Nokea
Thrombocytopenia is absent in:
- A. DIC
- B. Wiskott Aldrich syndrome
- C. Henoch Schonlein purpura
- D. myelosclerosis
Correct Answer: C
Rationale: Thrombocytopenia is absent in Henoch Schonlein purpura because it is primarily a vasculitis affecting small blood vessels, not directly causing platelet destruction. Thrombocytopenia is present in DIC due to widespread coagulation activation. Wiskott Aldrich syndrome and myelosclerosis both involve platelet dysfunction or decreased production, leading to thrombocytopenia.
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Basophilic stippling is classically seen in:
- A. CML
- B. myelosclerosis
- C. chronic lead poisoning
- D. iron def anemia
Correct Answer: C
Rationale: Basophilic stippling is caused by the presence of ribosomal RNA in red blood cells, which is a characteristic finding in chronic lead poisoning. Lead inhibits enzymes involved in heme synthesis, leading to accumulation of ribosomal RNA. In CML, there is an increase in immature white blood cells, not red blood cells. Myelosclerosis is associated with bone marrow fibrosis, not basophilic stippling. Iron deficiency anemia presents with microcytic, hypochromic red blood cells, not basophilic stippling.
A nurse is preparing to assist with a bone marrow biopsy. Which anatomical site should the nurse anticipate will be used to obtain the specimen?
- A. Ribs
- B. Humerus
- C. Posterior iliac crest
- D. Long bones in the legs
Correct Answer: C
Rationale: The correct answer is C: Posterior iliac crest. This site is commonly used for bone marrow biopsies due to its accessibility and abundance of red bone marrow. The iliac crest is a flat bone, making it easier to access for the procedure compared to the round shape of other bones listed. Ribs (A) are not commonly used due to the risk of pneumothorax. The humerus (B) is not an ideal site as it contains mostly yellow bone marrow. Long bones in the legs (D) are not typically used for bone marrow biopsies due to the difficulty in accessing and the higher risk of complications.
A 14-year-old boy presents with cough, shortness of breath, and difficulty lying down. His face and neck swell when his arms are raised. Chest x-ray reveals a large mediastinal mass. A tissue diagnosis is desired. A biopsy is performed with local anesthesia because the anesthesiologist thinks that the patient has a very high general anesthesia risk. Which of the following findings does not make general anesthesia unsafe?
- A. Tumor diameter greater than 45% of transthoracic diameter
- B. Tracheal cross-sectional area less than 50% of predicted
- C. Peak expiratory flow rate less than 50% of predicted
- D. A malignancy of hematopoietic origin
Correct Answer: D
Rationale: The correct answer is D. A malignancy of hematopoietic origin does not inherently make general anesthesia unsafe. This is because anesthesia risk is typically influenced by factors such as airway patency, respiratory function, and cardiac status. Choices A, B, and C all indicate potential complications that could make general anesthesia unsafe, such as airway obstruction due to a large mediastinal mass (A), compromised tracheal cross-sectional area (B), and impaired respiratory function (C). These factors would necessitate careful consideration and potential modifications in the anesthesia plan to ensure patient safety.
You receive a phone call from a community pediatrician who is caring for a 2-year-old toddler with a cancer predisposition syndrome. The pediatrician describes a child at the 95th percentile for height and weight with a history of corrective oral surgery to reduce a large tongue and a history of an omphalocele in infancy. The pediatrician is currently performing ultrasound of the abdomen and laboratory evaluation for this patient every 3 months. Which tumor is this patient most at risk of developing?
- A. Pleuropulmonary blastoma
- B. Hepatocellular carcinoma
- C. Cystic nephroma
- D. Nephroblastoma
Correct Answer: D
Rationale: The correct answer is D: Nephroblastoma. This patient most likely has Beckwith-Wiedemann Syndrome (BWS) due to the large tongue (macroglossia) and omphalocele. BWS is associated with an increased risk of nephroblastoma (Wilms tumor). The 95th percentile for height and weight is also a characteristic feature of BWS. Ultrasound and laboratory evaluation are appropriate monitoring tools for nephroblastoma in this patient due to the increased risk associated with BWS.
A: Pleuropulmonary blastoma is more commonly associated with DICER1 syndrome, not BWS.
B: Hepatocellular carcinoma is not commonly associated with BWS.
C: Cystic nephroma is not typically associated with BWS, and nephroblastoma is a more common tumor in this context.
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 is typically considered to be 1.5 to 2.5 times the normal value of activated partial thromboplastin time (aPTT). This range ensures adequate anticoagulation without increasing the risk of bleeding. Options A, B, and D are incorrect because they do not accurately reflect the therapeutic range for heparin. Option A provides a range in minutes, which is not a standard unit for aPTT measurement. Option B provides a range in seconds, which is too narrow for the therapeutic range of heparin. Option D provides a range in multiples of normal, but the upper limit of 3.0 times normal is higher than the typical upper limit of the therapeutic range for heparin.