Anatomy of Hematologic System

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You are seeing a 13-year-old boy with fatigue, weight loss, night sweats, and splenomegaly. Peripheral blood shows anemia, thrombocytosis, and leukocytosis (300,000/mm3). What is this patient's most likely diagnosis?

  • A. Leukemoid reaction
  • B. Acute lymphoblastic leukemia (ALL)
  • C. Chronic myeloid leukemia (CML)
  • D. Juvenile myelomonocytic leukemia (JMML)
Correct Answer: C

Rationale: The correct answer is C: Chronic myeloid leukemia (CML). This is a likely diagnosis due to the presence of fatigue, weight loss, night sweats, splenomegaly, anemia, thrombocytosis, and leukocytosis with an elevated white blood cell count. CML is characterized by the Philadelphia chromosome, resulting in the BCR-ABL fusion gene. This gene leads to uncontrolled proliferation of myeloid cells, causing the symptoms seen in this patient. Leukemoid reaction (A) is a reactive increase in white blood cells, usually in response to an infection. Acute lymphoblastic leukemia (B) typically presents with symptoms in children but is more commonly associated with lymphoblasts in the peripheral blood. JMML (D) is a rare myelodysplastic disorder in children characterized by monocytosis and a specific genetic mutation.

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A 17-year-old patient is referred to you for a platelet count of 1,200,000/mm3. On history, she notes that she often has numbness and tingling in her hands and feet and has frequent epistaxis. She is otherwise well-appearing and has no recent infections. On her exam, you note splenomegaly. What do you expect to see on further evaluation?

  • A. Elevated C-reactive protein
  • B. Low ferritin
  • C. A hypocellular bone marrow
  • D. Low von Willebrand factor activity
Correct Answer: D

Rationale: The correct answer is D: Low von Willebrand factor activity. This patient likely has Essential Thrombocythemia, a disorder characterized by excessive production of platelets by the bone marrow. This condition can lead to abnormal bleeding and clotting. The patient's symptoms of numbness, tingling, epistaxis, and splenomegaly are consistent with this diagnosis. Low von Willebrand factor activity is expected in Essential Thrombocythemia due to platelet dysfunction. Elevated C-reactive protein, low ferritin, and a hypocellular bone marrow are not typically associated with Essential Thrombocythemia and are less likely to be seen in this patient.

Half life of plat. Is:

  • A. 1-2days
  • B. 3-4days
  • C. 5-6days
  • D. 7-8days
Correct Answer: B

Rationale: The correct answer is B: 3-4 days. The half-life of a substance is the time it takes for half of the original amount to decay. In this case, since the half-life of platinum is 3-4 days, it means that after 3-4 days, half of the initial amount of platinum will have decayed. This answer is correct because it accurately represents the time frame for platinum decay. The other choices are incorrect because they do not correspond to the known half-life of platinum. Choice A (1-2 days), C (5-6 days), and D (7-8 days) are outside the typical half-life range for platinum, making them incorrect options.

The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse?

  • A. A 2-cm nontender supraclavicular node
  • B. A 1-cm mobile and nontender axillary node
  • C. An inability to palpate any superficial lymph nodes
  • D. Firm inguinal nodes in a patient with an infected foot
Correct Answer: A

Rationale: The correct answer is A: A 2-cm nontender supraclavicular node. This finding is concerning because supraclavicular nodes are not normally palpable. Enlarged supraclavicular nodes can indicate metastatic cancer. B is incorrect because mobile and nontender axillary nodes are usually benign. C is incorrect as the inability to palpate superficial nodes may be normal. D is incorrect as firm inguinal nodes could indicate a localized infection or inflammation.

A nurse is caring for a patient who has a diagnosis of acute leukemia. What assessment most directly addresses the most common cause of death among patients with leukemia?

  • A. Monitoring for infection
  • B. Monitoring nutritional status
  • C. Monitor electrolyte levels
  • D. Monitoring liver function
Correct Answer: A

Rationale: The correct answer is A: Monitoring for infection. Acute leukemia patients are at high risk for infections due to compromised immune function. Infection is the most common cause of death among leukemia patients. Regular monitoring for signs of infection, such as fever and abnormal white blood cell counts, is crucial for early detection and treatment. Option B, monitoring nutritional status, is important but not the most direct cause of death in leukemia patients. Option C, monitoring electrolyte levels, is important but not as directly related to the cause of death in leukemia patients. Option D, monitoring liver function, is not the most common cause of death in leukemia patients and is not directly related to leukemia complications.

Increase Fe & normal TIBC are found in:

  • A. thalassemia major
  • B. haemosidrosis
  • C. rheumatoid arthritis
  • D. dissiminated malignancy
Correct Answer: C

Rationale: The correct answer is C: rheumatoid arthritis. In rheumatoid arthritis, chronic inflammation can lead to anemia of chronic disease, causing increased levels of serum iron (Fe) due to decreased iron utilization and normal Total Iron Binding Capacity (TIBC). Thalassemia major (A) would show decreased TIBC due to iron overload. Haemosiderosis (B) would show increased Fe and TIBC due to iron overload. Disseminated malignancy (D) may show decreased Fe and TIBC due to anemia of chronic disease or other factors.

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