Nokea
You are discussing prognosis with the mother of a patient with stage 3, group III rhabdomyosarcoma. Which of the following is the most unfavorable primary site?
- A. Extremity
- B. Prostate
- C. Infratemporal fossa
- D. Neck
Correct Answer: A
Rationale: The correct answer is A: Extremity. Rhabdomyosarcoma has a better prognosis when located in the extremities compared to other sites due to easier surgical resection and less risk of metastasis. Prostate (B) is less common in children and has a poorer prognosis. Infratemporal fossa (C) and neck (D) sites have a higher risk of local invasion and metastasis, leading to a worse prognosis compared to extremity sites.
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A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?
- A. Uncontrolled bleeding
- B. Myocardial infarction
- C. Respiratory depression
- D. Decreased renal perfusion
Correct Answer: A
Rationale: The correct answer is A: Uncontrolled bleeding. Aspirin is an antiplatelet medication that inhibits platelet aggregation, leading to decreased clotting ability. This places the client at risk for uncontrolled bleeding during and after surgery. Myocardial infarction (B) is not directly associated with aspirin use. Respiratory depression (C) is not a common complication of aspirin. Decreased renal perfusion (D) is not a typical complication of aspirin use.
An 8-year-old boy undergoes a resection of a tumor in the right cerebrum next to the lateral ventricle (supratentorial). The pathologist feels the histology is most consistent with an ependymoma. The tumor is sent for advanced molecular and genetic testing. Which of the following findings would further support a diagnosis of ependymoma?
- A. BRAFKIAA1549 fusion
- B. BRAFV600E mutation
- C. RELA fusion
- D. H3K27M mutation
Correct Answer: C
Rationale: The correct answer is C: RELA fusion. Ependymomas are known to have specific genetic alterations, including RELA fusions. The fusion of RELA gene is a hallmark genetic abnormality observed in certain subtypes of ependymomas, aiding in the diagnosis. Conversely, choices A, B, and D are associated with other types of brain tumors such as pilocytic astrocytoma (A), melanoma (B), and diffuse intrinsic pontine glioma (D), respectively. These genetic alterations are not characteristic of ependymomas, making them incorrect choices in this context.
A hospitalized client has a platelet count of 58,000/mm³. What action by the nurse is best?
- A. Encourage high-protein foods.
- B. Institute neutropenic precautions.
- C. Limit visitors to healthy adults.
- D. Place the client on safety precautions.
Correct Answer: D
Rationale: The correct answer is D: Place the client on safety precautions. A platelet count of 58,000/mm³ indicates thrombocytopenia, increasing the risk of bleeding. Safety precautions aim to prevent injury and minimize bleeding risks. Encouraging high-protein foods (choice A) is not directly related to managing thrombocytopenia. Instituting neutropenic precautions (choice B) is for clients with low white blood cell counts, not platelet counts. Limiting visitors to healthy adults (choice C) is important for infection control, not specifically for thrombocytopenia. In summary, placing the client on safety precautions is the best action to prevent bleeding complications.
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.
Splenectomy is curative in:
- A. G6PD def.
- B. ITP
- C. thalassemia
- D. hereditary spherocytosis
Correct Answer: D
Rationale: Rationale: Splenectomy is curative in hereditary spherocytosis because it removes the site of red blood cell destruction. The spleen is responsible for filtering out abnormal or damaged red blood cells in this condition. Removing the spleen stops the destruction of spherocytes, leading to an improvement in anemia.
Summary of other choices:
A: G6PD def. - Splenectomy does not address the underlying enzyme deficiency causing hemolysis.
B: ITP - Splenectomy is used in refractory cases of ITP, but not considered curative.
C: Thalassemia - Splenectomy can be used to manage complications in thalassemia but does not cure the underlying genetic defect.