Nokea
The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?
- A. Do you take salicylates?
- B. Are you taking any oral contraceptives?
- C. Have you been prescribed antiseizure drugs?
- D. How long have you taken antihypertensive drugs?
Correct Answer: A
Rationale: Correct Answer: A: Do you take salicylates?
Rationale:
1. Petechiae are tiny red or purple spots caused by bleeding under the skin.
2. Salicylates (like aspirin) can cause bleeding issues leading to petechiae.
3. Asking about salicylate use helps identify a potential cause for the petechiae.
Summary of Incorrect Choices:
B: Oral contraceptives are not typically associated with petechiae.
C: Antiseizure drugs do not commonly cause petechiae.
D: Antihypertensive drugs are not known to be a common cause of petechiae.
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A patient is scheduled for upcoming surgery. He is on nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. You are being asked what to do with his medications for the surgery. What is the mechanism of action of NSAIDS?
- A. Irreversible inhibition of cyclooxygenase 1
- B. Irreversible inhibition of cyclooxygenase 2
- C. Reversible inhibition of cyclooxygenase 1
- D. Reversible inhibition of cyclooxygenase 2
Correct Answer: C
Rationale: Step 1: NSAIDs inhibit cyclooxygenase (COX) enzymes to reduce prostaglandin synthesis.
Step 2: Reversible inhibition means the effect is temporary and can be reversed.
Step 3: COX-1 inhibition leads to GI side effects, which can be concerning in surgery.
Step 4: COX-2 inhibition is more targeted for inflammation but can still pose cardiovascular risks.
Step 5: Reversible COX-1 inhibition allows for temporary discontinuation before surgery to minimize bleeding risk.
Summary: Choice C is correct as reversible COX-1 inhibition allows for safer management pre-surgery compared to irreversible inhibition in choices A and B, and COX-2 inhibition in choice D.
When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered?
- A. Platelet count
- B. Neutrophil count
- C. White blood cell count
- D. Hemoglobin (Hgb) level
Correct Answer: D
Rationale: The correct answer is D: Hemoglobin (Hgb) level. Pallor of the skin and nail beds indicates possible anemia, which is a condition characterized by low levels of hemoglobin. Thus, checking the hemoglobin level is crucial to confirm the suspicion of anemia. Platelet count (choice A) assesses for clotting ability, neutrophil count (choice B) and white blood cell count (choice C) are indicators of infection or inflammation, which are not directly related to pallor. Hemoglobin level directly correlates with the observed symptom of pallor, making it the most appropriate laboratory test to order.
Which of the following moves furthest to the anode on cellulose acetate electrophoresis of normal haemoglobin at pH 8.6?
- A. Haemoglobin A
- B. Haemoglobin D
- C. Haemoglobin A2
- D. Haemoglobin S
Correct Answer: A
Rationale: The correct answer is A: Haemoglobin A. In cellulose acetate electrophoresis at pH 8.6, haemoglobin A moves furthest towards the anode because it has the highest net negative charge among the normal haemoglobins. This is due to the high number of negatively charged amino acids in haemoglobin A compared to the other normal haemoglobins. Haemoglobin D, A2, and S have different amino acid sequences and charge distributions, resulting in them migrating at different rates. Haemoglobin D and A2 are minor components with lower net negative charge compared to A. Haemoglobin S, on the other hand, has a different charge distribution due to the substitution of glutamic acid with valine in the beta chain, causing it to migrate differently than haemoglobin A.
An 8-year-old boy undergoes a resection of a tumor in the right cerebrum next to the lateral ventricle (supratentorial). The pathologist feels the histology is most consistent with an ependymoma. The tumor is sent for advanced molecular and genetic testing. Which of the following findings would further support a diagnosis of ependymoma?
- A. BRAFKIAA1549 fusion
- B. BRAFV600E mutation
- C. RELA fusion
- D. H3K27M mutation
Correct Answer: C
Rationale: The correct answer is C: RELA fusion. Ependymomas are known to have specific molecular characteristics, with RELA fusion being a common genetic alteration associated with these tumors. The fusion of RELA gene is a key genetic event in the pathogenesis of supratentorial ependymomas. This fusion leads to the activation of the NF-κB signaling pathway, which is important in the development and progression of ependymomas.
Now, let's summarize why the other choices are incorrect:
A: BRAFKIAA1549 fusion - This fusion is typically associated with pilocytic astrocytomas, not ependymomas.
B: BRAFV600E mutation - This mutation is commonly found in other types of brain tumors like pleomorphic xanthoastrocytomas and gangliogliomas, not ependymomas.
D: H3K27M mutation - This mutation is typically seen in diffuse midline gliomas, such as diffuse
Basophilic stippling is classically seen in:
- A. CML
- B. myelosclerosis
- C. chronic lead poisoning
- D. iron def anemia
Correct Answer: C
Rationale: Basophilic stippling refers to the presence of blue-staining granules in red blood cells, which is a classic finding in chronic lead poisoning due to the inhibition of heme synthesis. In CML, the primary feature is the presence of the Philadelphia chromosome. Myelosclerosis is characterized by bone marrow fibrosis, not basophilic stippling. Iron deficiency anemia typically presents with microcytic hypochromic red blood cells, not basophilic stippling. Therefore, the correct answer is C: chronic lead poisoning.