Nokea
Splenectomy is contraindicated in:
- A. pyruvate kinase def.
- B. ITP
- C. BM failure
- D. angiogenic myeloid metaplasia
Correct Answer: C
Rationale: The correct answer is C: BM failure. Splenectomy is contraindicated in patients with bone marrow failure due to conditions such as aplastic anemia or myelodysplastic syndromes. The spleen plays a role in removing abnormal blood cells, and removing it can worsen cytopenias in these patients. Choices A, B, and D are not contraindications for splenectomy as they do not directly involve the bone marrow function. Pyruvate kinase deficiency (A) does not affect bone marrow function, ITP (B) is a platelet disorder, and angiogenic myeloid metaplasia (D) is a condition related to abnormal blood cell production, not bone marrow failure.
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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 30 year old patient had presented with fever and posterior cervical lymphadenopathy over the past two years. Which is the most probably causative organism?
- A. Trypanosoma cruzi
- B. Trypanosoma brucei rhodesiense
- C. Trypanosoma brucei gambiense
- D. Leishmania donovani
Correct Answer: C
Rationale: The correct answer is C: Trypanosoma brucei gambiense. This is the most probable causative organism because the patient's presentation of fever and posterior cervical lymphadenopathy over a prolonged period aligns with the chronic infection caused by Trypanosoma brucei gambiense, which leads to African Trypanosomiasis (sleeping sickness). Trypanosoma cruzi (choice A) causes Chagas disease, which typically presents with acute symptoms such as fever and swelling at the site of infection. Trypanosoma brucei rhodesiense (choice B) causes acute African Trypanosomiasis with a more rapid progression compared to gambiense. Leishmania donovani (choice D) causes visceral leishmaniasis, which presents with prolonged fever, splenomegaly, and pancytopenia, but not typically with cervical lymphadenopathy.
Splenectomy is contraindicated in:
- A. pyruvate kinase def.
- B. ITP
- C. BM failure
- D. angiogenic myeloid metaplasia
Correct Answer: C
Rationale: Splenectomy is contraindicated in bone marrow (BM) failure because the spleen plays a crucial role in hematopoiesis and immune function. Removing the spleen can worsen BM failure by disrupting hematopoiesis and exacerbating the existing condition. In pyruvate kinase deficiency, splenectomy can improve symptoms by reducing hemolysis. In immune thrombocytopenic purpura (ITP), splenectomy may be considered as a treatment option to increase platelet count. Angiogenic myeloid metaplasia does not have a direct contraindication for splenectomy, as the primary concern is the underlying disease pathology, not the surgical intervention.
You are consulted on a 4-year-old girl who is newly diagnosed with standard-risk pre-B acute lymphoblastic leukemia. After reviewing her previous complete blood examinations, you note she has had a platelet count ranging from 80,000 to 100,000 cells/mcL over the past 2 years. Her father mentions that he has also been told he has mild thrombocytopenia. You suspect the child may have a cancer predisposition syndrome. Which sample should you send for analysis, and which gene is most likely implicated?
- A. Skin fibroblasts to evaluate the RUNX1 gene
- B. Skin fibroblasts to evaluate the ETV6 gene
- C. Buccal swab to evaluate the RUNX1 gene
- D. Buccal swab to evaluate the ETV6 gene
Correct Answer: B
Rationale: The correct answer is B: Skin fibroblasts to evaluate the ETV6 gene. In this scenario, the presence of mild thrombocytopenia in both the father and the child raises suspicion of a genetic predisposition. ETV6 gene mutations are commonly associated with inherited thrombocytopenia and predisposition to leukemia. Skin fibroblasts are ideal for genetic testing due to their stable genetic material. Choice A is incorrect as RUNX1 gene mutations are linked to familial platelet disorder with predisposition to acute myeloid leukemia, not pre-B acute lymphoblastic leukemia. Choices C and D are incorrect as buccal swabs may not provide sufficient genetic material for comprehensive analysis.
A patient receiving blood complains of dyspnea. The nurse auscultates the patient's lungs and finds crackles that were not present before the start of the transfusion. Which type of reaction should the nurse suspect?
- A. Urticarial
- B. Hemolytic
- C. Anaphylactic
- D. Circulatory overload
Correct Answer: D
Rationale: The correct answer is D: Circulatory overload. Dyspnea and crackles post-transfusion indicate fluid overload, not an immune response. Step 1: Rule out urticarial (itching/rash) and anaphylactic (rapid onset, hypotension) reactions due to the absence of these symptoms. Step 2: Hemolytic reactions involve destruction of red blood cells, leading to hemoglobinuria and shock. Step 3: Circulatory overload results from an excessive volume of blood given, leading to pulmonary edema and crackles. In this case, the symptoms align with circulatory overload, making it the most likely reaction.