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Graft versus host disease is a complication of transfusion in patients of bone marrow transplantation. This can be best avoided by
- A. Transfusion of packed cells
- B. Irradiating the blood components before transfusion
- C. Transfusing fresh whole blood
- D. Replacement by crystalloids
Correct Answer: B
Rationale: The correct answer is B: Irradiating the blood components before transfusion. Graft versus host disease occurs when donor immune cells attack the recipient's tissues. Irradiating blood components helps to eliminate donor T cells, reducing the risk of this complication. Choice A (Transfusion of packed cells) does not address the issue of donor T cells. Choice C (Transfusing fresh whole blood) may actually increase the risk as it contains more viable donor immune cells. Choice D (Replacement by crystalloids) is not a suitable alternative for blood transfusion.
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A peripheral blood smear showing increase in numbers of neutrophils, band cells, basophils, eosinophils, and platelets is most suggestive
- A. Acute myeloid leukemia
- B. Acute lymphoid leukemia
- C. Chronic myelocytic leukemia
- D. Chronic lymphocytic leukemia
Correct Answer: C
Rationale: Rationale: A peripheral blood smear showing an increase in neutrophils, basophils, eosinophils, and platelets is indicative of Chronic Myelocytic Leukemia (CML). Neutrophils, basophils, and eosinophils are myeloid lineage cells typically elevated in CML. The presence of increased platelets is also common in CML due to the overproduction of cells in the bone marrow.
Summary of other choices:
A: Acute myeloid leukemia - Typically presents with a predominance of immature myeloid cells like blasts, rather than an increase in mature myeloid cells.
B: Acute lymphoid leukemia - Primarily involves lymphoid lineage cells, not myeloid cells as seen in the blood smear.
D: Chronic lymphocytic leukemia - Characterized by an increase in mature lymphocytes, not myeloid cells like neutrophils, basophils, and eosinophils.
The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse?
- A. A 2-cm nontender supraclavicular node
- B. A 1-cm mobile and nontender axillary node
- C. An inability to palpate any superficial lymph nodes
- D. Firm inguinal nodes in a patient with an infected foot
Correct Answer: A
Rationale: The correct answer is A: A 2-cm nontender supraclavicular node. This finding is concerning because supraclavicular nodes are not normally palpable. Enlarged supraclavicular nodes can indicate metastatic cancer. B is incorrect because mobile and nontender axillary nodes are usually benign. C is incorrect as the inability to palpate superficial nodes may be normal. D is incorrect as firm inguinal nodes could indicate a localized infection or inflammation.
Plummer Vinson syndrome is not associated with:
- A. angular stomatitis
- B. splenomegaly
- C. clubbing
- D. post cricoid web
Correct Answer: C
Rationale: The correct answer is C: clubbing. Plummer Vinson syndrome is characterized by the triad of iron deficiency anemia, dysphagia, and esophageal webs. Clubbing is not a typical feature of Plummer Vinson syndrome. Angular stomatitis (A), splenomegaly (B), and post cricoid web (D) are commonly associated with Plummer Vinson syndrome due to chronic iron deficiency anemia. Clubbing is more commonly seen in conditions such as chronic respiratory or cardiac diseases, not in Plummer Vinson syndrome.
A 12-year-old patient has been referred to you following complete resection with clean margins of a high-grade malignant peripheral nerve sheath tumor of the shoulder region. The tumor measured approximately 4 cm in greatest dimension. A CT scan of the chest and a bone scan were within normal limits. The patient does not have evidence of neurofibromatosis type 1 (NF1). Which of the following treatment approaches would you recommend?
- A. Chemotherapy with doxorubicin and ifosfamide
- B. Radiotherapy
- C. Chemotherapy with doxorubicin and ifosfamide plus radiotherapy
- D. Observation
Correct Answer: D
Rationale: The correct answer is D: Observation. Given the complete resection with clean margins, normal chest CT, bone scan, and absence of NF1, observation is appropriate. Chemotherapy or radiotherapy may be considered in the presence of residual disease, positive margins, or metastasis. Chemotherapy with doxorubicin and ifosfamide may cause unnecessary toxicity without clear benefit in this scenario. Radiotherapy may be reserved for cases with high-risk features. Combining chemotherapy and radiotherapy may lead to increased toxicity without proven benefit. Observation allows monitoring for disease recurrence while minimizing unnecessary treatment side effects.
A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?
- A. Give two more courses of intensification chemotherapy.
- B. Perform an autologous hematopoietic stem cell transplant (HSCT).
- C. Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
- D. Give one more course of intensification chemotherapy and then 1 year of maintenance chemotherapy.
Correct Answer: C
Rationale: The correct answer is C because the patient is in morphologic remission and MRD-negative after the second course of treatment. Given her high-risk AML and lack of HLA-matched siblings, a matched unrelated donor HSCT offers the best chance for long-term remission. Autologous HSCT (choice B) would risk reintroducing leukemic cells. Giving more courses of intensification chemotherapy alone (choice A) may not eradicate the disease. Maintenance chemotherapy alone (choice D) is not sufficient for high-risk AML. Therefore, choice C is the best option for maximizing the chances of a favorable outcome in this case.