Nokea
According to the FAB classification, the L2 stage is characterized by:
- A. Large heterogenous blasts with prominent nucleoli
- B. Small homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- C. Large homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- D. Large blasts with basophilic vacuolated cytoplasm
Correct Answer: C
Rationale: The correct answer is C because according to the FAB classification, the L2 stage is characterized by large homogenous blasts with scanty nucleoli and a higher nucleus to cytoplasm ratio. This is because in the L2 stage, the blasts are more immature and have a larger size compared to other stages. Choice A is incorrect because it describes blasts with prominent nucleoli, which is not characteristic of the L2 stage. Choice B is incorrect because it describes small homogenous blasts with scanty nucleoli, which does not align with the characteristics of the L2 stage. Choice D is incorrect because it describes large blasts with basophilic vacuolated cytoplasm, which is not a feature of the L2 stage.
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Several gene mutations have been associated with juvenile myelomonocytic leukemia (JMML), and they may or may not have prognostic implications. A gene expression–based classification system has been found to be an independent predictor of clinical outcome in these patients. What is the disease signature that predicts a poor outcome?
- A. Tyrosine kinase inhibitors
- B. Acute myeloid leukemia–like
- C. Chronic myeloid leukemia-like
- D. BRAF pathway abnormalities
Correct Answer: B
Rationale: The correct answer is B: Acute myeloid leukemia-like. In JMML, a disease signature resembling acute myeloid leukemia (AML) has been associated with a poor outcome. This signature includes features such as increased blasts, abnormal karyotypes, and mutations in genes like NRAS and KRAS. AML-like JMML cases often have aggressive disease progression and poorer response to treatment. Tyrosine kinase inhibitors (choice A) are not typically used in JMML treatment. Chronic myeloid leukemia-like (choice C) is not associated with a poor outcome in JMML. BRAF pathway abnormalities (choice D) may be present in some cases of JMML but are not the primary disease signature predicting poor outcomes.
A patient who is infected with hookworms produces signs and symptoms of anemia. Which of the following can be seen in the peripheral blood smear of the patient?
- A. Howell-Jolly bodies
- B. Basophilic stippling
- C. Target cells
- D. Spherocytes
Correct Answer: B
Rationale: The correct answer is B: Basophilic stippling. Hookworm infection can lead to anemia due to chronic blood loss. Basophilic stippling is a characteristic finding in the peripheral blood smear of patients with iron deficiency anemia, which can result from hookworm infection. Basophilic stippling represents the aggregation of ribosomes and is seen in erythrocytes that contain denatured ribosomal RNA. Howell-Jolly bodies are remnants of nuclear material and are typically seen in patients with functional asplenia. Target cells are seen in conditions like liver disease or hemoglobinopathies. Spherocytes are seen in immune hemolytic anemias.
You are caring for a patient with a large localized Ewing sarcoma of the soft tissues of the arm. The surgeon believes that the tumor can be resected without amputation but asks whether you can give some chemotherapy to shrink the tumor before surgery. Which of the following would you tell the surgeon?
- A. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy to improve the prognosis.
- B. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will not be necessary if the tumor is completely resected at week 12 of therapy.
- C. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will be necessary even if the tumor is completely resected at week 12 of therapy.
- D. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy; you recognize that this is the only way to avoid radiotherapy.
Correct Answer: B
Rationale: The correct answer is B because starting chemotherapy before resection at week 12 can help shrink the tumor, making it more manageable for surgery. A is incorrect because preoperative chemotherapy can improve outcomes. C is incorrect because radiotherapy may not be necessary if the tumor is completely resected. D is incorrect because radiotherapy may still be necessary even if the tumor is resected before chemotherapy.
An 18-year old male patient with acute lymphoblastic leukemia recently started maintenance therapy and is complaining of increased hip pain. The pain increases during weight-bearing activity; however, it occasionally hurts at night as well. His CBCd is normal. Which of the following risk factors is most commonly associated with this process?
- A. Younger age at diagnosis
- B. Non-White race
- C. Low body-mass index
- D. Dexamethasone exposure
Correct Answer: D
Rationale: The correct answer is D: Dexamethasone exposure. Dexamethasone is a corticosteroid commonly used in the treatment of acute lymphoblastic leukemia. It can lead to avascular necrosis of the hip, causing hip pain during weight-bearing activities. This is due to its negative impact on bone health and blood supply to the hip joint. Other choices are incorrect because younger age at diagnosis is not a risk factor for avascular necrosis, non-White race and low body-mass index are not directly associated with this process.
A patient has a bone marrow aspiration from the posterior iliac crest. Before the procedure, the patient's vital signs were: blood pressure 132/82 mm Hg and pulse 88 beats/min. One hour after the procedure, the blood pressure is 108/70 mm Hg and pulse is 96 beats/min. Which assessment is the least important for the patient at this time?
- A. Observe the puncture site.
- B. Check the patient's most recent complete blood count report.
- C. Ask the patient about feelings of lightheadedness or dizziness.
- D. Determine if the patient had any medications before the procedure.
Correct Answer: B
Rationale: The correct answer is B because the patient's vital signs have changed post-procedure, indicating a potential complication. Checking the complete blood count report is the least important at this time as it does not immediately impact the patient's current condition.
A: Observing the puncture site is important to assess for bleeding or infection.
C: Asking about lightheadedness or dizziness is crucial to monitor for signs of hypovolemia or shock.
D: Determining medications taken before the procedure is essential to identify any potential interactions or adverse effects.
In summary, monitoring vital signs, assessing the puncture site, and checking for symptoms of hypovolemia or shock are more critical post-procedure than reviewing the complete blood count report.