Nokea
After seven days of treatment with sulfonamides, a patient's hemoglobin had decreased from 14.7 gm/100ml to 10gm/100ml. The most likely cause of hemolysis in this patient is
- A. Sickle cell disease
- B. Thalassemia minor
- C. Hereditary spherocytosis
- D. Glucose 6-phosphate dehydrogenase deficiency (G6PD)
Correct Answer: D
Rationale: The correct answer is D: Glucose 6-phosphate dehydrogenase deficiency (G6PD). Sulfonamides can trigger hemolysis in patients with G6PD deficiency due to oxidative stress on red blood cells. G6PD enzyme deficiency impairs the ability of red blood cells to combat oxidative damage, leading to hemolysis. In this case, the patient's hemoglobin decreased significantly after sulfonamide treatment, indicating red blood cell destruction. The other choices (A: Sickle cell disease, B: Thalassemia minor, C: Hereditary spherocytosis) are not directly associated with sulfonamide-induced hemolysis and would not explain the observed decrease in hemoglobin levels after treatment.
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An oncology nurse is caring for a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patient's most recent blood tests, the nurse should anticipate what imbalance?
- A. Hypercalcemia
- B. Hyperproteinemia
- C. Elevated serum viscosity
- D. Elevated RBC count
Correct Answer: A
Rationale: The correct answer is A: Hypercalcemia. In multiple myeloma, bone destruction releases calcium into the bloodstream, leading to hypercalcemia. Elevated serum viscosity (C) is not typically associated with multiple myeloma. Hyperproteinemia (B) may be present due to increased production of abnormal proteins, but it does not directly cause bone destruction. Elevated RBC count (D) is not a common finding in multiple myeloma and is not directly related to bone destruction.
Which of the following statements about myeloablative, myeloablative but reduced toxicity, reduced intensity, and non-myeloablative approaches is not correct?
- A. Myeloablative approaches are needed for high-risk malignancies to maximize depth of remission and decrease the likelihood of relapse.
- B. Reduced intensity regimens can be successfully used for most nonmalignant disorders to minimize risk of late effects.
- C. Reduced intensity regimens can markedly decrease the risk of transplant-related mortality in patients who have underlying significant comorbidities but at the cost of more relapse and possibly more graft-versus-host disease.
- D. Non-myeloablative regimens are used for the very highest risk patients to minimize toxicity and for certain diseases such as aplastic anemia.
Correct Answer: B
Rationale: B is the correct answer because reduced intensity regimens are not suitable for most nonmalignant disorders. Myeloablative approaches are typically used for high-risk malignancies to maximize remission depth and reduce relapse likelihood. Reduced intensity regimens are used for patients with significant comorbidities to decrease transplant-related mortality, but may lead to more relapse and graft-versus-host disease. Non-myeloablative regimens are utilized for high-risk patients to minimize toxicity and for specific diseases like aplastic anemia.
Sickle cell an. Is not complicated by:
- A. papillary necrosis
- B. pancreatitis
- C. osteomyelitis
- D. CHF
Correct Answer: B
Rationale: Step-by-step rationale for choice B (pancreatitis) being correct:
1. Sickle cell anemia primarily affects red blood cells, leading to vaso-occlusive crises.
2. Pancreatitis is not a known complication of sickle cell anemia.
3. Complications of sickle cell anemia commonly involve organs affected by sickling, such as the bones (osteomyelitis), kidneys (papillary necrosis), and heart (CHF).
Summary:
A: Papillary necrosis - Correct, as it can affect the kidneys in sickle cell anemia.
B: Pancreatitis - Correct, as it is not a typical complication of sickle cell anemia.
C: Osteomyelitis - Incorrect, as it can affect the bones in sickle cell anemia.
D: CHF - Incorrect, as it can affect the heart in sickle cell anemia.
A laboratory finding of aplastic anaemia
- A. Pancytopaenia
- B. Erythrocytosis
- C. Bone marrow hypercellularity
- D. Reticulocytosis
Correct Answer: A
Rationale: The correct answer is A: Pancytopenia. Aplastic anemia is characterized by a decrease in all blood cell types (red blood cells, white blood cells, and platelets), leading to pancytopenia. This is due to bone marrow failure, resulting in decreased production of blood cells. Erythrocytosis (B) is an increase in red blood cells, which is the opposite of what is seen in aplastic anemia. Bone marrow hypercellularity (C) is not typically observed in aplastic anemia, as the bone marrow is usually hypocellular. Reticulocytosis (D) is an increase in immature red blood cells and is not a characteristic finding in aplastic anemia where there is decreased production of all blood cell types.
Which of the following anemia is associated with splenomegaly:
- A. chronic renal failure
- B. aplastic anemia
- C. hereditary spherocytosis
- D. sickle cell anaemia
Correct Answer: C
Rationale: Rationale: Hereditary spherocytosis is associated with splenomegaly due to the spleen's increased destruction of abnormal red blood cells. In this condition, red blood cells have a spherical shape, making them more prone to destruction by the spleen. Chronic renal failure (A) is not typically associated with splenomegaly. Aplastic anemia (B) is characterized by bone marrow failure and does not directly involve the spleen. Sickle cell anemia (D) leads to splenomegaly in children but not in adults due to splenic sequestration crises, making it less likely to be the correct choice.