In iron deficiency anemia there is characteristically
- A. An atrophic gastritis
- B. A low mean corpuscular volume
- C. A reduced total iron binding capacity
- D. Megaloblastic changes in the bone marrow
Correct Answer: B
Rationale: Step-by-step rationale:
1. Iron deficiency leads to decreased hemoglobin synthesis, resulting in smaller red blood cells.
2. Mean corpuscular volume (MCV) measures the average size of red blood cells.
3. In iron deficiency anemia, MCV is low due to the smaller red blood cells.
4. Therefore, choice B is correct as it reflects the characteristic feature of iron deficiency anemia.
Summary:
A: Atrophic gastritis is seen in pernicious anemia, not iron deficiency anemia.
C: Total iron binding capacity is increased, not reduced, in iron deficiency anemia.
D: Megaloblastic changes in the bone marrow are seen in megaloblastic anemias, not iron deficiency anemia.
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A laboratory study is conducted to determine the optimal usage of platelets for transfusion. The blood bank inventory along with the transfusion records and medical records of subjects who were recipients of platelet transfusion are reviewed. Which of the following conclusions is most likely to be made from this study?
- A. Frozen storage of platelets helps increase the units available.
- B. Platelet transfusions are rarely successful in patients with autoimmune thrombocytopenia.
- C. Platelet units carry no risk for transmission of hepatitis C infection.
- D. Pooled donor platelets are preferred over single-donor platelets.
Correct Answer: B
Rationale: Step-by-step rationale for why answer B is correct:
1. Autoimmune thrombocytopenia is a condition where the body's immune system attacks and destroys its own platelets.
2. Platelet transfusions in patients with autoimmune thrombocytopenia are less likely to be successful due to the underlying immune response.
3. Reviewing transfusion records of subjects with this condition would likely show a pattern of unsuccessful platelet transfusions.
4. This conclusion is supported by medical knowledge and understanding of autoimmune thrombocytopenia.
Summary:
- Choice A is incorrect because frozen storage of platelets does not necessarily increase units available in the context of the study.
- Choice C is incorrect as platelet units can carry a risk of transmission for hepatitis C infection.
- Choice D is incorrect as the preference for pooled donor platelets over single-donor platelets is not a conclusion that can be drawn from the study.
A leukemia investigator plans to obtain bone marrow under general anesthesia to measure minimal residual disease (MRD) and to see if this time point can predict early relapse. The specimen will be obtained at a time point when otherwise no bone marrow would be sampled. The results are not shared with the treating oncologist, and no therapeutic interventions are decided or based on the results. Which of the following statements is most accurate about this intervention?
- A. It constitutes a minimal-risk procedure because bone marrow assessments are considered routine for patients diagnosed with acute lymphoblastic leukemia.
- B. It constitutes a minimal-risk procedure because it is a single additional procedure being performed during the course of treatment.
- C. It constitutes a greater than minimal-risk procedure because it is being done under general anesthesia.
- D. It is justifiable because future patients may benefit from knowledge gained by the research.
Correct Answer: C
Rationale: The correct answer is C because obtaining bone marrow under general anesthesia carries inherent risks that make it greater than minimal-risk. Here's a step-by-step rationale:
1. General anesthesia poses risks such as allergic reactions, breathing problems, and potential complications, making the procedure more than minimal-risk.
2. Even though bone marrow assessments are routine for leukemia patients, the use of general anesthesia elevates the risk level.
3. The fact that the results are not shared with the treating oncologist and no therapeutic interventions are based on them indicates that the procedure is solely for research purposes, emphasizing the risk-benefit analysis.
4. Choice A is incorrect because the use of general anesthesia increases the procedure's risk level beyond routine.
5. Choice B is incorrect as the focus should be on the inherent risks of general anesthesia, not just the number of procedures performed.
6. Choice D is irrelevant to the risk assessment of the specific procedure and does not address the immediate safety concerns associated with general anesthesia.
A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?
- A. PT
- B. WBC
- C. Hgb
- D. Platelets
Correct Answer: C
Rationale: The correct answer is C: Hgb (hemoglobin). Epoetin is a medication used to stimulate the production of red blood cells, which contain hemoglobin. Therefore, an increase in hemoglobin level indicates that the therapy is effective in treating anemia.
Incorrect choices:
A: PT (prothrombin time) is a measure of blood clotting time and is not directly related to epoetin therapy.
B: WBC (white blood cell count) is not affected by epoetin therapy, as it primarily targets red blood cell production.
D: Platelets are involved in blood clotting and are not directly influenced by epoetin therapy for anemia.
In summary, the increase in hemoglobin level is the most relevant indicator of the effectiveness of epoetin therapy for treating anemia.
You are seeing a 12-year-old boy in the survivorship program who presented at 2 years old with a desmoplastic nodular medulloblastoma. You note the child recently underwent germline genetic testing and was found to have nevoid basal cell carcinoma syndrome. In which gene is the child most likely to have a pathogenic variant?
- A. PTEN
- B. CDKN2A
- C. SUFU
- D. SMARCB1
Correct Answer: C
Rationale: Rationale: The correct answer is C: SUFU. Nevoid basal cell carcinoma syndrome, also known as Gorlin syndrome, is associated with pathogenic variants in the SUFU gene. SUFU is a tumor suppressor gene involved in the sonic hedgehog signaling pathway, which plays a role in medulloblastoma and basal cell carcinoma development. PTEN (A) is associated with Cowden syndrome, CDKN2A (B) with familial atypical multiple mole melanoma syndrome, and SMARCB1 (D) with rhabdoid tumor predisposition syndrome, but not specifically linked to nevoid basal cell carcinoma syndrome.
A nurse is caring for a patient who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the patient's sacral area and petechiae in her forearms. In addition to informing the patient's primary care provider, the nurse should perform what action?
- A. Initiate measures to prevent venous thromboembolism (VTE).
- B. Check the patient's most recent platelet level.
- C. Place the patient on protective isolation.
- D. Ambulate the patient to promote circulatory function.
Correct Answer: B
Rationale: Step-by-step rationale for why answer B is correct:
1. Petechiae and ecchymoses indicate potential thrombocytopenia in a leukemia patient.
2. Checking the patient's platelet level will confirm thrombocytopenia and guide treatment.
3. Low platelet levels can lead to bleeding complications, hence the importance of monitoring.
4. Prompt intervention based on platelet level results can prevent worsening complications.
Summary of why other choices are incorrect:
A: Initiating measures to prevent VTE is not directly related to the patient's current presentation of ecchymoses and petechiae.
C: Placing the patient on protective isolation is not indicated for thrombocytopenia.
D: Ambulating the patient may be beneficial for circulation but does not address the underlying issue of potential thrombocytopenia.