Nokea
Mr XY was found to be anemic. During history taking, he informed his doctor that he was a strict vegetarian who did not consume any meat, fish or milk products.
- A. Iron deficiency
- B. Vitamin B12 deficiency
- C. Defects in erythropoietin production
- D. Calcium-deficiency
Correct Answer: B
Rationale: The correct answer is B: Vitamin B12 deficiency. As a strict vegetarian who does not consume any meat, fish, or milk products, Mr XY is at risk for Vitamin B12 deficiency. Vitamin B12 is primarily found in animal products and is essential for red blood cell production. Anemia can result from Vitamin B12 deficiency, leading to symptoms such as fatigue and weakness. Iron deficiency (A) is also common in vegetarians, but in this case, the focus is on Vitamin B12 due to the exclusion of all animal products. Defects in erythropoietin production (C) are not related to Mr XY's dietary choices. Calcium-deficiency (D) is not directly related to anemia in this scenario.
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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: The correct answer is B: sideroblastic anemia. In sideroblastic anemia, there is impaired heme synthesis leading to the accumulation of iron in the mitochondria of red blood cell precursors. This results in increased serum iron levels due to the release of iron from the mitochondria. Decreased Iron Binding Capacity (IBC) occurs as a compensatory mechanism due to the increased serum iron levels.
Choice A, hookworm infestation, would typically result in iron deficiency anemia with decreased serum iron levels and normal to increased IBC. Choice C, alcoholic liver disease, is associated with decreased serum iron levels and normal to increased IBC due to impaired iron metabolism. Choice D, thalassemia major, presents with normal to decreased serum iron levels and normal to increased IBC due to ineffective erythropoiesis.
An oncology nurse is providing health education for a patient who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia?
- A. The different leukemias all involve unregulated proliferation of WBC
- B. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function.
- C. The different leukemias all result in a decrease in the production of white blood cells.
- D. The different leukemias all involve the development of cancer in the lymphatic system.
Correct Answer: A
Rationale: The correct answer is A: The different leukemias all involve unregulated proliferation of WBC. Leukemia is a type of cancer that affects the blood and bone marrow, leading to the uncontrolled growth of white blood cells. This abnormal proliferation of white blood cells is a common feature across all subtypes of leukemia.
Explanation:
1. Leukemia is a cancer of the blood and bone marrow.
2. In leukemia, there is uncontrolled proliferation of white blood cells.
3. Different subtypes of leukemia may have specific characteristics, but they all involve the abnormal growth of white blood cells.
Summary:
Choice B is incorrect because leukemias do not involve unregulated proliferation of red blood cells. Choice C is incorrect because leukemias do not always result in a decrease in white blood cell production. Choice D is incorrect because leukemia is not specifically related to the lymphatic system; it affects the blood and bone marrow.
A 13-year-old Hispanic girl is found to have a WBC count of 6,500/mm3 with 40% Auer rod–containing granular blasts that, by flow cytometry, express very bright CD33 but are negative for human leukocyte antigen–DR isotype (HLA-DR). She is oozing blood around her peripheral IV site. Coagulation studies reveal an international normalized ratio (INR) of 3.4, a fibrinogen of 170, and a markedly elevated D-dimer. Marrow aspirate shows nearly 90% blasts with a similar morphology. You send the marrow to the fluorescence in situ hybridization (FISH) lab and request STAT testing for the most likely recurrent genetic abnormality based on the clinical presentation. How do you plan to initiate therapy?
- A. Perform a lumbar puncture to determine leukemic involvement, then proceed with induction chemotherapy.
- B. Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.
- C. Start dexamethasone and hydroxyurea immediately while aggressively managing coagulopathy with blood product support.
- D. Start induction chemotherapy, obtain HLA typing, and start a donor search because of the poor prognosis associated with this leukemic phenotype.
Correct Answer: B
Rationale: The correct answer is B: Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.
Rationale:
1. The clinical presentation describes acute promyelocytic leukemia (APL), characterized by Auer rod-containing blasts, coagulopathy (elevated INR, D-dimer), and CD33 positivity. ATRA is the standard treatment for APL.
2. ATRA induces differentiation of leukemic promyelocytes, reducing the risk of disseminated intravascular coagulation (DIC) and bleeding.
3. Aggressively managing the coagulopathy with blood product support is crucial to prevent hemorrhagic complications.
Summary:
A: Not needed as the clinical presentation already suggests APL. Lumbar puncture is not indicated for APL diagnosis.
C: Dexamethasone and hydroxyurea are not standard treatments for APL. Immediate ATRA therapy is preferred.
D
Splenectomy is curative in:
- A. G6PD def.
- B. ITP
- C. thalassemia
- D. hereditary spherocytosis
Correct Answer: D
Rationale: The correct answer is D: hereditary spherocytosis. Splenectomy is curative in hereditary spherocytosis because the spleen is responsible for the destruction of the abnormal spherocytes in this condition. Removing the spleen eliminates the primary site of red blood cell destruction, leading to an improvement in anemia and other symptoms.
Incorrect choices:
A: Splenectomy is contraindicated in G6PD deficiency as it can worsen hemolysis by increasing the workload on other organs.
B: Splenectomy can be beneficial in ITP to increase platelet counts but is not curative as the underlying autoimmune process persists.
C: Splenectomy is not curative in thalassemia as it does not address the underlying genetic defect causing abnormal hemoglobin synthesis.
The typical Reed-Sternberg cells are either infrequent or absent. Instead, lymphocytic and histiocytic cells or 'popcorn cells' are seen within a background of inflammatory cells, which are predominantly benign lymphocytes. Which type of Hodgkin's lymphoma best suit the description?
- A. Nodular sclerosis
- B. Mixed cellularity
- C. Lymphocyte depleted
- D. Lymphocyte predominance
Correct Answer: D
Rationale: Rationale for Choice D (Lymphocyte predominance):
1. Reed-Sternberg cells are infrequent or absent in lymphocyte predominance Hodgkin's lymphoma.
2. 'Popcorn cells' are seen in lymphocyte predominance Hodgkin's lymphoma.
3. Predominance of benign lymphocytes in the background is characteristic of lymphocyte predominance Hodgkin's lymphoma.
Summary of other choices:
A: Nodular sclerosis - Characterized by collagen bands dividing lymph node into nodules, not 'popcorn cells'.
B: Mixed cellularity - Reed-Sternberg cells present, not 'popcorn cells'.
C: Lymphocyte depleted - Few to no lymphocytes seen, not benign lymphocytes as described in the question.