Nokea
Increase serum iron:-decrease IBC a feature of:
- A. Hookworm infestation
- B. sideroblastic an.
- C. alcoholic liver dis.
- D. th.major
Correct Answer: B
Rationale: Step-by-step rationale:
1. Sideroblastic anemia results in defective heme synthesis, leading to iron accumulation in the mitochondria.
2. This excess iron saturation decreases the Iron Binding Capacity (IBC) in the serum.
3. Therefore, in sideroblastic anemia, increasing serum iron is associated with a decrease in IBC.
Summary of other choices:
A: Hookworm infestation causes iron deficiency anemia with increased IBC.
C: Alcoholic liver disease can lead to iron overload, not a decrease in IBC.
D: Thalassemia major is associated with increased IBC due to ineffective erythropoiesis.
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An infant is born with a firm mass over the chest with a central area of purpura and a 'halo' around it. An ultrasound reveals a high-flow lesion. What is the most likely diagnosis?
- A. Fibrosarcoma
- B. Infantile hemangioma
- C. Congenital hemangioma
- D. Capillary malformation
Correct Answer: C
Rationale: The correct answer is C: Congenital hemangioma. A congenital hemangioma presents as a firm mass with purpura and a 'halo' due to rapid growth of blood vessels. The central area of purpura indicates thrombosis. The high-flow lesion on ultrasound suggests an increased blood flow. Fibrosarcoma (A) is a malignant tumor of fibrous tissue and does not present with these characteristic features. Infantile hemangioma (B) typically appears after birth and has a different clinical presentation. Capillary malformation (D) is a vascular malformation that does not typically show the same features as described in the question.
A hospitalized client has a platelet count of 58,000/mm³. What action by the nurse is best?
- A. Encourage high-protein foods.
- B. Institute neutropenic precautions.
- C. Limit visitors to healthy adults.
- D. Place the client on safety precautions.
Correct Answer: D
Rationale: The correct answer is D: Place the client on safety precautions. A platelet count of 58,000/mm³ indicates thrombocytopenia, increasing the risk of bleeding. Safety precautions aim to prevent injury and minimize bleeding risks. Encouraging high-protein foods (choice A) is not directly related to managing thrombocytopenia. Instituting neutropenic precautions (choice B) is for clients with low white blood cell counts, not platelet counts. Limiting visitors to healthy adults (choice C) is important for infection control, not specifically for thrombocytopenia. In summary, placing the client on safety precautions is the best action to prevent bleeding complications.
A hospitalized client has a platelet count of 58,000/mm³. What action by the nurse is best?
- A. Encourage high-protein foods.
- B. Institute neutropenic precautions.
- C. Limit visitors to healthy adults.
- D. Place the client on safety precautions.
Correct Answer: D
Rationale: The correct answer is D: Place the client on safety precautions. A platelet count of 58,000/mm³ indicates thrombocytopenia, increasing the risk of bleeding. Placing the client on safety precautions will minimize the risk of injury and bleeding. Encouraging high-protein foods (choice A) is not directly related to managing thrombocytopenia. Neutropenic precautions (choice B) are for clients with low neutrophil counts, not low platelet counts. Limiting visitors to healthy adults (choice C) is important for infection control, not addressing the risk of bleeding.
A 2-month-old infant is brought to your clinic with an extensive scaly rash on the scalp, which has been biopsied and shown to be Langerhans cell histiocytosis (LCH). You want to determine whether this patient has skin-only LCH or involvement of any of the 'high-risk' organs. The child has a normal CBC; normal liver enzymes and bilirubin; and a normal skeletal survey, skull films, and chest X ray. What other screening test will be important for finding involvement of a high-risk organ?
- A. Reticulocyte count
- B. Erythrocyte sedimentation rate
- C. Alkaline phosphatase
- D. Serum albumin and total protein
Correct Answer: D
Rationale: The correct answer is D: Serum albumin and total protein. In LCH, high-risk organ involvement includes the liver and spleen. Serum albumin and total protein levels can help assess liver function, as low levels may indicate liver involvement. A normal CBC, liver enzymes, and bilirubin do not rule out organ involvement, as LCH can affect organs without causing significant abnormalities in these tests. Reticulocyte count (A) is not relevant for assessing high-risk organ involvement in LCH. Erythrocyte sedimentation rate (B) is a nonspecific marker of inflammation and not specific for organ involvement. Alkaline phosphatase (C) is more indicative of bone or liver disease rather than specifically assessing high-risk organ involvement in LCH.
An otherwise healthy 18-year-old female is diagnosed with high-risk neuroblastoma after presenting with fatigue and bony pain. Imaging findings demonstrate a left adrenal mass with multiple osseous metastases. She successfully completes standard therapy for high-risk neuroblastoma, but experiences several episodes of disease recurrence and ultimately dies of her disease 10 years after her initial diagnosis. During her treatment, her tumor was sent for molecular analysis. Of the following, what molecular aberration was most likely to have been detected?
- A. ETV6-NTRK3 gene fusion
- B. PTPN11 mutation
- C. ATRX mutation
- D. WT1 mutation
Correct Answer: C
Rationale: The correct answer is C: ATRX mutation. In neuroblastoma, ATRX mutations are associated with poor prognosis and high-risk disease. ATRX gene mutations are commonly found in cases with aggressive behavior and poor outcomes, such as in this case where the patient experienced disease recurrence and ultimately died. ATRX mutations are linked to chromosomal instability and telomere dysfunction, which can contribute to tumor progression and resistance to therapy.
A: ETV6-NTRK3 gene fusion is more commonly associated with infantile fibrosarcoma and secretory breast carcinoma, not neuroblastoma.
B: PTPN11 mutations are typically seen in juvenile myelomonocytic leukemia and Noonan syndrome, not neuroblastoma.
D: WT1 mutations are more commonly found in Wilms tumor and acute myeloid leukemia, not neuroblastoma.
In summary, the ATRX mutation is the most likely molecular aberration detected in this patient with high-risk neuroblast