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). G6PD deficiency can cause hemolysis in response to oxidative stress, such as medications like sulfonamides. The decrease in hemoglobin levels after sulfonamide treatment indicates hemolysis, which is a common manifestation of G6PD deficiency. Sickle cell disease (A), thalassemia minor (B), and hereditary spherocytosis (C) do not typically present with hemolysis triggered by sulfonamides. G6PD deficiency is the most likely cause in this scenario due to the timing of hemolysis after the drug exposure and the characteristic response of G6PD-deficient red blood cells to oxidative stress.
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Macrocytosis is a characteristic of all except:
- A. an. Of myxedema
- B. methotrexate induced
- C. chronic alcoholism induced liver dis.
- D. SLE
Correct Answer: D
Rationale: Macrocytosis is characterized by enlarged red blood cells. In Systemic Lupus Erythematosus (SLE), macrocytosis is not a typical finding. The other conditions listed - anemia of myxedema, methotrexate-induced macrocytosis, and macrocytosis due to chronic alcoholism-induced liver disease - are associated with macrocytosis due to various underlying mechanisms. Therefore, the correct answer is D, as macrocytosis is not a characteristic feature of SLE.
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.
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. This can result in symptoms like excessive thirst, fatigue, confusion, and kidney issues. Hyperproteinemia (B) is not typically associated with multiple myeloma. Elevated serum viscosity (C) is more related to conditions like Waldenström macroglobulinemia, not multiple myeloma. Elevated RBC count (D) is not a common finding in multiple myeloma and is more suggestive of polycythemia vera.
You examine a 10-year-old boy with severe aplastic anemia. He has no dysmorphic features and is at the 50th percentile for height and weight. Family history includes a sister with aplastic anemia unresponsive to anti-human thymocyte globulin (ATG) and cyclosporine who died early in the course of an unrelated donor hematopoietic stem cell transplant complicated by severe mucositis and transplant-related organ toxicities. There are no other siblings. A cousin died of acute myeloid leukemia at age 5 years. A peripheral blood sample test for Fanconi anemia is negative with no increased chromosomal breaks in response to diepoxylbutane or mitomycin C. Which of the following is the most important next step in management?
- A. Administer ATG and cyclosporine.
- B. Search for a donor for matched unrelated transplant.
- C. Send a bone marrow aspirate for Fanconi anemia testing.
- D. Send a skin fibroblast culture for Fanconi anemia testing.
Correct Answer: D
Rationale: The correct answer is D: Send a skin fibroblast culture for Fanconi anemia testing. This is the most important next step in management because the patient's history, including a family member with aplastic anemia and a cousin with leukemia, raises suspicion for a genetic disorder like Fanconi anemia. Testing skin fibroblasts for Fanconi anemia can help confirm or rule out this diagnosis. Administering ATG and cyclosporine (choice A) may not be effective if the underlying cause is a genetic disorder. Searching for a donor for matched unrelated transplant (choice B) is premature without confirming the diagnosis. Sending a bone marrow aspirate for Fanconi anemia testing (choice C) may not yield accurate results as the peripheral blood sample test was negative, making skin fibroblast culture the preferred choice.
A laboratory finding of aplastic anaemia
- A. Pancytopaenia
- B. Erythrocytosis
- C. Bone marrow hypercellularity
- D. Reticulocytosis
Correct Answer: A
Rationale: Rationale:
1. Aplastic anemia is characterized by bone marrow failure, leading to decreased production of all blood cell types.
2. Pancytopenia refers to low levels of red blood cells, white blood cells, and platelets, consistent with aplastic anemia.
3. Erythrocytosis is an increase in red blood cell count, contradictory to the reduced production in aplastic anemia.
4. Bone marrow hypercellularity indicates increased cellularity, opposite to the hypocellularity seen in aplastic anemia.
5. Reticulocytosis is an elevated number of immature red blood cells, which is not typically seen in the context of bone marrow failure in aplastic anemia.
Summary:
A is correct as it aligns with the characteristic pancytopenia in aplastic anemia. B, C, and D are incorrect due to their inconsistency with the pathophysiology of the condition.