Nokea
An oncology nurse is providing health education for a patient who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia?
- A. The different leukemias all involve unregulated proliferation of WBC
- B. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function.
- C. The different leukemias all result in a decrease in the production of white blood cells.
- D. The different leukemias all involve the development of cancer in the lymphatic system.
Correct Answer: A
Rationale: The correct answer is A because all subtypes of leukemia involve unregulated proliferation of white blood cells (WBC). Leukemia is a type of cancer that starts in the blood-forming tissues, leading to the production of abnormal WBCs in the bone marrow. This uncontrolled growth of WBCs interferes with the production of normal blood cells.
Choice B is incorrect because leukemia does not involve unregulated proliferation of red blood cells, but rather white blood cells. It also does not necessarily result in decreased bone marrow function as stated in the choice.
Choice C is incorrect because while some subtypes of leukemia may result in a decrease in the production of normal white blood cells, the primary issue is the unregulated proliferation of abnormal WBCs.
Choice D is incorrect because leukemia is not specifically related to cancer development in the lymphatic system. Leukemia primarily affects the bone marrow and blood.
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You receive a phone call from a community pediatrician who is caring for a 2-year-old toddler with a cancer predisposition syndrome. The pediatrician describes a child at the 95th percentile for height and weight with a history of corrective oral surgery to reduce a large tongue and a history of an omphalocele in infancy. The pediatrician is currently performing ultrasound of the abdomen and laboratory evaluation for this patient every 3 months. Which tumor is this patient most at risk of developing?
- A. Pleuropulmonary blastoma
- B. Hepatocellular carcinoma
- C. Cystic nephroma
- D. Nephroblastoma
Correct Answer: D
Rationale: The correct answer is D: Nephroblastoma. This patient most likely has Beckwith-Wiedemann Syndrome (BWS) due to the large tongue (macroglossia) and omphalocele. BWS is associated with an increased risk of nephroblastoma (Wilms tumor). The 95th percentile for height and weight is also a characteristic feature of BWS. Ultrasound and laboratory evaluation are appropriate monitoring tools for nephroblastoma in this patient due to the increased risk associated with BWS.
A: Pleuropulmonary blastoma is more commonly associated with DICER1 syndrome, not BWS.
B: Hepatocellular carcinoma is not commonly associated with BWS.
C: Cystic nephroma is not typically associated with BWS, and nephroblastoma is a more common tumor in this context.
A 9-year-old boy is being treated for standard-risk acute lymphoblastic leukemia. His treatment protocol calls for administration of intravenous methotrexate and intramuscular L-asparaginase during interim maintenance chemotherapy. What is the most appropriate sequence of drug administration?
- A. Administer L-asparaginase during the methotrexate infusion.
- B. Administer L-asparaginase immediately after the methotrexate infusion.
- C. Administer both drugs at the same time to maximize synergistic activity.
- D. Administer methotrexate 24 hours after the asparaginase.
Correct Answer: B
Rationale: The correct answer is B: Administer L-asparaginase immediately after the methotrexate infusion. This is the most appropriate sequence because methotrexate can impair the activity of L-asparaginase if administered together. By waiting to administer L-asparaginase after the methotrexate infusion, the efficacy of both drugs is maximized without interference. Administering L-asparaginase during the methotrexate infusion (Choice A) would lead to decreased effectiveness of L-asparaginase. Administering both drugs at the same time (Choice C) is not recommended due to potential drug interactions. Administering methotrexate 24 hours after the asparaginase (Choice D) does not optimize the synergistic effects of the drugs during interim maintenance chemotherapy.
C6PD reflect false normal report in:
- A. iron def .an.
- B. hypoplastic an.
- C. hairy cell leuk.
- D. shortly after haemolysis
Correct Answer: D
Rationale: The correct answer is D, shortly after hemolysis, because G6PD deficiency leads to a false-normal result due to the presence of reticulocytes in the blood following hemolysis. This is because reticulocytes have normal enzyme activity, masking the underlying deficiency. Iron deficiency anemia (A), hypoplastic anemia (B), and hairy cell leukemia (C) do not involve the same mechanism of false-normal reports in C6PD deficiency as seen in hemolysis.
A 7-year-old boy presents with recent onset of vomiting and lethargy. Blood smear shows increased neutrophils with a left shift and 8% abnormal cells. Bone marrow contains 60% of the same cells. Flow cytometry shows that the cells are TdT–, CD10+, CD19+, CD20+, sIg+. What is the most likely diagnosis?
- A. Burkitt leukemia/lymphoma
- B. B-cell acute lymphoblastic leukemia (ALL)
- C. T-cell ALL
- D. Hematogones
Correct Answer: A
Rationale: The correct answer is A: Burkitt leukemia/lymphoma. This diagnosis is supported by the presence of abnormal cells that are CD10+, CD19+, CD20+, sIg+, which are characteristic of Burkitt lymphoma. The absence of TdT– indicates that it is not T-cell ALL. B-cell ALL would typically show TdT positivity. Hematogones are immature B-cell precursors commonly seen in the bone marrow of healthy children and do not typically present with the described clinical picture. The high percentage of abnormal cells in both blood and bone marrow, along with the specific immunophenotype, point towards Burkitt leukemia/lymphoma.
The typical Reed-Sternberg cells are either infrequent or absent. Instead, lymphocytic and histiocytic cells or 'popcorn cells' are seen within a background of inflammatory cells, which are predominantly benign lymphocytes. Which type of Hodgkin's lymphoma best suit the description?
- A. Nodular sclerosis
- B. Mixed cellularity
- C. Lymphocyte depleted
- D. Lymphocyte predominance
Correct Answer: D
Rationale: The correct answer is D: Lymphocyte predominance. In this type of Hodgkin's lymphoma, the typical Reed-Sternberg cells are absent or rare. Instead, popcorn cells (lymphocytic and histiocytic cells) are seen among benign lymphocytes. This is characteristic of lymphocyte predominance subtype.
A: Nodular sclerosis - characterized by lacunar Reed-Sternberg cells in a background of collagen bands.
B: Mixed cellularity - characterized by numerous Reed-Sternberg cells, eosinophils, plasma cells, and histiocytes in a background of mixed inflammatory cells.
C: Lymphocyte depleted - characterized by few Reed-Sternberg cells in a background of fibrosis and few inflammatory cells.
Therefore, based on the description provided, choice D is the most appropriate answer.