Nokea
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. This imaging study is the most useful for determining the disease stage in a patient with paraganglioma. Paragangliomas are neuroendocrine tumors that express somatostatin receptors, which can be detected using Ga 68-DOTATATE PET/CT. This imaging modality helps to localize primary and metastatic lesions, as well as assess disease extent and stage.
Now let's analyze the other options:
A: Bone Scan - Not useful for determining disease stage in paraganglioma.
B: Lumbar puncture for cerebrospinal fluid cytology - Not indicated for staging paraganglioma.
C: Bone marrow aspirate and biopsy - Not specific for staging paraganglioma.
In summary, Ga 68-DOTATATE PET/CT is the most appropriate study for determining disease stage in a patient with paraganglioma due to its
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A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding?
- A. Have you had a recent weight loss?
- B. Do you have any history of lung disease?
- C. Have you noticed any dark or bloody stools?
- D. What is your dietary intake of meats and protein?
Correct Answer: B
Rationale: The correct answer is B: Do you have any history of lung disease? A high hemoglobin and hematocrit can be indicative of chronic hypoxia, often seen in lung diseases like COPD. The nurse should ask about lung disease to explore the possibility of chronic hypoxia as the underlying cause. Choices A, C, and D are incorrect as they do not directly relate to the potential cause of elevated hemoglobin and hematocrit levels in this scenario.
A 4-year-old boy is pale with intermittent jaundice and splenomegaly. Laboratory results are as follows: RBC 4.85 M/mcL (N); Hgb 8.6 g/dL (L); Hct 25.8% (L); MCV 81.6 (N); MCHC 38% (H); RDW 20% (H); Retic 7% (H). What are the two best tests to distinguish autoimmune hemolytic anemia from hereditary spherocytosis?
- A. Free erythrocyte protoporphyrin and IgG levels
- B. Hemoglobin electrophoresis and direct antiglobulin test (DAT)
- C. Lactate dehydrogenase (LDH) and modified Russell viper venom test
- D. Red cell distribution width (RDW) and mean corpuscular hemoglobin concentration (MCHC)
Correct Answer: E
Rationale: As the correct answer is not provided, I'll provide a step-by-step rationale for each choice:
A: Free erythrocyte protoporphyrin and IgG levels are not specific tests for distinguishing between autoimmune hemolytic anemia and hereditary spherocytosis.
B: Hemoglobin electrophoresis and direct antiglobulin test (DAT) can help differentiate between these two conditions as autoimmune hemolytic anemia is associated with a positive DAT, while hereditary spherocytosis typically has a negative DAT.
C: Lactate dehydrogenase (LDH) and modified Russell viper venom test are not specific tests for distinguishing between autoimmune hemolytic anemia and hereditary spherocytosis.
D: Red cell distribution width (RDW) and mean corpuscular hemoglobin concentration (MCHC) are not typically used to distinguish between autoimmune hemolytic anemia and hereditary spherocytosis.
Therefore, the best tests
A 4-year-old child with acute lymphoblastic leukemia is receiving high-dose methotrexate during interim maintenance. He receives ondansetron and арrepitant during his stay, which control his nausea and vomiting well. These medications work by inhibiting signaling in which part of the brain?
- A. Vestibular system
- B. Cerebral cortex
- C. Hypothalamus
- D. Vomiting center
Correct Answer: E
Rationale: The correct answer is D: Vomiting center. Ondansetron and aprepitant are antiemetic medications that work by inhibiting signaling in the vomiting center of the brain. The vomiting center is located in the medulla oblongata in the brainstem, which plays a crucial role in triggering the reflexes that lead to nausea and vomiting. By blocking signals in the vomiting center, these medications effectively prevent and control nausea and vomiting.
Incorrect choices:
A: The vestibular system is responsible for balance and spatial orientation, not for controlling nausea and vomiting.
B: The cerebral cortex is involved in higher brain functions such as thinking and decision-making, not in regulating nausea and vomiting.
C: The hypothalamus regulates various physiological processes like temperature regulation and hormone release, but it is not directly involved in controlling nausea and vomiting.
A 9-year-old boy presents to the emergency department with emesis and headache of 3 weeks' duration. MRI reveals a large heterogeneous mass in the cerebellum. He undergoes a resection, and the pathology is most consistent with a classic medulloblastoma. Which of the following findings would classify the patient as a high-risk medulloblastoma?
- A. Elevated serum and CSF AFP and beta-HCG tumor markers
- B. WNT subgrouping on molecular classification
- C. A presurgical spine MRI that reveals bulky tumor in the spine
- D. A postoperative brain MRI with no signs of residual tumor
Correct Answer: C
Rationale: The correct answer is C. A presurgical spine MRI revealing bulky tumor in the spine classifies the patient as high-risk due to leptomeningeal spread. This indicates dissemination of the tumor cells beyond the primary site, leading to a poorer prognosis. Choice A is incorrect as AFP and beta-HCG markers are associated with germ cell tumors, not medulloblastomas. Choice B is incorrect as WNT subgrouping is associated with better outcomes. Choice D is incorrect because the absence of residual tumor postoperatively does not necessarily indicate high-risk disease.
A nurse is caring for a client who is about to begin therapy with recombinant factor IX to treat hemophilia B. The client asks the nurse about the risk of disease transmission with recombinant factor IX as compared with plasma derived factor IX. The nurse should explain that the recombinant factor IX practically eliminates the risk for which of the following?
- A. HIV
- B. Cytomegalovirus
- C. Creutzfeldt-Jakob disease
- D. Anaphylaxis
Correct Answer: C
Rationale: Rationale: The correct answer is C: Creutzfeldt-Jakob disease (CJD). Recombinant factor IX is produced synthetically in a laboratory, eliminating the risk of transmitting prion diseases like CJD. Plasma-derived products, on the other hand, carry a theoretical risk of transmitting CJD due to potential contamination. HIV and cytomegalovirus can be transmitted through blood products, but both plasma-derived and recombinant factor IX are rigorously tested for these viruses. Anaphylaxis is a potential risk with any factor IX product, regardless of the source. Therefore, the nurse should explain to the client that recombinant factor IX practically eliminates the risk of CJD transmission compared to plasma-derived factor IX.