Nokea
The nurse is staying with a patient who has been started on a blood transfusion. Which assessment should the nurse perform during a blood product infusion to detect a reaction?
- A. Vital signs
- B. Skin turgor
- C. Bowel sounds
- D. Pupil reactivity
Correct Answer: A
Rationale: The correct answer is A: Vital signs. During a blood transfusion, the nurse should monitor the patient's vital signs regularly to detect any signs of a transfusion reaction, such as fever, chills, rash, or hypotension. Vital signs provide crucial information about the patient's overall condition and can help the nurse identify and respond promptly to any adverse reactions. Skin turgor (B), bowel sounds (C), and pupil reactivity (D) are not directly related to monitoring for transfusion reactions and are not sensitive indicators of an adverse reaction during a blood transfusion. Monitoring vital signs is essential for patient safety and early detection of any complications during the transfusion process.
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A 7-year-old boy presents with recent onset of vomiting and lethargy. Blood smear shows increased neutrophils with a left shift and 8% abnormal cells. Bone marrow contains 60% of the same cells. Flow cytometry shows that the cells are TdT–, CD10+, CD19+, CD20+, sIg+. What is the most likely diagnosis?
- A. Burkitt leukemia/lymphoma
- B. B-cell acute lymphoblastic leukemia (ALL)
- C. T-cell ALL
- D. Hematogones
Correct Answer: A
Rationale: The correct answer is A: Burkitt leukemia/lymphoma. The key features in the case are increased neutrophils with a left shift, presence of abnormal cells in blood and bone marrow, and flow cytometry showing TdT–, CD10+, CD19+, CD20+, sIg+. These findings are consistent with Burkitt leukemia/lymphoma, a highly aggressive B-cell neoplasm. The presence of CD10, CD19, and CD20, along with sIg positivity, points towards a B-cell origin. Additionally, the characteristic translocation t(8;14) involving c-Myc oncogene is commonly seen in Burkitt lymphoma. The absence of TdT expression rules out T-cell ALL (Choice C). Hematogones (Choice D) are normal precursor B-cells found in bone marrow, but they do not typically present with the clinical features described. B-cell ALL (Choice B) lacks the specific features seen in this case
Bone marrow responds to iron therapy by increasing erythropoietic activity. Which of the following in bone marrow would most likely indicate erythropoiesis?
- A. Myelocytes
- B. Reticulocytes
- C. Ring sideroblasts
- D. Target cells
Correct Answer: B
Rationale: The correct answer is B: Reticulocytes. Reticulocytes are immature red blood cells released by the bone marrow into the bloodstream in response to increased erythropoietic activity. They indicate ongoing erythropoiesis as they mature into fully functional red blood cells. Myelocytes (A) are immature granulocytic precursors, not involved in erythropoiesis. Ring sideroblasts (C) are seen in conditions like sideroblastic anemia and indicate abnormal iron metabolism. Target cells (D) are red blood cells with a central bull's eye appearance and are associated with conditions like liver disease and thalassemias, not specifically erythropoiesis.
An infant is born with a firm mass over the chest with a central area of purpura and a 'halo' around it. An ultrasound reveals a high-flow lesion. What is the most likely diagnosis?
- A. Fibrosarcoma
- B. Infantile hemangioma
- C. Congenital hemangioma
- D. Capillary malformation
Correct Answer: C
Rationale: The correct answer is C: Congenital hemangioma. A congenital hemangioma presents as a firm mass with purpura and a 'halo' due to rapid growth of blood vessels. The central area of purpura indicates thrombosis. The high-flow lesion on ultrasound suggests an increased blood flow. Fibrosarcoma (A) is a malignant tumor of fibrous tissue and does not present with these characteristic features. Infantile hemangioma (B) typically appears after birth and has a different clinical presentation. Capillary malformation (D) is a vascular malformation that does not typically show the same features as described in the question.
A laboratory study is conducted to determine the optimal usage of platelets for transfusion. The blood bank inventory along with the transfusion records and medical records of subjects who were recipients of platelet transfusion are reviewed. Which of the following conclusions is most likely to be made from this study?
- A. Frozen storage of platelets helps increase the units available.
- B. Platelet transfusions are rarely successful in patients with autoimmune thrombocytopenia.
- C. Platelet units carry no risk for transmission of hepatitis C infection.
- D. Pooled donor platelets are preferred over single-donor platelets.
Correct Answer: B
Rationale: Step-by-step rationale for why answer B is correct:
1. Autoimmune thrombocytopenia is a condition where the body's immune system attacks and destroys its own platelets.
2. Platelet transfusions in patients with autoimmune thrombocytopenia are less likely to be successful due to the underlying immune response.
3. Reviewing transfusion records of subjects with this condition would likely show a pattern of unsuccessful platelet transfusions.
4. This conclusion is supported by medical knowledge and understanding of autoimmune thrombocytopenia.
Summary:
- Choice A is incorrect because frozen storage of platelets does not necessarily increase units available in the context of the study.
- Choice C is incorrect as platelet units can carry a risk of transmission for hepatitis C infection.
- Choice D is incorrect as the preference for pooled donor platelets over single-donor platelets is not a conclusion that can be drawn from the study.
In iron deficiency anemia there is characteristically
- A. An atrophic gastritis
- B. A low mean corpuscular volume
- C. A reduced total iron binding capacity
- D. Megaloblastic changes in the bone marrow
Correct Answer: B
Rationale: The correct answer is B: A low mean corpuscular volume. In iron deficiency anemia, there is a decreased amount of iron available for hemoglobin synthesis, leading to smaller and paler red blood cells. This results in a low mean corpuscular volume (MCV). Atrophic gastritis (choice A) is associated with vitamin B12 deficiency anemia, not iron deficiency anemia. Choice C (reduced total iron binding capacity) is incorrect because in iron deficiency anemia, there is an increased total iron binding capacity due to the body's attempt to capture more iron. Megaloblastic changes in the bone marrow (choice D) are seen in megaloblastic anemia, not iron deficiency anemia.