Nokea
Which of the following is false regarding Burkitt's lymphoma?
- A. Associated with translocation of c-myc gene on chromosome 18
- B. Usually presents with abdominal involvement in HIV patients
- C. Common in Africa children due to Epstein Barr infection after malaria exposure.
- D. Histologically characterized by a 'starry sky' appearance
Correct Answer: A
Rationale: The correct answer is A because Burkitt's lymphoma is associated with translocation of c-myc gene on chromosome 8, not chromosome 18. This translocation leads to uncontrolled cell proliferation. Choice B is incorrect because Burkitt's lymphoma commonly presents with jaw or facial bone involvement in HIV patients. Choice C is incorrect as the association between Epstein Barr infection and malaria exposure in African children increases the risk of Burkitt's lymphoma. Choice D is incorrect because Burkitt's lymphoma is histologically characterized by a 'starry sky' appearance due to macrophages engulfing apoptotic tumor cells, not due to the presence of the c-myc translocation.
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A patient with non-Hodgkin's lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurse's best response?
- A. Everyone should do these things because they're health promotion activities that apply to everyone.
- B. You don't want to develop a second cancer, do you?
- C. You need to do this just to be on the safe side.
- D. It's important to reduce other factors that increase the risk of second cancers.
Correct Answer: D
Rationale: The correct answer is D because reducing factors that increase the risk of second cancers is crucial for a patient with non-Hodgkin's lymphoma due to the potential for developing secondary cancers. Alcohol, smoking, and sun exposure are known risk factors for various cancers, including secondary cancers. By avoiding these behaviors, the patient can decrease the likelihood of developing another cancer.
Choice A is incorrect because while health promotion activities are beneficial, the specific reason for a patient with non-Hodgkin's lymphoma to stop drinking, smoking, and avoiding sun exposure is to reduce the risk of second cancers, not just for general health.
Choice B is incorrect because it uses fear tactics and does not provide a clear rationale for why the patient should make these lifestyle changes.
Choice C is incorrect because it lacks a specific explanation for the importance of avoiding alcohol, smoking, and sun exposure in relation to reducing the risk of second cancers.
A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding?
- A. Hematocrit of 35%
- B. Hemoglobin of 11.8 g/dL
- C. Platelet count of 400000/L
- D. White blood cell (WBC) count of 2800/L
Correct Answer: D
Rationale: The correct answer is D because a low WBC count of 2800/L indicates leukopenia, which can compromise the immune system in older adults, leading to increased susceptibility to infections. This finding is concerning as it can pose serious health risks.
A: A hematocrit of 35% is within the normal range for older adults and not a cause for concern.
B: A hemoglobin level of 11.8 g/dL is slightly lower but still within an acceptable range for older adults and unlikely to be a major concern.
C: A platelet count of 400000/L is within the normal range and would not be a significant worry for the nurse.
In summary, a low WBC count can indicate a weakened immune system, making it the most concerning finding among the choices given.
A 20-month-old otherwise healthy male presents late for his 18-month well child check. During his first year of life, he took iron-fortified formula and had a point-of-care hemoglobin (Hgb) of 12 g/dL at his 1-year well child check. His mother reports that he is a picky eater but loves milk and has recently become obsessive about chewing the corners of his cardboard books. Physical examination is normal except for a flow murmur. Which combination of laboratory test results listed below would most likely characterize this patient?
- A. Hgb 8.7 g/dL, mean corpuscular volume (MCV) 60 fL, serum ferritin 2 ng/mL
- B. Hgb 12.0 g/dL, MCV 80 fL, serum ferritin 30 ng/mL
- C. Hgb 9.2 g/dL, MCV 60 fL, serum ferritin 30 ng/mL
- D. Hgb 11.2 g/dL, MCV 90 fL, serum ferritin 7 ng/mL
Correct Answer: A
Rationale: The correct answer is A because it indicates iron deficiency anemia. The low Hgb of 8.7 g/dL is below normal range for his age. The MCV of 60 fL is low, indicating microcytic anemia which is characteristic of iron deficiency. The serum ferritin level of 2 ng/mL is very low, supporting the diagnosis.
Choice B is incorrect as the Hgb and MCV are within normal range, and the ferritin level is not indicative of iron deficiency. Choice C has a low Hgb but normal MCV and ferritin level. Choice D has a normal Hgb and low ferritin, but the MCV is high, inconsistent with iron deficiency anemia.
A 17-year-old patient is referred to you for a platelet count of 1,200,000/mm3. On history, she notes that she often has numbness and tingling in her hands and feet and has frequent epistaxis. She is otherwise well-appearing and has no recent infections. On her exam, you note splenomegaly. What do you expect to see on further evaluation?
- A. Elevated C-reactive protein
- B. Low ferritin
- C. A hypocellular bone marrow
- D. Low von Willebrand factor activity
Correct Answer: D
Rationale: The correct answer is D: Low von Willebrand factor activity. A platelet count of 1,200,000/mm3 suggests thrombocytosis, which can be seen in conditions like essential thrombocythemia. This condition is associated with low von Willebrand factor activity, leading to increased bleeding tendency despite high platelet counts. Numbness, tingling, epistaxis, and splenomegaly are common features of essential thrombocythemia. Elevated C-reactive protein is not typically associated with this condition. Low ferritin is more indicative of iron deficiency anemia, not thrombocytosis. A hypocellular bone marrow is not expected in essential thrombocythemia, as it is characterized by increased platelet production.
Koilonychias is a specific feature of
- A. Hemolytic anemia
- B. Sickle cell disease
- C. Thalassemia major
- D. Iron deficiency anemia
Correct Answer: D
Rationale: Step-by-step rationale for why the correct answer is D (Iron deficiency anemia):
1. Koilonychias is characterized by spoon-shaped nails, a classic sign of iron deficiency anemia due to changes in nail structure.
2. Iron deficiency leads to decreased production of keratin, causing nail deformities like koilonychias.
3. Hemolytic anemia (choice A) and Sickle cell disease (choice B) are not typically associated with koilonychias.
4. Thalassemia major (choice C) can cause nail changes, but koilonychias is more commonly seen in iron deficiency anemia.