Nokea
Which of the following is the most suitable anti malarial drug for pregnant women?
- A. Atovaquone and proguanil
- B. Quinine and doxycycline
- C. Quinine and clindamycin
- D. Primaquine
Correct Answer: C
Rationale: The correct answer is C: Quinine and clindamycin. Quinine is considered safe for use in pregnancy to treat malaria, as it has been used for many years without significant adverse effects. Clindamycin is also safe for use in pregnancy and can be used in combination with quinine to treat malaria. Atovaquone and proguanil (choice A) are not recommended for use in pregnancy due to limited safety data. Quinine and doxycycline (choice B) is not suitable for pregnant women as doxycycline is contraindicated during pregnancy. Primaquine (choice D) is not recommended for use during pregnancy as it can cause harm to the fetus.
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Best tit modality in CML is:
- A. hydroxyurea
- B. allogenic BMT
- C. interferon alpha
- D. radiotherapy
Correct Answer: B
Rationale: The best treatment modality for Chronic Myeloid Leukemia (CML) is allogenic Bone Marrow Transplant (BMT) due to its potential for cure by replacing abnormal cells with healthy donor cells. Hydroxyurea only controls symptoms, interferon alpha has limited efficacy, and radiotherapy is not a standard treatment for CML. BMT offers a curative potential by replacing cancerous cells with healthy donor cells, making it the most effective option for treating CML.
A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patient's care plan?
- A. Protective isolation and vigilant use of standard precautions
- B. Provision of a high-calorie, low-texture diet and appropriate oral hygiene
- C. Including the family in planning the patient's activities of daily living
- D. Monitoring and treating the patient's pain
Correct Answer: A
Rationale: The correct answer is A: Protective isolation and vigilant use of standard precautions. This is the priority because patients with AML undergoing induction therapy are immunocompromised and at high risk for infection. Isolating the patient and using standard precautions help prevent exposure to pathogens.
B: Providing a high-calorie, low-texture diet and oral hygiene is important but not the priority as infection control takes precedence.
C: Including the family in planning activities of daily living is beneficial for holistic care but not the priority compared to infection prevention.
D: Monitoring and treating pain is essential, but in this case, infection prevention is the priority due to the patient's immunocompromised state.
Your patient with relapsed high-risk neuroblastoma returns to your care after travelling to an outside institution for [131]I-MIBG therapy. In the weeks following [131]I-MIBG therapy, what adverse events directly attributable to this therapy will the patient most likely encounter?
- A. Myelosuppression requiring growth factor and blood product support
- B. Severe mucositis
- C. Hemorrhagic cystitis
- D. Symptomatic hypothyroidism
Correct Answer: A
Rationale: The correct answer is A: Myelosuppression requiring growth factor and blood product support.
Rationale:
1. [131]I-MIBG therapy targets neuroblastoma cells but can also affect bone marrow, leading to myelosuppression.
2. Myelosuppression can result in low blood cell counts, necessitating growth factors and blood product support.
3. Severe mucositis (B) is not a common adverse event of [131]I-MIBG therapy.
4. Hemorrhagic cystitis (C) is more commonly associated with certain chemotherapies, not [131]I-MIBG.
5. Symptomatic hypothyroidism (D) is a potential long-term side effect, not an immediate consequence following [131]I-MIBG therapy.
You are treating a patient with localized osteosarcoma of the distal femur with methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy. At week 10 of treatment, the patient undergoes complete resection of the tumor. Pathology demonstrates 40% necrosis. Which of the following represents the most appropriate further therapy?
- A. Ifosfamide and etoposide (IE)
- B. MAP plus ifosfamide and etoposide (MAPIE)
- C. Gemcitabine docetaxel
- D. MAP
Correct Answer: D
Rationale: The correct answer is D: MAP. In localized osteosarcoma, the response to preoperative chemotherapy is evaluated based on the percentage of tumor necrosis. A necrosis of 40% is considered a good response. The standard of care after surgery is to continue with the same chemotherapy regimen to complete the course. Continuing with MAP in this case is important to ensure that any remaining cancer cells are effectively treated. Option A (IE) and option B (MAPIE) are not indicated as they are different regimens and not the standard of care for this scenario. Option C (Gemcitabine docetaxel) is also not the appropriate choice as it is not the standard treatment protocol for localized osteosarcoma.
A 10-year-old patient with aplastic anemia, who is blood type B negative, is receiving a red blood cell transfusion. About 10 minutes after the transfusion starts, the patient develops anxiety and lower back pain. The transfusion continues for another 5 minutes until it is stopped when he develops a temperature of 40 °C with chills and rigors. A transfusion reaction work-up is most likely to reveal what findings?
- A. Spherocytes on peripheral blood smear
- B. Gram-negative Bacillus on gram stain of remaining RBC unit
- C. Chest x-ray with bilateral pulmonary infiltrates that are new compared to an x-ray done last week
- D. DAT positive for C3
Correct Answer: D
Rationale: The correct answer is D because in this scenario, the patient is experiencing symptoms of a transfusion reaction, likely a hemolytic transfusion reaction due to ABO incompatibility. The presence of a positive Direct Antiglobulin Test (DAT) for C3 indicates complement activation, supporting the diagnosis.
Choice A (Spherocytes on peripheral blood smear) is incorrect as spherocytes are seen in autoimmune hemolytic anemia, not typically in transfusion reactions.
Choice B (Gram-negative Bacillus on gram stain of remaining RBC unit) is unlikely as the symptoms are more indicative of a hemolytic reaction rather than an infection.
Choice C (Chest x-ray with bilateral pulmonary infiltrates) is suggestive of transfusion-related acute lung injury (TRALI), but the symptoms described in the question (fever, chills, rigors) are more indicative of a hemolytic reaction rather than TRALI.