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 seen in conditions where RBCs are physically sheared or damaged as they pass through small blood vessels. In microangiopathic hemolytic anemia, abnormal or damaged blood vessels cause mechanical destruction of RBCs, leading to the formation of schistocytes. Sickle cell trait (A) and Thalassemia (B) are genetic disorders that do not typically cause schistocytes. Idiopathic thrombocytopenic purpura (D) is a condition characterized by low platelet count, not associated with schistocytes.
You may also like to solve these questions
A patient is suffered from vitamin K deficiency. Which of the coagulation factors will not be affected?
- A. Factor II
- B. Factor VII
- C. Factor VIII
- D. Factor IX
Correct Answer: C
Rationale: The correct answer is C, Factor VIII. Vitamin K is crucial for the activation of Factors II, VII, IX, and X in the coagulation cascade. Factor VIII is not dependent on vitamin K for its synthesis or activation, so it will not be affected by vitamin K deficiency. Factors II, VII, and IX will be affected as they require vitamin K for their activation. Therefore, Factor VIII is the only factor that will not be impacted by vitamin K deficiency.
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: Hyperleukocytosis; leukapheresis or manual exchange transfusion and initiation of induction chemotherapy. In this scenario, the patient's symptoms and lab findings are consistent with acute myeloid leukemia (AML) with leukostasis, causing hypoxia and interstitial infiltrates. Leukapheresis or manual exchange transfusion is crucial to rapidly reduce the high white blood cell count, which can help alleviate symptoms and prevent complications like tissue hypoxia. Initiation of induction chemotherapy is also essential for long-term management of AML.
Rationale for why other choices are incorrect:
A: Hyperleukocytosis alone without leukostasis does not typically require immediate leukoreduction, as in this case. Induction chemotherapy should be initiated promptly to address the underlying AML.
C: COVID-19 infection would not typically present with such profound leukocytosis and monocytic morphology. Convalescent plasma and prednisone are not
Plat. Transfusion is not indicated in:
- A. aplastic an.
- B. uraemia with bleeding
- C. DIC
- D. immunogenic thrombocytopenia
Correct Answer: D
Rationale: The correct answer is D: immunogenic thrombocytopenia. Platelet transfusion is not indicated in immunogenic thrombocytopenia because it involves antibodies attacking platelets, which would render transfused platelets ineffective. Platelet transfusion is indicated in aplastic anemia (A) to increase platelet count, in uremia with bleeding (B) to replace dysfunctional platelets, and in DIC (C) to help manage severe bleeding. In summary, platelet transfusion is contraindicated in immunogenic thrombocytopenia due to ineffective platelet response.
Which of the following is not true in thrombasthenia:
- A. prolonged bleeding time
- B. normal plat .Count
- C. plat .Aggregation defect
- D. prolonged clotting time
Correct Answer: D
Rationale: In thrombasthenia, there is a deficiency or dysfunction of integrin αIIbβ3 (GPIIb/IIIa), leading to impaired platelet aggregation. Prolonged bleeding time (A) is seen due to defective platelet function. Platelet count (B) is typically normal as thrombasthenia does not affect platelet production. Platelet aggregation defect (C) is a characteristic feature of thrombasthenia. Prolonged clotting time (D) is not associated with thrombasthenia as it primarily affects platelet function, not the coagulation cascade. Hence, choice D is the correct answer.
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.