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: Rationale:
1. INR standardizes PT results across labs.
2. Warfarin therapy requires close monitoring.
3. INR helps adjust warfarin dose accurately.
4. INR is not specific to heparin, oral anticoagulants, or screening for clotting system abnormalities.
Summary:
A: Heparin is monitored by aPTT.
B: Oral anticoagulant therapy is monitored by INR.
C: Intrinsic clotting abnormalities are not detected by INR.
D: Warfarin therapy monitoring is standardized by INR.
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You are seeing a 12-year-old female who presented to the emergency department with the sudden onset of severe abdominal pain. Imaging that was obtained to rule out appendicitis revealed a mass adjacent to the bladder. The mass was surgically resected, and pathology demonstrated a paraganglioma. Which of the studies below would be most useful to determine disease stage for this patient?
- A. Bone Scan
- B. Lumbar puncture for cerebrospinal fluid cytology
- C. Bone marrow aspirate and biopsy
- D. Ga 68-DOTATATE PET/CT
Correct Answer: D
Rationale: The correct answer is D: Ga 68-DOTATATE PET/CT. Paragangliomas are neuroendocrine tumors that can secrete catecholamines and have a high expression of somatostatin receptors. Ga 68-DOTATATE PET/CT is the most appropriate imaging study to determine disease stage in patients with paragangliomas because it can detect the somatostatin receptor expression in these tumors, aiding in localization, staging, and treatment planning.
A: Bone scan is not the most useful study for determining disease stage in paraganglioma.
B: Lumbar puncture for cerebrospinal fluid cytology is not relevant for staging paraganglioma.
C: Bone marrow aspirate and biopsy are not the most appropriate studies for staging paraganglioma.
A 19-year-old freshman in college presents with 'lumps' on the right side of his neck and in the right axilla. He had a fever to 39 °C 1 day in the past week. On physical exam, there are firm anterior cervical and axillary nodes, all greater than 2 cm in diameter. A chest x-ray shows a large mediastinal mass. A biopsy of the axillary node reveals classic Hodgkin lymphoma. Which of the following symptoms revealed during the history is a B symptom?
- A. Fever to 39 °C
- B. 10% weight loss in past 6 months
- C. Fatigue
- D. Alcohol-induced pain
Correct Answer: B
Rationale: The correct answer is B: 10% weight loss in the past 6 months. In Hodgkin lymphoma, B symptoms include unexplained weight loss of more than 10% in the past 6 months, fever >38°C, and night sweats. Weight loss is a significant indicator of systemic illness and malignancy. In this case, the patient's weight loss, along with the presence of fever and lymphadenopathy, fulfills the criteria for B symptoms in Hodgkin lymphoma. Choices A, C, and D are incorrect because fever, fatigue, and alcohol-induced pain are not specifically classified as B symptoms in the context of Hodgkin lymphoma. Fever alone does not qualify as a B symptom unless it is associated with other systemic symptoms like weight loss and night sweats. Fatigue can be a nonspecific symptom in many conditions, and alcohol-induced pain is not a recognized B symptom in Hodgkin lymphoma.
Several gene mutations have been associated with juvenile myelomonocytic leukemia (JMML), and they may or may not have prognostic implications. A gene expression–based classification system has been found to be an independent predictor of clinical outcome in these patients. What is the disease signature that predicts a poor outcome?
- A. Tyrosine kinase inhibitors
- B. Acute myeloid leukemia–like
- C. Chronic myeloid leukemia-like
- D. BRAF pathway abnormalities
Correct Answer: B
Rationale: The correct answer is B: Acute myeloid leukemia-like. This is because JMML shares similarities with acute myeloid leukemia in terms of aggressive progression and poor outcomes. Children with JMML who exhibit an acute myeloid leukemia-like gene expression signature have been shown to have a worse prognosis compared to those with other gene expression profiles. The other choices (A, C, D) are incorrect because tyrosine kinase inhibitors are not directly related to predicting clinical outcomes in JMML, chronic myeloid leukemia-like gene expression profile does not necessarily predict poor outcomes in JMML, and BRAF pathway abnormalities are not specifically associated with predicting poor outcomes in JMML.
An 18-year old male patient with acute lymphoblastic leukemia recently started maintenance therapy and is complaining of increased hip pain. The pain increases during weight-bearing activity; however, it occasionally hurts at night as well. His CBCd is normal. Which of the following risk factors is most commonly associated with this process?
- A. Younger age at diagnosis
- B. Non-White race
- C. Low body-mass index
- D. Dexamethasone exposure
Correct Answer: D
Rationale: The correct answer is D: Dexamethasone exposure. Dexamethasone is a corticosteroid commonly used in the treatment of acute lymphoblastic leukemia. It can cause avascular necrosis of the hip due to its effect on bone metabolism, leading to increased hip pain during weight-bearing activities. This is a known side effect seen more commonly in patients exposed to dexamethasone.
Incorrect Choices:
A: Younger age at diagnosis - Age is not a known risk factor for avascular necrosis in this context.
B: Non-White race - Race is not a known risk factor for avascular necrosis in this context.
C: Low body-mass index - Body mass index is not a known risk factor for avascular necrosis in this context.
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 diagnosing CML due to the characteristic presence of increased mature and immature granulocytes, especially neutrophils, in the blood smear. This finding is known as a "left-shift" and is a hallmark of CML. In contrast, NHL (choice A) primarily involves lymphocytes, multiple myeloma (choice B) is characterized by abnormal plasma cells, and myelodysplastic syndrome (choice C) typically presents with dysplastic changes in blood cell precursors. Therefore, based on the specific blood cell findings, CML is the most likely diagnosis when observing a peripheral blood picture.