Nokea
Outstanding feature of ITP:
- A. fever
- B. gum bleeding
- C. moderate splenomegaly
- D. stema tenderness
Correct Answer: B
Rationale: The correct answer is B: gum bleeding. In Immune Thrombocytopenic Purpura (ITP), the hallmark feature is thrombocytopenia leading to mucocutaneous bleeding, including gum bleeding. Fever (choice A) is not a typical feature of ITP. Splenomegaly (choice C) can be present in chronic ITP but is not a defining feature. Sterna tenderness (choice D) is not specific to ITP and is not considered a characteristic feature. Thus, gum bleeding is the outstanding feature of ITP due to the primary pathophysiology of decreased platelet count leading to bleeding manifestations.
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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: The correct answer is D: Nephroblastoma. This patient likely has Beckwith-Wiedemann syndrome based on the large tongue (macroglossia) and omphalocele. Beckwith-Wiedemann syndrome is associated with an increased risk of developing nephroblastoma (Wilms tumor). The 95th percentile for height and weight is also a common feature of this syndrome. Pleuropulmonary blastoma (choice A) is more commonly seen in patients with DICER1 mutations. Hepatocellular carcinoma (choice B) is not typically associated with Beckwith-Wiedemann syndrome. Cystic nephroma (choice C) is more commonly seen in patients with DICER1 mutations, not Beckwith-Wiedemann syndrome.
The nurse notes that a patient's gaping wound is developing a blood clot. Which body substance is responsible for this clot formation?
- A. Plasma
- B. Platelets
- C. Red blood cells
- D. White blood cells
Correct Answer: B
Rationale: Platelets are responsible for clot formation in the body. When a wound occurs, platelets are activated and adhere to the site, forming a plug to stop bleeding. They release chemicals to further enhance clot formation. Plasma is the liquid component of blood, red blood cells carry oxygen, and white blood cells are part of the immune system, none of which are directly involved in clot formation.
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.
Which of the following is wrong concerning Philadelphia chromosome:
- A. shortening of long arm of chromosome 22
- B. Philadelphia:-ve cases have bad prognosis
- C. diagnostic of CML
- D. found in lymphocytes
Correct Answer: D
Rationale: The correct answer is D, as the Philadelphia chromosome is typically found in myeloid cells, not lymphocytes. This is because the Philadelphia chromosome results from a translocation between chromosomes 9 and 22, leading to the formation of the BCR-ABL fusion gene, which is associated with chronic myeloid leukemia (CML). Choice A is correct as the Philadelphia chromosome results from the shortening of the long arm of chromosome 22. Choice B is incorrect as Philadelphia positivity in CML patients is associated with a worse prognosis. Choice C is correct as the presence of the Philadelphia chromosome is a diagnostic hallmark of CML.
Which of the following is the most suitable anti malarial drug for pregnant women?
- A. Atovaquone and proguanil
- B. Quinine and doxycycline
- C. Quinine and clindamycin
- D. Primaquine
Correct Answer: C
Rationale: The correct answer is C: Quinine and clindamycin. Quinine is considered safe for use in pregnancy to treat malaria, as it has been used for many years without significant adverse effects. Clindamycin is also safe for use in pregnancy and can be used in combination with quinine to treat malaria. Atovaquone and proguanil (choice A) are not recommended for use in pregnancy due to limited safety data. Quinine and doxycycline (choice B) is not suitable for pregnant women as doxycycline is contraindicated during pregnancy. Primaquine (choice D) is not recommended for use during pregnancy as it can cause harm to the fetus.