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You are caring for a patient with a large localized Ewing sarcoma of the soft tissues of the arm. The surgeon believes that the tumor can be resected without amputation but asks whether you can give some chemotherapy to shrink the tumor before surgery. Which of the following would you tell the surgeon?
- A. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy to improve the prognosis.
- B. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will not be necessary if the tumor is completely resected at week 12 of therapy.
- C. You agree with waiting to do the resection until week 12 of therapy and will begin chemotherapy; you recognize that radiotherapy will be necessary even if the tumor is completely resected at week 12 of therapy.
- D. If the tumor can be resected without amputation, then the best time to do the resection is before any chemotherapy; you recognize that this is the only way to avoid radiotherapy.
Correct Answer: B
Rationale: The correct answer is B because starting chemotherapy before resection at week 12 can help shrink the tumor, making it more manageable for surgery. A is incorrect because preoperative chemotherapy can improve outcomes. C is incorrect because radiotherapy may not be necessary if the tumor is completely resected. D is incorrect because radiotherapy may still be necessary even if the tumor is resected before chemotherapy.
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A 19-year-old freshman in college presents with 'lumps' on the right side of his neck and in the right axilla. He had a fever to 39 °C 1 day in the past week. On physical exam, there are firm anterior cervical and axillary nodes, all greater than 2 cm in diameter. A chest x-ray shows a large mediastinal mass. A biopsy of the axillary node reveals classic Hodgkin lymphoma. Which of the following symptoms revealed during the history is a B symptom?
- A. Fever to 39 °C
- B. 10% weight loss in past 6 months
- C. Fatigue
- D. Alcohol-induced pain
Correct Answer: B
Rationale: The correct answer is B: 10% weight loss in the past 6 months. In Hodgkin lymphoma, B symptoms include unexplained weight loss of more than 10% in the past 6 months, fever >38°C, and night sweats. Weight loss is a significant indicator of systemic illness and malignancy. In this case, the patient's weight loss, along with the presence of fever and lymphadenopathy, fulfills the criteria for B symptoms in Hodgkin lymphoma. Choices A, C, and D are incorrect because fever, fatigue, and alcohol-induced pain are not specifically classified as B symptoms in the context of Hodgkin lymphoma. Fever alone does not qualify as a B symptom unless it is associated with other systemic symptoms like weight loss and night sweats. Fatigue can be a nonspecific symptom in many conditions, and alcohol-induced pain is not a recognized B symptom in Hodgkin lymphoma.
A patient who is suspected of having acute viral hemorrhagic fever reveals history of tick bite. Which of the following is the most possible causative agent?
- A. Hantavirus
- B. Rift Valley virus
- C. Crimean Congo virus
- D. Marburg virus
Correct Answer: C
Rationale: The correct answer is C: Crimean Congo virus. This is the most likely causative agent of acute viral hemorrhagic fever following a tick bite due to its association with tick transmission. Crimean Congo virus is a tick-borne virus that causes severe hemorrhagic fever in humans. The other options, Hantavirus, Rift Valley virus, and Marburg virus, are not typically transmitted by ticks. Hantavirus is spread through rodent feces, Rift Valley virus is transmitted by mosquitoes, and Marburg virus is transmitted through direct contact with infected animals or their bodily fluids. Therefore, based on the history of tick bite, Crimean Congo virus is the most probable causative agent.
The health care provider tells the nurse that a client is to be started on a platelet inhibitor. About what drug does the nurse plan to teach the client?
- A. Clopidogrel (Plavix)
- B. Enoxaparin (Lovenox)
- C. Reteplase (Retavase)
- D. Warfarin (Coumadin)
Correct Answer: A
Rationale: The correct answer is A: Clopidogrel (Plavix). Platelet inhibitors like Clopidogrel work by preventing blood clots by inhibiting platelet aggregation. Clopidogrel is commonly used to reduce the risk of heart attack and stroke. Enoxaparin (Lovenox) is a low molecular weight heparin used to prevent blood clots. Reteplase (Retavase) is a thrombolytic agent used to dissolve blood clots. Warfarin (Coumadin) is an anticoagulant that works by inhibiting clotting factors in the liver, but it does not directly target platelets like Clopidogrel.
A nurse is administering epoetin intravenously to a client who has renal failure. Which of the following actions should the nurse take?
- A. Shake the vial before using.
- B. Administer via IV bolus over 1 to 3 min.
- C. Dilute the drug first with D5W.
- D. Save the used vial for the next dose.
Correct Answer: B
Rationale: The correct answer is B: Administer via IV bolus over 1 to 3 min. This route and method of administration is appropriate for epoetin to ensure proper absorption and effect. Shaking the vial (A) can denature the drug. Diluting with D5W (C) is not recommended as it may alter the drug's effectiveness. Saving the used vial for the next dose (D) is unsafe and violates infection control practices.
You are seeing a 12-year-old female who presented to the emergency department with the sudden onset of severe abdominal pain. Imaging that was obtained to rule out appendicitis revealed a mass adjacent to the bladder. The mass was surgically resected, and pathology demonstrated a paraganglioma. Which of the studies below would be most useful to determine disease stage for this patient?
- A. Bone Scan
- B. Lumbar puncture for cerebrospinal fluid cytology
- C. Bone marrow aspirate and biopsy
- D. Ga 68-DOTATATE PET/CT
Correct Answer: D
Rationale: The correct answer is D: Ga 68-DOTATATE PET/CT. Paragangliomas are neuroendocrine tumors that can secrete catecholamines and have a high expression of somatostatin receptors. Ga 68-DOTATATE PET/CT is the most appropriate imaging study to determine disease stage in patients with paragangliomas because it can detect the somatostatin receptor expression in these tumors, aiding in localization, staging, and treatment planning.
A: Bone scan is not the most useful study for determining disease stage in paraganglioma.
B: Lumbar puncture for cerebrospinal fluid cytology is not relevant for staging paraganglioma.
C: Bone marrow aspirate and biopsy are not the most appropriate studies for staging paraganglioma.