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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A 13-year-old Hispanic girl is found to have a WBC count of 6,500/mm3 with 40% Auer rod–containing granular blasts that, by flow cytometry, express very bright CD33 but are negative for human leukocyte antigen–DR isotype (HLA-DR). She is oozing blood around her peripheral IV site. Coagulation studies reveal an international normalized ratio (INR) of 3.4, a fibrinogen of 170, and a markedly elevated D-dimer. Marrow aspirate shows nearly 90% blasts with a similar morphology. You send the marrow to the fluorescence in situ hybridization (FISH) lab and request STAT testing for the most likely recurrent genetic abnormality based on the clinical presentation. How do you plan to initiate therapy?
- A. Perform a lumbar puncture to determine leukemic involvement, then proceed with induction chemotherapy.
- B. Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.
- C. Start dexamethasone and hydroxyurea immediately while aggressively managing coagulopathy with blood product support.
- D. Start induction chemotherapy, obtain HLA typing, and start a donor search because of the poor prognosis associated with this leukemic phenotype.
Correct Answer: B
Rationale: The correct answer is B: Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support. The patient's presentation is consistent with acute promyelocytic leukemia (APL), indicated by the presence of Auer rod-containing blasts, very bright CD33 expression, and coagulopathy (elevated INR, low fibrinogen, elevated D-dimer). APL is associated with a specific genetic abnormality involving the PML-RARA fusion gene. ATRA is the mainstay of induction therapy for APL as it induces differentiation of leukemic promyelocytes. Aggressive management of coagulopathy is crucial to prevent life-threatening bleeding complications.
Incorrect answers:
A: Performing a lumbar puncture is not necessary at this stage as the patient's symptoms and laboratory findings point towards APL, not central nervous system involvement.
C: Dexamethasone and hydroxyurea are not
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. The central line type is a categorical variable with no inherent order or ranking. Each type is distinct and cannot be quantitatively ordered or measured. It is not continuous (A), as it is not on a scale. It is not dichotomous (B) as there are more than two categories. It is not ordinal (D) because the types do not have a clear order or ranking. Therefore, central line type is best represented by a nominal data structure.
A client is having a bone marrow aspiration and biopsy. What action by the nurse takes priority?
- A. Administer pain medication first.
- B. Ensure that valid consent is in the medical record.
- C. Have the client shower in the morning.
- D. Premedicate the client with sedatives.
Correct Answer: B
Rationale: The correct answer is B: Ensure that valid consent is in the medical record. This is the priority because obtaining informed consent is essential before any invasive procedure like a bone marrow aspiration and biopsy. It ensures that the client understands the procedure, risks, benefits, and alternatives. Administering pain medication (A), having the client shower (C), and premedicating with sedatives (D) are important aspects of care but obtaining valid consent is crucial for legal and ethical reasons before proceeding with the procedure.
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 Langerhans cell histiocytosis (LCH), involvement of high-risk organs like the liver, spleen, and bone marrow can occur. Serum albumin and total protein levels can indicate liver involvement as hypoalbuminemia and hypoproteinemia can be seen in liver dysfunction. The other choices, A (Reticulocyte count), B (Erythrocyte sedimentation rate), and C (Alkaline phosphatase) are not specific for evaluating high-risk organ involvement in LCH. Reticulocyte count is related to red blood cell production, ESR is a nonspecific marker of inflammation, and alkaline phosphatase is commonly elevated in various conditions, not specific for high-risk organ involvement in LCH.
In iron deficiency anemia there is characteristically
- A. An atrophic gastritis
- B. A low mean corpuscular volume
- C. A reduced total iron binding capacity
- D. Megaloblastic changes in the bone marrow
Correct Answer: B
Rationale: Step-by-step rationale:
1. Iron deficiency leads to decreased hemoglobin synthesis, resulting in smaller red blood cells.
2. Mean corpuscular volume (MCV) measures the average size of red blood cells.
3. In iron deficiency anemia, MCV is low due to the smaller red blood cells.
4. Therefore, choice B is correct as it reflects the characteristic feature of iron deficiency anemia.
Summary:
A: Atrophic gastritis is seen in pernicious anemia, not iron deficiency anemia.
C: Total iron binding capacity is increased, not reduced, in iron deficiency anemia.
D: Megaloblastic changes in the bone marrow are seen in megaloblastic anemias, not iron deficiency anemia.