
- D: Chronic lymphocytic leukemia involves lymphocytes, not myeloid cells like in the given case.
You may also like to solve these questions
A client is having a bone marrow biopsy today. What action by the nurse takes priority?
- A. Administer pain medication first.
- B. Ensure valid consent is on the chart.
- C. Have the client shower in the morning.
- D. Premedicate the client with sedatives.
Correct Answer: B
Rationale: The correct answer is B: Ensure valid consent is on the chart. This is the priority because the client must provide informed consent before undergoing a bone marrow biopsy. Without valid consent, the procedure cannot proceed ethically or legally. Administering pain medication (choice A) or sedatives (choice D) may be important for the client's comfort but obtaining consent is essential. Having the client shower in the morning (choice C) is not directly related to the immediate safety or success of the biopsy.
Hepato-splenomegaly with lymphadenopathy occur in all except:
- A. ALL
- B. lymphoma
- C. CML
- D. dissiminated TB
Correct Answer: C
Rationale: Step-by-step rationale:
1. Chronic Myeloid Leukemia (CML) primarily involves the bone marrow and blood, not the liver, spleen, or lymph nodes.
2. Hepato-splenomegaly with lymphadenopathy are commonly seen in Acute Lymphoblastic Leukemia (ALL) and lymphoma.
3. Disseminated TB can cause hepato-splenomegaly but typically does not present with lymphadenopathy.
Therefore, C (CML) is the correct answer as it does not typically present with the described findings.
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: Rationale for correct answer A:
1. Both parents must be carriers for the child to have alpha thalassemia.
2. The child has an abnormal complete blood count, indicating a hemoglobinopathy.
3. The child inherited a trans-deletion genotype alpha thalassemia trait from both parents.
4. Silent carriers have no symptoms but can pass on the trait.
Summary for incorrect choices:
B: In cis deletion, both parents would have to pass on the trait, which is not the case here.
C: Spontaneous mutation is unlikely for alpha thalassemia.
D: Both parents having cis deletions would result in a more severe form of alpha thalassemia.
The nurse is assisting with the preparation of a blood transfusion for a patient. Which type of fluid should the nurse select to transfuse with the blood?
- A. 0.9% normal saline
- B. Dextrose 5% and water
- C. Dextrose 5% and 0.9% normal saline
- D. Dextrose 5% and 0.45% normal saline
Correct Answer: A
Rationale: The correct answer is A: 0.9% normal saline. When preparing a blood transfusion, it is essential to select a compatible fluid that will not cause hemolysis of the red blood cells. Normal saline is isotonic and compatible with blood, making it the ideal choice. Dextrose solutions can cause hemolysis and should not be used for blood transfusions. Choice B and C contain dextrose, which is not suitable for blood transfusions. Choice D contains a lower concentration of normal saline, which may not be as effective in maintaining the osmotic balance of the blood cells. Therefore, selecting 0.9% normal saline ensures the safety and integrity of the transfused blood.
A 12-year-old patient has been referred to you following complete resection with clean margins of a high-grade malignant peripheral nerve sheath tumor of the shoulder region. The tumor measured approximately 4 cm in greatest dimension. A CT scan of the chest and a bone scan were within normal limits. The patient does not have evidence of neurofibromatosis type 1 (NF1). Which of the following treatment approaches would you recommend?
- A. Chemotherapy with doxorubicin and ifosfamide
- B. Radiotherapy
- C. Chemotherapy with doxorubicin and ifosfamide plus radiotherapy
- D. Observation
Correct Answer: D
Rationale: The correct answer is D: Observation. In this case, the patient has undergone complete resection of the tumor with clean margins and there is no evidence of metastasis or neurofibromatosis type 1. Given these factors, observation is the most appropriate approach as there is no indication for adjuvant chemotherapy or radiotherapy. Chemotherapy with doxorubicin and ifosfamide (Choice A) is typically reserved for cases with high-risk features such as incomplete resection or metastasis. Radiotherapy (Choice B) may be considered in certain cases, but in this scenario where surgery was curative and there is no evidence of spread, it is not necessary. Chemotherapy plus radiotherapy (Choice C) may be overly aggressive and carry unnecessary risks for a patient who has already had successful surgery. Thus, observation is the most appropriate approach in this situation.