Nokea
RBCs break into fragments, they are referred to as schistocytes. These type of cells are seen in
- A. Sickle cell trait
- B. Thalassemia
- C. Microangiopathic hemolytic anemia
- D. Idiopathic thrombocytopenic purpura
Correct Answer: C
Rationale: The correct answer is C, Microangiopathic hemolytic anemia. Schistocytes are fragmented red blood cells caused by mechanical damage as they pass through narrowed vessels. This occurs in conditions like thrombotic thrombocytopenic purpura and hemolytic uremic syndrome, which are types of microangiopathic hemolytic anemia. Sickle cell trait (A) and Thalassemia (B) are genetic disorders affecting red blood cell structure and production, not causing mechanical fragmentation. Idiopathic thrombocytopenic purpura (D) is a disorder characterized by low platelet count, unrelated to RBC fragmentation.
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Henoch Schonlein purpura is not associated with:
- A. thrombocytopenia
- B. palpable purpura
- C. intussusception
- D. acute diffuse glomerulonephritis
Correct Answer: A
Rationale: Henoch-Schonlein purpura (HSP) is a vasculitis that primarily affects small blood vessels. Thrombocytopenia, which is a low platelet count, is not typically associated with HSP. Palpable purpura, intestinal intussusception, and acute diffuse glomerulonephritis are commonly seen in HSP due to immune-mediated inflammation of blood vessels, gastrointestinal involvement, and renal complications. Thrombocytopenia, on the other hand, is not a characteristic feature of HSP, making choice A the correct answer.
An 8-year-old girl presents with National Cancer Institute (NCI) Standard Risk acute pre-B-cell acute lymphoblastic leukemia. Her family history is significant for her mother having been diagnosed with breast cancer at age 34 years and a maternal uncle who developed osteosarcoma as a teenager. What cytogenetic abnormality is most likely to be detected in this patient?
- A. t(1;19)
- B. CRLF2 rearrangement with a JAK2 mutation
- C. KMT24 rearrangement
- D. Hypodiploidy with a modal chromosome number of 34
Correct Answer: D
Rationale: The correct answer is D: Hypodiploidy with a modal chromosome number of 34. In pediatric pre-B-cell acute lymphoblastic leukemia, hypodiploidy (fewer than 44 chromosomes) is associated with poor prognosis. A modal chromosome number of 34 is specifically linked to high-risk disease.
A: t(1;19) is characteristic of pre-B-cell acute lymphoblastic leukemia but is associated with intermediate prognosis, not standard risk.
B: CRLF2 rearrangement with a JAK2 mutation is seen in a subset of high-risk acute lymphoblastic leukemia cases, not standard risk.
C: KMT24 rearrangement is not a known cytogenetic abnormality in acute lymphoblastic leukemia.
A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurse's most appropriate action?
- A. Tell him that you will give him privacy and leave the room.
- B. Offer to call pastoral care.
- C. Ask if he would like you to sit with him while he collects his thoughts.
- D. Tell him that you can understand how he's feeling.
Correct Answer: C
Rationale: The correct answer is C: Ask if he would like you to sit with him while he collects his thoughts. This is the most appropriate action because it shows empathy and support for the patient's emotional distress. By offering to sit with the patient, the nurse acknowledges the patient's feelings and provides a comforting presence. This can help the patient feel understood and supported during a difficult time.
Choices A and D are incorrect because they do not actively offer emotional support or show empathy towards the patient. Choice A may make the patient feel abandoned, and choice D may come across as insincere or dismissive of the patient's emotions.
Choice B, offering to call pastoral care, is also not the most appropriate action in this scenario because the patient may need immediate emotional support from the nurse. Pastoral care can be considered later if the patient expresses a desire for spiritual or religious support.
According to the FAB classification, the L2 stage is characterized by:
- A. Large heterogenous blasts with prominent nucleoli
- B. Small homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- C. Large homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- D. Large blasts with basophilic vacuolated cytoplasm
Correct Answer: C
Rationale: The correct answer is C because according to the FAB classification, the L2 stage is characterized by large homogenous blasts with scanty nucleoli and a higher nucleus to cytoplasm ratio. This is because in the L2 stage, the blasts are more immature and have a larger size compared to other stages. Choice A is incorrect because it describes blasts with prominent nucleoli, which is not characteristic of the L2 stage. Choice B is incorrect because it describes small homogenous blasts with scanty nucleoli, which does not align with the characteristics of the L2 stage. Choice D is incorrect because it describes large blasts with basophilic vacuolated cytoplasm, which is not a feature of the L2 stage.
A 9-year-old boy presents to the emergency department with emesis and headache of 3 weeks' duration. MRI reveals a large heterogeneous mass in the cerebellum. He undergoes a resection, and the pathology is most consistent with a classic medulloblastoma. Which of the following findings would classify the patient as a high-risk medulloblastoma?
- A. Elevated serum and CSF AFP and beta-HCG tumor markers
- B. WNT subgrouping on molecular classification
- C. A presurgical spine MRI that reveals bulky tumor in the spine
- D. A postoperative brain MRI with no signs of residual tumor
Correct Answer: C
Rationale: The correct answer is C. A presurgical spine MRI revealing bulky tumor in the spine classifies the patient as high-risk due to leptomeningeal spread. This indicates dissemination of the tumor cells beyond the primary site, leading to a poorer prognosis. Choice A is incorrect as AFP and beta-HCG markers are associated with germ cell tumors, not medulloblastomas. Choice B is incorrect as WNT subgrouping is associated with better outcomes. Choice D is incorrect because the absence of residual tumor postoperatively does not necessarily indicate high-risk disease.