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Peripheral bl. Picture is most useful in:
- A. NHL
- B. multiple myeloma
- C. myelodysplastic syndrome
- D. CML
Correct Answer: D
Rationale: The correct answer is D: CML. Peripheral blood picture is most useful in CML because it typically shows increased white blood cell count with left shift, basophilia, and presence of the Philadelphia chromosome. In contrast, A (NHL) primarily involves lymph nodes, B (multiple myeloma) shows monoclonal protein in serum/bone marrow, and C (myelodysplastic syndrome) presents with cytopenias and dysplastic changes in blood cells. Therefore, based on the specific findings seen in CML on peripheral blood, it is the most appropriate choice.
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An 18-year old male patient presents with bruising, fatigue, and diffuse extremity pain. He is noted to be tachypneic and hypoxic and has a diffuse interstitial infiltrate on chest x-ray. CBC reveals a WBC count of 285,000/mm3 (85% myeloblasts, with monocytic morphology), hemoglobin of 7.9 g/dL, and platelet count of 36,000/mm3. What is the most likely cause of the infiltrate and respiratory symptoms and the most appropriate initial treatment?
- A. Hyperleukocytosis; initiation of induction chemotherapy
- B. Hyperleukocytosis; leukapheresis or manual exchange transfusion and initiation of induction chemotherapy
- C. COVID-19 infection; convalescent plasma and prednisone
- D. Pneumococcal pneumonia; vancomycin
Correct Answer: B
Rationale: The correct answer is B. The patient's presentation with tachypnea, hypoxia, and diffuse interstitial infiltrate on chest x-ray suggests leukostasis syndrome due to hyperleukocytosis. The extremely high WBC count of 285,000/mm3 with myeloblasts indicates acute myeloid leukemia. Leukapheresis or manual exchange transfusion is needed to rapidly reduce the number of leukemic blasts in circulation to prevent complications like tissue hypoxia. Initiation of induction chemotherapy is essential for long-term management of AML.
Choice A is incorrect because induction chemotherapy alone may not rapidly reduce the WBC count in cases of leukostasis. Choice C is incorrect as the patient's clinical scenario is not consistent with COVID-19 infection, and convalescent plasma is not indicated for leukostasis. Choice D is incorrect as the patient's symptoms are not typical for pneumococcal pneumonia, and vancomycin is not the initial
The nurse is assisting with the collection of data from a patient with a hematologic disorder. On which body system should the nurse expect to focus when collecting this data?
- A. Respiratory
- B. Genitourinary
- C. Cardiovascular
- D. All body systems
Correct Answer: D
Rationale: The correct answer is D: All body systems. When assessing a patient with a hematologic disorder, the nurse needs to consider the impact on multiple body systems. Hematologic disorders can affect the cardiovascular system (such as anemia or clotting disorders), respiratory system (such as decreased oxygen-carrying capacity), genitourinary system (such as kidney dysfunction in conditions like hemolytic uremic syndrome), and other systems. By focusing on all body systems, the nurse ensures a comprehensive assessment to identify any potential complications or manifestations related to the hematologic disorder. Choices A, B, and C are incorrect because hematologic disorders can have implications beyond these specific systems, necessitating a more holistic approach to data collection.
You are consulting on a 10-year-old male with severe persistent neutropenia, a history of recurrent infections, and warts. The rest of the peripheral blood count is normal. His mother also has neutropenia. Bone marrow examination shows a hypercellular marrow and retained myeloid cells with vacuolated cytoplasm. There are no abnormalities in the red cells or platelet precursors. Cytogenetics are 46XY. You start granulocyte colony stimulating factor therapy and the neutrophil count increases. A mutation in which of the following genes is most likely to have caused this familial inherited bone marrow failure syndrome?
- A. CXCR4
- B. ELANE
- C. GATA 2
- D. Mitochondrial DNA
Correct Answer: A
Rationale: The correct answer is A: CXCR4. In this case, the patient presents with severe neutropenia, recurrent infections, and warts, suggestive of WHIM syndrome, where CXCR4 mutations are often involved. CXCR4 plays a crucial role in immune cell trafficking and retention in the bone marrow. The hypercellular marrow and vacuolated myeloid cells are consistent with WHIM syndrome. The absence of abnormalities in red cells or platelet precursors rules out other syndromes. Mutations in ELANE are commonly associated with congenital neutropenia, not familial inherited bone marrow failure syndromes. GATA2 mutations are linked to familial myelodysplastic syndromes, not typically presenting with neutropenia and warts. Mitochondrial DNA mutations are more related to mitochondrial disorders, which usually manifest with multi-system involvement, not specific to bone marrow failure syndromes.
A 50-year-old male who had frequent infections of his upper respiratory tract manifested with subcutaneous petechiae over his arms and legs. Investigations revealed low hemoglobin and a dry tap marrow. The most likely condition the patient is suffering from
- A. Iron deficiency anemia
- B. Megaloblastic anemia
- C. Hemolytic anemia
- D. Aplastic anemia
Correct Answer: D
Rationale: The correct answer is D: Aplastic anemia. This condition is characterized by pancytopenia, which includes low hemoglobin (anemia), low platelets (manifested as petechiae), and low white blood cells (frequent infections). Dry tap marrow is a classic finding in aplastic anemia due to bone marrow failure. Iron deficiency anemia (choice A) typically presents with microcytic hypochromic anemia without pancytopenia. Megaloblastic anemia (choice B) is characterized by macrocytic anemia with hypersegmented neutrophils and is usually caused by deficiencies in vitamin B12 or folate. Hemolytic anemia (choice C) presents with anemia due to increased destruction of red blood cells, which does not explain the low platelets and white blood cells seen in this patient.
Which of the following is not the criteria in the international prognostic index for non Hodgkin's lymphoma?
- A. Number of extranodal sites
- B. LDH level
- C. Lymphocyte count
- D. Performance status
Correct Answer: C
Rationale: The correct answer is C: Lymphocyte count. The International Prognostic Index (IPI) for non-Hodgkin's lymphoma includes factors such as age, number of extranodal sites, LDH level, performance status, and stage. Lymphocyte count is not a specific criteria in the IPI. This index is used to predict the outcome of patients with aggressive lymphomas. A higher score indicates a worse prognosis. A low lymphocyte count is not a consistent prognostic factor for non-Hodgkin's lymphoma, unlike the other factors listed. Therefore, choice C is not a criteria in the IPI, making it the correct answer.