Nokea
Hepato-splenomegaly with lymphadenopathy occur in all except:
- A. ALL
- B. lymphoma
- C. CML
- D. dissiminated TB
Correct Answer: C
Rationale: Step-by-step rationale:
1. Chronic Myeloid Leukemia (CML) primarily involves the bone marrow and blood, not the liver, spleen, or lymph nodes.
2. Hepato-splenomegaly with lymphadenopathy are commonly seen in Acute Lymphoblastic Leukemia (ALL) and lymphoma.
3. Disseminated TB can cause hepato-splenomegaly but typically does not present with lymphadenopathy.
Therefore, C (CML) is the correct answer as it does not typically present with the described findings.
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A young child with consanguineous parents has developmental delay and a history of multiple recurrent bacterial infections and short stature. He presents to the emergency department following trauma and requires a blood transfusion. Blood work identifies leukocytosis, neutrophilia, and the Bombay blood group (absent H antigen as well as absent A and B antigens). What is this patient's diagnosis?
- A. Chediak-Higashi syndrome
- B. Leukocyte adhesion deficiency (LAD) Type II
- C. CD18 deficiency
- D. Griscelli syndrome
Correct Answer: B
Rationale: The correct answer is B: Leukocyte adhesion deficiency (LAD) Type II. This diagnosis is supported by the patient's history of recurrent bacterial infections, leukocytosis, neutrophilia, and the Bombay blood group. LAD Type II is characterized by a defect in the CD18 integrin molecules, leading to impaired leukocyte adhesion and migration to sites of infection. The Bombay blood group is due to the absence of H antigen, which is also seen in LAD Type II.
A: Chediak-Higashi syndrome is characterized by recurrent infections, albinism, and peripheral neuropathy, not leukocyte adhesion deficiency.
C: CD18 deficiency is actually another term for LAD Type I, not LAD Type II.
D: Griscelli syndrome presents with silvery hair and immunodeficiency, but does not involve leukocyte adhesion deficiency.
You are seeing a 13-year-old boy with fatigue, weight loss, night sweats, and splenomegaly. Peripheral blood shows anemia, thrombocytosis, and leukocytosis (300,000/mm3). What is this patient's most likely diagnosis?
- A. Leukemoid reaction
- B. Acute lymphoblastic leukemia (ALL)
- C. Chronic myeloid leukemia (CML)
- D. Juvenile myelomonocytic leukemia (JMML)
Correct Answer: C
Rationale: The correct answer is C: Chronic myeloid leukemia (CML). This is a likely diagnosis due to the presence of fatigue, weight loss, night sweats, splenomegaly, anemia, thrombocytosis, and leukocytosis with an elevated white blood cell count. CML is characterized by the Philadelphia chromosome, resulting in the BCR-ABL fusion gene. This gene leads to uncontrolled proliferation of myeloid cells, causing the symptoms seen in this patient. Leukemoid reaction (A) is a reactive increase in white blood cells, usually in response to an infection. Acute lymphoblastic leukemia (B) typically presents with symptoms in children but is more commonly associated with lymphoblasts in the peripheral blood. JMML (D) is a rare myelodysplastic disorder in children characterized by monocytosis and a specific genetic mutation.
A client is having a bone marrow biopsy today. What action by the nurse takes priority?
- A. Administer pain medication first.
- B. Ensure valid consent is on the chart.
- C. Have the client shower in the morning.
- D. Premedicate the client with sedatives.
Correct Answer: B
Rationale: The correct answer is B: Ensure valid consent is on the chart. This is the priority because obtaining informed consent is crucial before any invasive procedure like a bone marrow biopsy. Without valid consent, the procedure cannot proceed legally or ethically. Administering pain medication (choice A) and premedicating with sedatives (choice D) are important for client comfort but are not the priority. Having the client shower in the morning (choice C) is not directly related to the immediate safety or success of the biopsy.
A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer?
- A. Alteplase
- B. Aspirin
- C. Clopidogrel
- D. Heparin
Correct Answer: A
Rationale: The correct answer is A: Alteplase. Alteplase is a thrombolytic agent used to dissolve blood clots and restore blood flow in acute ischemic stroke. It is crucial to administer within a specific time frame for the best outcome. Aspirin (B) and Clopidogrel (C) are antiplatelet agents that prevent further clot formation but are not used for immediate clot dissolution in acute ischemic stroke. Heparin (D) is an anticoagulant that prevents clot formation and is not typically used as the initial treatment for acute ischemic stroke.
A 60-year-old patient with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize?
- A. The importance of adhering to the prescribed drug regimen
- B. The need to ensure that vaccinations are up to date
- C. The importance of daily physical activity
- D. The need to avoid shellfish and raw foods
Correct Answer: A
Rationale: The correct answer is A: The importance of adhering to the prescribed drug regimen. This is crucial in managing chronic myeloid leukemia effectively. Medication adherence is essential to control the disease and prevent complications. Skipping doses can lead to treatment failure or drug resistance.
B: While vaccinations are important, they are not the top priority in managing chronic myeloid leukemia.
C: Daily physical activity is beneficial for overall health but is not the primary concern in this case.
D: Avoiding shellfish and raw foods is not a key aspect of managing chronic myeloid leukemia.