Nokea
The nurse is concerned that a patient is demonstrating signs of red blood cell production. What laboratory value did the nurse most likely use to make this decision?
- A. Iron
- B. Bilirubin
- C. Thrombin
- D. Intrinsic factor
Correct Answer: B
Rationale: The correct answer is B: Bilirubin. Bilirubin is a product of red blood cell breakdown and its levels can indicate the rate of red blood cell production. Elevated bilirubin can suggest increased RBC destruction or hemolysis. Iron (A) is related to anemia but not a direct indicator of RBC production. Thrombin (C) is a clotting factor, not related to RBC production. Intrinsic factor (D) is involved in vitamin B12 absorption, not directly linked to RBC production.
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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 once a mosquito vector, usually Aedes aegypti, is infected with the dengue virus, it remains infective for life. This is due to the virus establishing a lifelong infection in the mosquito's salivary glands.
A: Incorrect. Dengue is caused by an RNA virus, specifically the flavivirus.
C: Incorrect. Aedes mosquitoes prefer clean, stagnant water for breeding, not polluted water.
D: Incorrect. Joint symptoms are common in both dengue fever and chikungunya, but usually more severe in chikungunya.
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 can be indicative of chronic hypoxia, often seen in lung diseases like COPD. The nurse should ask about lung disease to explore the possibility of chronic hypoxia as the underlying cause. Choices A, C, and D are incorrect as they do not directly relate to the potential cause of elevated hemoglobin and hematocrit levels in this scenario.
According to the FAB classification, the L2 stage is characterized by:
- A. Large heterogenous blasts with prominent nucleoli
- B. Small homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- C. Large homogenous blasts with scanty nucleoli and higher nucleus to cytoplasm ratio
- D. Large blasts with basophilic vacuolated cytoplasm
Correct Answer: C
Rationale: The correct answer is C because according to the FAB classification, the L2 stage is characterized by large homogenous blasts with scanty nucleoli and a higher nucleus to cytoplasm ratio. This is because in the L2 stage, the blasts are more immature and have a larger size compared to other stages. Choice A is incorrect because it describes blasts with prominent nucleoli, which is not characteristic of the L2 stage. Choice B is incorrect because it describes small homogenous blasts with scanty nucleoli, which does not align with the characteristics of the L2 stage. Choice D is incorrect because it describes large blasts with basophilic vacuolated cytoplasm, which is not a feature of the L2 stage.
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
A patient who is suspected of having acute viral hemorrhagic fever reveals history of tick bite. Which of the following is the most possible causative agent?
- A. Hantavirus
- B. Rift Valley virus
- C. Crimean Congo virus
- D. Marburg virus
Correct Answer: C
Rationale: The correct answer is C: Crimean Congo virus. This is because Crimean Congo virus is a tick-borne virus known to cause acute viral hemorrhagic fever. Tick bite history increases suspicion for this virus. A: Hantavirus is transmitted through rodent feces and urine. B: Rift Valley virus is transmitted through mosquito bites. D: Marburg virus is transmitted through contact with infected animals.