Nokea
The typical Reed-Sternberg cells are either infrequent or absent. Instead, lymphocytic and histiocytic cells or 'popcorn cells' are seen within a background of inflammatory cells, which are predominantly benign lymphocytes. Which type of Hodgkin's lymphoma best suit the description?
- A. Nodular sclerosis
- B. Mixed cellularity
- C. Lymphocyte depleted
- D. Lymphocyte predominance
Correct Answer: D
Rationale: Rationale for Choice D (Lymphocyte predominance):
1. Reed-Sternberg cells are infrequent or absent in lymphocyte predominance Hodgkin's lymphoma.
2. 'Popcorn cells' are seen in lymphocyte predominance Hodgkin's lymphoma.
3. Predominance of benign lymphocytes in the background is characteristic of lymphocyte predominance Hodgkin's lymphoma.
Summary of other choices:
A: Nodular sclerosis - Characterized by collagen bands dividing lymph node into nodules, not 'popcorn cells'.
B: Mixed cellularity - Reed-Sternberg cells present, not 'popcorn cells'.
C: Lymphocyte depleted - Few to no lymphocytes seen, not benign lymphocytes as described in the question.
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The nurse is reviewing the activated partial thromboplastin time for a patient receiving heparin. Which value indicates that the medication is within the therapeutic range?
- A. 2.5 to 9.5 minutes
- B. 9.5 to 11.3 seconds
- C. 1.5 to 2.0 times normal
- D. 2.0 to 3.0 times normal
Correct Answer: C
Rationale: The correct answer is C (1.5 to 2.0 times normal) because the therapeutic range for heparin therapy is typically considered to be 1.5 to 2.0 times the normal control value for activated partial thromboplastin time (aPTT). This range ensures adequate anticoagulation to prevent clot formation without increasing the risk of bleeding. Options A, B, and D are incorrect because they provide ranges that are either too short or too long for the therapeutic goal of heparin therapy. Option A (2.5 to 9.5 minutes) and Option D (2.0 to 3.0 times normal) are outside the typical therapeutic range for heparin, indicating subtherapeutic and supratherapeutic levels, respectively. Option B (9.5 to 11.3 seconds) is also incorrect as it reflects a range for prothrombin time (PT) rather than aPTT.
Dohle bodies are patches of dilated endoplasmic reticulum that appear as cerulean blue cytoplasmic puddles. These findings are mostly seen in
- A. Chronic myeloid leukemia
- B. Leukemoid reaction
- C. Chediak-Higashi syndrome
- D. Infectious mononucleosis
Correct Answer: D
Rationale: Step-by-step rationale for why choice D (Infectious mononucleosis) is correct:
1. Infectious mononucleosis is caused by the Epstein-Barr virus.
2. Dohle bodies are seen in the peripheral blood of patients with infectious mononucleosis.
3. These bodies represent aggregates of rough endoplasmic reticulum in neutrophils.
4. The appearance of Dohle bodies is attributed to the viral infection in infectious mononucleosis.
Summary:
A: Chronic myeloid leukemia - Dohle bodies are not typically seen in this condition.
B: Leukemoid reaction - Dohle bodies are not specific to a leukemoid reaction.
C: Chediak-Higashi syndrome - This syndrome is characterized by giant granules in neutrophils, not Dohle bodies.
The main vector transmitting malaria in Sabah is Anopheles balabacensis. This vector breeds in
- A. Artificial containers in urban centres
- B. Drains
- C. Temporary collecting of water in jungles
- D. Rock pools in control areas
Correct Answer: C
Rationale: The correct answer is C because Anopheles balabacensis, the main vector transmitting malaria in Sabah, breeds in temporary water collections in jungles. This is supported by research showing that this mosquito species prefers breeding in natural habitats like jungle pools. Choices A, B, and D are incorrect because Anopheles balabacensis is not typically found breeding in artificial containers in urban centers, drains, or rock pools in control areas. These habitats do not provide the specific environmental conditions required for the breeding and survival of this particular mosquito species.
A nurse is caring for a client who is about to begin taking epoetin. An increase in which of the following laboratory values should indicate to the nurse that the therapy is effective?
- A. PT
- B. WBC
- C. Hgb
- D. Platelets
Correct Answer: C
Rationale: The correct answer is C: Hgb (hemoglobin). Epoetin is a medication used to stimulate the production of red blood cells, which contain hemoglobin. Therefore, an increase in hemoglobin level indicates that the therapy is effective in treating anemia.
Incorrect choices:
A: PT (prothrombin time) is a measure of blood clotting time and is not directly related to epoetin therapy.
B: WBC (white blood cell count) is not affected by epoetin therapy, as it primarily targets red blood cell production.
D: Platelets are involved in blood clotting and are not directly influenced by epoetin therapy for anemia.
In summary, the increase in hemoglobin level is the most relevant indicator of the effectiveness of epoetin therapy for treating anemia.
A 2-month-old infant is brought to your clinic with an extensive scaly rash on the scalp, which has been biopsied and shown to be Langerhans cell histiocytosis (LCH). You want to determine whether this patient has skin-only LCH or involvement of any of the 'high-risk' organs. The child has a normal CBC; normal liver enzymes and bilirubin; and a normal skeletal survey, skull films, and chest X ray. What other screening test will be important for finding involvement of a high-risk organ?
- A. Reticulocyte count
- B. Erythrocyte sedimentation rate
- C. Alkaline phosphatase
- D. Serum albumin and total protein
Correct Answer: D
Rationale: The correct answer is D: Serum albumin and total protein. In LCH, high-risk organ involvement includes the liver and spleen. Serum albumin and total protein levels can help assess liver function, as low levels may indicate liver involvement. A normal CBC, liver enzymes, and bilirubin do not rule out organ involvement, as LCH can affect organs without causing significant abnormalities in these tests. Reticulocyte count (A) is not relevant for assessing high-risk organ involvement in LCH. Erythrocyte sedimentation rate (B) is a nonspecific marker of inflammation and not specific for organ involvement. Alkaline phosphatase (C) is more indicative of bone or liver disease rather than specifically assessing high-risk organ involvement in LCH.