Nokea
The International Normalized Ratio (INR) was developed for the purpose of
- A. Monitoring heparin therapy
- B. Monitoring oral anticoagulant therapy
- C. Screening for intrinsic clotting system abnormalities
- D. Standardizing the monitoring of warfarin therapy
Correct Answer: D
Rationale: The correct answer is D because the International Normalized Ratio (INR) was specifically developed to standardize the monitoring of warfarin therapy. INR allows for consistent interpretation of prothrombin time results across different laboratories, ensuring accurate dosing of warfarin. Choice A is incorrect because heparin therapy is typically monitored using activated partial thromboplastin time (aPTT). Choice B is incorrect as INR, not aPTT, is used for monitoring oral anticoagulant therapy such as warfarin. Choice C is incorrect as INR is not used for screening clotting system abnormalities, but rather for monitoring anticoagulant therapy.
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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
Dengue is a common vector-borne disease prevalent in tropical countries. Which of the following statement is true for dengue fever?
- A. It is caused by a DNA virus
- B. The vector once infected with the virus remains infective for life
- C. The vector prefers polluted water for propagation
- D. Joint symptoms are commoner in dengue fever compared to chikungunya
Correct Answer: B
Rationale: The correct answer is B because the Aedes mosquito, the vector for dengue fever, remains infective for life once it is infected with the dengue virus. This is due to the virus establishing a lifelong infection in the mosquito's salivary glands. The other choices are incorrect because: A) Dengue is caused by an RNA virus, not a DNA virus. C) The Aedes mosquito prefers clean, stagnant water for breeding, not polluted water. D) Joint symptoms are commoner in chikungunya, not dengue fever.
A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?
- A. Have you had a recent weight loss?
- B. Do you have any history of lung disease?
- C. Have you noticed any dark or bloody stools?
- D. What is your dietary intake of meats and protein?
Correct Answer: B
Rationale: The correct answer is B: Do you have any history of lung disease? A high hemoglobin and hematocrit could indicate polycythemia, which can be secondary to chronic hypoxia from lung disease. Asking about lung disease helps determine if there is an underlying cause of the elevated levels.
Incorrect Choices:
A: Recent weight loss is more relevant for anemia.
C: Dark or bloody stools are more indicative of gastrointestinal bleeding and iron deficiency anemia.
D: Dietary intake of meats and protein is not directly related to the elevated hemoglobin and hematocrit levels.
You are caring for a patient with a large localized Ewing sarcoma of the soft tissues of the arm. The surgeon believes that the tumor can be resected without amputation but asks whether you can give some chemotherapy to shrink the tumor before surgery. Which of the following would you tell the surgeon?
- A. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy to improve the prognosis.
- B. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will not be necessary if the tumor is completely resected at week 12 of therapy.
- C. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will be necessary even if the tumor is completely resected at week 12 of therapy.
- D. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy; you recognize that this is the only way to avoid radiotherapy.
Correct Answer: B
Rationale: Step 1: Agreeing to wait until week 12 of therapy before resection allows chemotherapy to shrink the tumor, making surgery easier and potentially less extensive.
Step 2: Waiting until week 12 also helps assess the tumor's response to chemotherapy, guiding further treatment decisions.
Step 3: Choosing not to delay the resection until week 12 may risk more extensive surgery or complications due to the tumor's size.
Step 4: Opting for radiotherapy regardless of tumor resection status at week 12 is not advisable as unnecessary radiation exposure should be avoided unless absolutely necessary.
A 4-year-old boy is pale with intermittent jaundice and splenomegaly. Laboratory results are as follows: RBC 4.85 M/mcL (N); Hgb 8.6 g/dL (L); Hct 25.8% (L); MCV 81.6 (N); MCHC 38% (H); RDW 20% (H); Retic 7% (H). What are the two best tests to distinguish autoimmune hemolytic anemia from hereditary spherocytosis?
- A. Free erythrocyte protoporphyrin and IgG levels
- B. Hemoglobin electrophoresis and direct antiglobulin test (DAT)
- C. Lactate dehydrogenase (LDH) and modified Russell viper venom test
- D. Red cell distribution width (RDW) and mean corpuscular hemoglobin concentration (MCHC)
Correct Answer: E
Rationale: I'm sorry, but the correct answer is not provided in the question. Could you please provide the correct answer or clarify the question so that I can give you a detailed explanation based on the correct information?