Nokea
Which of the following requires IL-2 and IL-4 in the conversion of unilineage progenitor cell into mature circulating cell?
- A. Neutrophil
- B. Eosinophil
- C. Basophil
- D. B lymphocyte
Correct Answer: D
Rationale: The correct answer is D: B lymphocyte. IL-2 and IL-4 are essential for the differentiation of B lymphocytes from unilineage progenitor cells into mature circulating cells. IL-2 is crucial for B cell proliferation and survival, while IL-4 is required for B cell activation and class switching. Neutrophils do not require IL-2 and IL-4 for differentiation. Eosinophils are primarily influenced by IL-5. Basophils are influenced by IL-3 and IL-5. Therefore, B lymphocytes are the only cell type among the choices that specifically requires IL-2 and IL-4 for their maturation.
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The typical Reed-Sternberg cells are either infrequent or absent. Instead, lymphocytic and histiocytic cells or 'popcorn cells' are seen within a background of inflammatory cells, which are predominantly benign lymphocytes. Which type of Hodgkin's lymphoma best suit the description?
- A. Nodular sclerosis
- B. Mixed cellularity
- C. Lymphocyte depleted
- D. Lymphocyte predominance
Correct Answer: D
Rationale: Rationale for Choice D (Lymphocyte predominance):
1. Reed-Sternberg cells are infrequent or absent in lymphocyte predominance Hodgkin's lymphoma.
2. 'Popcorn cells' are seen in lymphocyte predominance Hodgkin's lymphoma.
3. Predominance of benign lymphocytes in the background is characteristic of lymphocyte predominance Hodgkin's lymphoma.
Summary of other choices:
A: Nodular sclerosis - Characterized by collagen bands dividing lymph node into nodules, not 'popcorn cells'.
B: Mixed cellularity - Reed-Sternberg cells present, not 'popcorn cells'.
C: Lymphocyte depleted - Few to no lymphocytes seen, not benign lymphocytes as described in the question.
A 2-month-old infant is brought to your clinic with an extensive scaly rash on the scalp, which has been biopsied and shown to be Langerhans cell histiocytosis (LCH). You want to determine whether this patient has skin-only LCH or involvement of any of the 'high-risk' organs. The child has a normal CBC; normal liver enzymes and bilirubin; and a normal skeletal survey, skull films, and chest X ray. What other screening test will be important for finding involvement of a high-risk organ?
- A. Reticulocyte count
- B. Erythrocyte sedimentation rate
- C. Alkaline phosphatase
- D. Serum albumin and total protein
Correct Answer: D
Rationale: The correct answer is D: Serum albumin and total protein. In LCH, high-risk organ involvement includes the liver and spleen. Serum albumin and total protein levels can help assess liver function, as low levels may indicate liver involvement. A normal CBC, liver enzymes, and bilirubin do not rule out organ involvement, as LCH can affect organs without causing significant abnormalities in these tests. Reticulocyte count (A) is not relevant for assessing high-risk organ involvement in LCH. Erythrocyte sedimentation rate (B) is a nonspecific marker of inflammation and not specific for organ involvement. Alkaline phosphatase (C) is more indicative of bone or liver disease rather than specifically assessing high-risk organ involvement in LCH.
An otherwise healthy 18-year-old female is diagnosed with high-risk neuroblastoma after presenting with fatigue and bony pain. Imaging findings demonstrate a left adrenal mass with multiple osseous metastases. She successfully completes standard therapy for high-risk neuroblastoma, but experiences several episodes of disease recurrence and ultimately dies of her disease 10 years after her initial diagnosis. During her treatment, her tumor was sent for molecular analysis. Of the following, what molecular aberration was most likely to have been detected?
- A. ETV6-NTRK3 gene fusion
- B. PTPN11 mutation
- C. ATRX mutation
- D. WT1 mutation
Correct Answer: C
Rationale: The correct answer is C: ATRX mutation. In neuroblastoma, ATRX mutations are associated with poor prognosis and high-risk disease. ATRX gene mutations are commonly found in cases with aggressive behavior and poor outcomes, such as in this case where the patient experienced disease recurrence and ultimately died. ATRX mutations are linked to chromosomal instability and telomere dysfunction, which can contribute to tumor progression and resistance to therapy.
A: ETV6-NTRK3 gene fusion is more commonly associated with infantile fibrosarcoma and secretory breast carcinoma, not neuroblastoma.
B: PTPN11 mutations are typically seen in juvenile myelomonocytic leukemia and Noonan syndrome, not neuroblastoma.
D: WT1 mutations are more commonly found in Wilms tumor and acute myeloid leukemia, not neuroblastoma.
In summary, the ATRX mutation is the most likely molecular aberration detected in this patient with high-risk neuroblast
The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient?
- A. Do you take salicylates?
- B. Are you taking any oral contraceptives?
- C. Have you been prescribed antiseizure drugs?
- D. How long have you taken antihypertensive drugs?
Correct Answer: A
Rationale: The correct answer is A: Do you take salicylates? Petechiae can be a sign of salicylate use, which can cause bleeding disorders. By asking about salicylates, the nurse can determine if the petechiae are related to medication. Choice B is not directly related to petechiae. Choice C is more specific to antiseizure drugs and not commonly associated with petechiae. Choice D is unrelated to petechiae and focuses on hypertension management. Asking about salicylates is the most appropriate to assess potential medication-induced petechiae.
The commonest cause of jaundice in thalassemia is:
- A. viral hepatitis c
- B. iron deposition in liver
- C. viral hepatitis B
- D. haemolysis
Correct Answer: D
Rationale: The correct answer is D: haemolysis. In thalassemia, there is an abnormality in hemoglobin production leading to the destruction of red blood cells, causing hemolysis. This results in the release of bilirubin, leading to jaundice. Iron deposition in the liver (choice B) is seen in conditions like hemochromatosis, not thalassemia. Viral hepatitis B and C (choices A and C) can cause jaundice, but they are not the commonest cause in thalassemia patients, as hemolysis is the primary mechanism in this population.