Nokea
Waldeyer's ring does not include:
- A. faucal tonsils
- B. submandibular glands
- C. adenoids
- D. lingual tonsils
Correct Answer: B
Rationale: The correct answer is B: submandibular glands. Waldeyer's ring consists of a ring of lymphoid tissue in the pharynx, including the palatine tonsils (faucal tonsils), adenoids, and lingual tonsils. Submandibular glands are salivary glands located beneath the mandible and are not part of Waldeyer's ring. Therefore, B is the correct answer. Choices A, C, and D are incorrect because they are all components of Waldeyer's ring.
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A 5-year-old boy presents with a 3-week history of his right eye “not moving to the right side.†The remainder of his neurologic exam is normal with the exception of a weak gag. MRI of the brain reveals a diffusely infiltrative mass in the pons. If this patient were to undergo a stereotactic biopsy, what would be the most likely molecular finding?
- A. BRAFKIAA1549 fusion
- B. Trisomy 21
- C. H3 K27M mutation
- D. RELA fusion
Correct Answer: C
Rationale: The correct answer is C: H3 K27M mutation. In children with diffuse midline gliomas, the most common molecular finding is the H3 K27M mutation. This mutation is associated with a worse prognosis and is commonly found in tumors located in the pons, which is consistent with the MRI findings in this case.
Choice A (BRAFKIAA1549 fusion) is incorrect as this fusion is typically associated with pilocytic astrocytomas, which are low-grade tumors and not typically found in the pons.
Choice B (Trisomy 21) is incorrect as it is a chromosomal abnormality associated with Down syndrome, not a molecular finding in brain tumors.
Choice D (RELA fusion) is incorrect as this fusion is typically found in ependymomas, which are not typically located in the pons.
You have a new patient consult in clinic this morning. The referral packet includes the newborn screen report, which is flagged abnormal hemoglobinopathy screen, F, A, Bart's, refer to hematology, and a complete blood count done at 4 years of age with a hemoglobin of 10 g/dL and an MCV of 68. The pediatrician has informed the parents the child has some form of alpha thalassemia. The older brother had the same newborn screen results but had a normal complete blood count when checked. The mother wants to know why her second child has an abnormal complete blood count when she and her husband do not have any blood problems. How would you respond to the child's mother?
- A. The mother and father are both silent carriers and each passed a deleted alpha globin allele to their child. The child inherited a trans-deletion genotype alpha thalassemia trait.
- B. The mother has cis deletion alpha thalassemia and the father has no alpha globin deletion, giving the child alpha thalassemia trait.
- C. Neither parent has an alpha globin deletion; this was a new spontaneous mutation causing alpha thalassemia in the child.
- D. Both parents carry cis deletions in the alpha globin gene cluster.
Correct Answer: A
Rationale: Rationale for correct answer A:
1. Both parents must be carriers for the child to have alpha thalassemia.
2. The child has an abnormal complete blood count, indicating a hemoglobinopathy.
3. The child inherited a trans-deletion genotype alpha thalassemia trait from both parents.
4. Silent carriers have no symptoms but can pass on the trait.
Summary for incorrect choices:
B: In cis deletion, both parents would have to pass on the trait, which is not the case here.
C: Spontaneous mutation is unlikely for alpha thalassemia.
D: Both parents having cis deletions would result in a more severe form of alpha thalassemia.
A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?
- A. Protamine
- B. Desmopressin
- C. Ferrous sulfate
- D. Heparin
Correct Answer: D
Rationale: The correct answer is D: Heparin. Following an acute MI, a client receiving alteplase may also be prescribed heparin to prevent re-thrombosis and further clot formation. Alteplase is a thrombolytic agent that works by breaking down clots, while heparin is an anticoagulant that helps prevent new clots from forming. Protamine (choice A) is used to reverse the effects of heparin, not typically administered alongside alteplase. Desmopressin (choice B) is used for conditions like diabetes insipidus, unrelated to MI treatment. Ferrous sulfate (choice C) is an iron supplement, not indicated in this scenario.
The nurse is assessing a client experiencing anemia. Which laboratory findings will the nurse expect for this client? (Select all that apply.)
- A. Increased hematocrit
- B. Decreased red blood cell count
- C. Decreased serum iron
- D. Decreased hemoglobin
Correct Answer: b
Rationale: The correct answer is B: Decreased red blood cell count. Anemia is characterized by a decrease in the number of red blood cells, leading to a lower than normal red blood cell count. In anemia, the body cannot transport enough oxygen to tissues, leading to symptoms such as fatigue and shortness of breath. Increased hematocrit (A) and decreased hemoglobin (D) are related to anemia but not specific enough to be conclusive. Decreased serum iron (C) may be seen in iron-deficiency anemia but is not always present in all types of anemia.
A young child with consanguineous parents has developmental delay and a history of multiple recurrent bacterial infections and short stature. He presents to the emergency department following trauma and requires a blood transfusion. Blood work identifies leukocytosis, neutrophilia, and the Bombay blood group (absent H antigen as well as absent A and B antigens). What is this patient's diagnosis?
- A. Chediak-Higashi syndrome
- B. Leukocyte adhesion deficiency (LAD) Type II
- C. CD18 deficiency
- D. Griscelli syndrome
Correct Answer: B
Rationale: The correct answer is B: Leukocyte adhesion deficiency (LAD) Type II. This diagnosis is supported by the patient's history of recurrent bacterial infections, leukocytosis, neutrophilia, and the Bombay blood group. LAD Type II is characterized by a defect in the CD18 integrin molecules, leading to impaired leukocyte adhesion and migration to sites of infection. The Bombay blood group is due to the absence of H antigen, which is also seen in LAD Type II.
A: Chediak-Higashi syndrome is characterized by recurrent infections, albinism, and peripheral neuropathy, not leukocyte adhesion deficiency.
C: CD18 deficiency is actually another term for LAD Type I, not LAD Type II.
D: Griscelli syndrome presents with silvery hair and immunodeficiency, but does not involve leukocyte adhesion deficiency.