Nokea
In microcytic hypochromic anaemia
- A. Red cells are larger with normal staining
- B. Red blood cell count is increased
- C. Haemtocrit and mean corpuscular haemoglobin are normal
- D. Red cells are smaller with a pale large central pallor
Correct Answer: D
Rationale: In microcytic hypochromic anemia, the correct answer is D because red cells are smaller (microcytic) and have a pale large central pallor (hypochromic). This is due to decreased hemoglobin content and iron deficiency. Choice A is incorrect as red cells are smaller, not larger. Choice B is incorrect as the red blood cell count is typically decreased in this type of anemia. Choice C is incorrect as both hematocrit and mean corpuscular hemoglobin are decreased in microcytic hypochromic anemia, not normal. Therefore, the correct answer is D based on the characteristic features of microcytic hypochromic anemia.
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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: Step-by-step rationale for why the correct answer is D, Nephroblastoma:
1. The child has a cancer predisposition syndrome, likely Beckwith-Wiedemann syndrome (BWS).
2. BWS is associated with an increased risk of developing Wilms tumor (nephroblastoma).
3. The large tongue, omphalocele, and overgrowth placing the child at the 95th percentile for height and weight are all characteristic features of BWS.
4. Therefore, the patient is most at risk of developing nephroblastoma.
Summary of why the other choices are incorrect:
A: Pleuropulmonary blastoma - Not typically associated with BWS or the described clinical features.
B: Hepatocellular carcinoma - Not commonly linked to BWS or the clinical presentation provided.
C: Cystic nephroma - Not a typical tumor associated with BWS or the clinical findings described in the patient.
Best tit modality in CML is:
- A. hydroxyurea
- B. allogenic BMT
- C. interferon alpha
- D. radiotherapy
Correct Answer: B
Rationale: The best treatment modality for Chronic Myeloid Leukemia (CML) is allogenic Bone Marrow Transplant (BMT) due to its potential for cure by replacing abnormal cells with healthy donor cells. Hydroxyurea only controls symptoms, interferon alpha has limited efficacy, and radiotherapy is not a standard treatment for CML. BMT offers a curative potential by replacing cancerous cells with healthy donor cells, making it the most effective option for treating CML.
A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects?
- A. Dusky nail beds
- B. Petechiae
- C. Enlarged spleen
- D. Swollen calf
Correct Answer: C
Rationale: The correct answer is C: Enlarged spleen. Filgrastim stimulates the production of neutrophils, which can lead to splenomegaly as the spleen stores a large number of these cells. This can cause symptoms such as abdominal discomfort or fullness. Dusky nail beds (A), petechiae (B), and swollen calf (D) are not typically associated with filgrastim therapy and are more likely related to other conditions or medications.
A nurse is caring for a client who is taking filgrastim to treat neutropenia. The nurse should assess the client for which of the following adverse effects?
- A. Dusky nail beds
- B. Petechiae
- C. Enlarged spleen
- D. Swollen calf
Correct Answer: C
Rationale: Step-by-step rationale for why choice C is correct:
1. Filgrastim stimulates the production of neutrophils.
2. An enlarged spleen can indicate an increase in neutrophils.
3. Therefore, assessing the client for an enlarged spleen is crucial to monitor the drug's effectiveness and potential adverse effects.
Summary of why other choices are incorrect:
A: Dusky nail beds - Not directly related to filgrastim or neutropenia.
B: Petechiae - Typically associated with low platelet count, not neutrophil increase.
D: Swollen calf - Unlikely to be a direct adverse effect of filgrastim for neutropenia.
A 19-year old male patient with a history of acute lymphoblastic leukemia, currently 13 years from completion of therapy, presents for a fertility consultation. He is interested in his risk for infertility. Which of the following statements is true?
- A. A semen analysis at this point would provide accurate information about future fertility.
- B. Males can maintain gonadal function at higher cumulative alkylator dosages compared with females.
- C. He should have been offered sperm cryopreservation at diagnosis.
- D. His risk for testosterone deficiency is greater than his risk for infertility.
Correct Answer: A
Rationale: The correct answer is A. A semen analysis at this point would provide accurate information about future fertility because it assesses sperm count, motility, and morphology, which are crucial indicators of fertility potential. This is important for the patient to understand his current fertility status and make informed decisions about future fertility preservation options.
Choice B is incorrect because males are also susceptible to gonadal toxicity from alkylating agents, and there is no evidence to suggest that they can maintain gonadal function at higher dosages compared to females.
Choice C is incorrect because sperm cryopreservation should ideally have been offered at the time of leukemia diagnosis, but it is not too late to assess current fertility status with a semen analysis.
Choice D is incorrect as the patient's primary concern is infertility, not testosterone deficiency, which is a different issue altogether.