Nokea
Which of the following is a cause of secondary neutropaenia in adults?
- A. Congenital
- B. Anti-hypertensive drugs
- C. Part of general pancytopaenia
- D. Familial
Correct Answer: C
Rationale: The correct answer is C: Part of general pancytopenia. Secondary neutropenia in adults can occur as part of general pancytopenia, where there is a decrease in all blood cell types. This can be caused by various conditions such as infections, medications, autoimmune disorders, and bone marrow disorders.
Rationale:
A: Congenital is incorrect because congenital neutropenia refers to a condition present at birth, not secondary neutropenia.
B: Anti-hypertensive drugs may cause drug-induced neutropenia, but it is not the primary cause of secondary neutropenia in adults.
D: Familial neutropenia is a genetic disorder that runs in families and is not a common cause of secondary neutropenia in adults.
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A 4-year-old male child presents to the emergency department with his fourth invasive Staph infection. CBC consistently identifies moderate neutropenia. Sophisticated lab testing identifies lack of Toll-like receptor responses. The patient undergoes whole exome sequencing and is found to have pathogenic variants in IRAK4. What does 'IRAK4' stand for?
- A. Interferon gamma receptor-associated kinase 4
- B. Inducible RAS activating kinase 4
- C. Interleukin-1 receptor-associated kinase 4
- D. Immune response activating kinase 4
Correct Answer: C
Rationale: The correct answer is C: Interleukin-1 receptor-associated kinase 4 (IRAK4).
1. IRAK4 is involved in the immune response pathway triggered by interleukin-1 receptor signaling.
2. Lack of Toll-like receptor responses in the patient aligns with the role of IRAK4 in the interleukin-1 receptor pathway.
3. Pathogenic variants in IRAK4 can lead to immunodeficiency, explaining recurrent Staph infections.
4. Choices A, B, and D do not accurately reflect the known function of IRAK4 and its association with interleukin-1 receptor signaling.
In the laboratory diagnosis of leishmaniasis, the expected parasite stage in vitro is
- A. Amastigote
- B. Promastigote
- C. Trypomastigote
- D. Schizont
Correct Answer: B
Rationale: The correct answer is B: Promastigote. In the laboratory diagnosis of leishmaniasis, the parasite stage typically observed in vitro is the promastigote stage. This is because promastigotes are the infective form of the parasite found in the sandfly vector. When a sample is taken from a patient, it is cultured in a suitable medium where promastigotes develop. Amastigotes (choice A) are the intracellular form found in the host, not typically observed in vitro. Trypomastigotes (choice C) are the stage found in Trypanosoma species, not Leishmania. Schizonts (choice D) are a stage in the life cycle of Plasmodium species causing malaria, not Leishmania. Promastigotes are the stage most commonly used for laboratory diagnosis and research in leishmaniasis.
Sickle cell an. Is not complicated by:
- A. papillary necrosis
- B. pancreatitis
- C. osteomyelitis
- D. CHF
Correct Answer: B
Rationale: Step-by-step rationale for choice B (pancreatitis) being correct:
1. Sickle cell anemia primarily affects red blood cells, leading to vaso-occlusive crises.
2. Pancreatitis is not a known complication of sickle cell anemia.
3. Complications of sickle cell anemia commonly involve organs affected by sickling, such as the bones (osteomyelitis), kidneys (papillary necrosis), and heart (CHF).
Summary:
A: Papillary necrosis - Correct, as it can affect the kidneys in sickle cell anemia.
B: Pancreatitis - Correct, as it is not a typical complication of sickle cell anemia.
C: Osteomyelitis - Incorrect, as it can affect the bones in sickle cell anemia.
D: CHF - Incorrect, as it can affect the heart in sickle cell anemia.
A study is designed to investigate the rates of central line–associated blood stream infections among pediatric hematology/oncology patients. Three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]) were included in the study. What data structure is central line type?
- A. Continuous
- B. Dichotomous
- C. Nominal
- D. Ordinal
Correct Answer: C
Rationale: The correct answer is C: Nominal. Central line type is a nominal data structure because it represents categories without any inherent order or ranking. In this study, the central line types (port, PICC, TEC) are distinct categories with no numerical significance or order. They are simply different types of central lines used for medical purposes. Continuous (A) data involves numerical values with infinite possibilities, which is not the case here. Dichotomous (B) data consists of only two categories, while in this study there are three central line types. Ordinal (D) data involves categories with a specific order or ranking, which is not applicable to central line types as they do not have a natural order.
A nurse is monitoring a client who is undergoing anticoagulant therapy with heparin. Which of the following findings should the nurse identify as a possible indication of hemorrhage?
- A. Rapid pulse
- B. Yellowing of the sclera
- C. Elevated blood pressure
- D. Pale-colored stools
Correct Answer: A
Rationale: The correct answer is A: Rapid pulse. When a client is undergoing anticoagulant therapy with heparin, the nurse should monitor for signs of hemorrhage. A rapid pulse can indicate internal bleeding, a common complication of anticoagulant therapy. Other choices such as B: Yellowing of the sclera, C: Elevated blood pressure, and D: Pale-colored stools are not typically associated with hemorrhage. Yellowing of the sclera may indicate jaundice, elevated blood pressure may be related to other conditions, and pale-colored stools may indicate liver or gallbladder issues. Rapid pulse is the most pertinent finding related to hemorrhage in this context.