Nokea
Blinatumomab, a bispecific T-cell engaging molecule, is active against which CD antigen that is expressed on B-lymphoblasts?
- A. CD10
- B. CD15
- C. CD19
- D. CD20
Correct Answer: C
Rationale: Rationale:
1. Blinatumomab is designed to engage T cells to target CD19 antigen on B-lymphoblasts.
2. CD19 is a specific marker expressed on B cells, making it a target for Blinatumomab.
3. CD10 is not targeted by Blinatumomab and is commonly found on early B-cell precursors.
4. CD15 and CD20 are not targeted by Blinatumomab and have different functions unrelated to B-lymphoblasts.
Summary:
- CD19 is the correct answer as it is the specific target for Blinatumomab on B-lymphoblasts.
- CD10, CD15, and CD20 are incorrect as they are not the targeted antigens for Blinatumomab and have different roles in immune function.
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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: Step-by-step rationale:
1. Macrocytosis refers to larger-than-normal red blood cells.
2. Systemic Lupus Erythematosus (SLE) is not typically associated with macrocytosis.
3. Anemia of myxedema, methotrexate-induced, and chronic alcoholism-induced liver disease can all lead to macrocytosis.
4. Therefore, the correct answer is D: SLE, as it is not commonly associated with macrocytosis.
A 3-month-old female presents to the emergency room with vomiting and abdominal distension. She has a left-side abdominal mass, and an abdominal ultrasound confirms an 8-cm mass arising from the left kidney. Liver lesions are also noted. Nephrectomy is performed and reveals a histologic diagnosis of malignant rhabdoid tumor of the kidney (MRTK). Which of the following is not a true statement about the management of this patient?
- A. Most patients with rhabdoid tumor of the kidney present in infancy.
- B. Most patients with rhabdoid tumor of the kidney present with metastatic (stage III or IV) disease.
- C. She has an excellent prognosis with surgery, chemotherapy, and radiation.
- D. Germline testing for SMARCB1/INI1 mutation on chromosome 22 is recommended, with brain MRI every 3 months until she is 5 years old, if testing is germline positive for SMARCB1/INI1.
Correct Answer: C
Rationale: The correct answer is C: She has an excellent prognosis with surgery, chemotherapy, and radiation. This statement is not true because malignant rhabdoid tumor of the kidney (MRTK) has a poor prognosis, even with aggressive treatment. Here's a breakdown:
1. MRTK is an aggressive and rare tumor that often presents in infancy, supporting statement A.
2. Most patients with MRTK present with metastatic disease, indicating poor prognosis, aligning with statement B.
3. Germline testing for SMARCB1/INI1 mutation is essential due to the genetic predisposition associated with MRTK, supporting statement D.
In summary, statement C is incorrect as MRTK typically has a challenging clinical course despite comprehensive treatment approaches.
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.
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.
A nursing student wants to know why clients with chronic obstructive pulmonary disease tend to be polycythemic. What response by the nurse instructor is best?
- A. It is due to side effects of medications for bronchodilation.
- B. It is from overactive bone marrow in response to chronic disease.
- C. It combats the anemia caused by an increased metabolic rate.
- D. It compensates for tissue hypoxia caused by lung disease.
Correct Answer: D
Rationale: The correct answer is D. In chronic obstructive pulmonary disease (COPD), the lungs are unable to efficiently exchange oxygen and carbon dioxide, leading to tissue hypoxia. The body compensates for this by producing more red blood cells (polycythemia) to increase oxygen-carrying capacity. This helps deliver more oxygen to tissues.
Choice A is incorrect because medications for bronchodilation do not directly cause polycythemia. Choice B is incorrect because overactive bone marrow is not the primary reason for polycythemia in COPD. Choice C is incorrect because polycythemia in COPD is not a response to combat anemia but rather to address tissue hypoxia.