Nokea
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: A neutrophilic leukocytosis and a left shift with a basophilia and thrombocytosis without increased blasts are typical of the chronic phase of CML. Cytogenetics/fluorescence in situ hybridization(FISH) showing t(9;22)(q34;q11.2) would be diagnostic.
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An 18-month old boy presents with a primary testicular tumor. Without even seeing the slide, you bet your morning coffee that he has a:
- A. Pure seminoma
- B. Mature teratoma
- C. Immature teratoma
- D. Yolk sac tumor
Correct Answer: D
Rationale: Yolk sac tumor is the most common testicular tumor in young boys.
While assessing a newborn with cleft lip, the nurse would be alert that which of the following will most likely be compromised?
- A. Sucking ability
- B. Respiratory status
- C. Locomotion
- D. GI function
Correct Answer: A
Rationale: Because of the defect, the child will be unable to form the mouth adequately around nipple, thereby requiring special devices to allow for feeding and sucking gratification.
Hypergonadotropic hypogonadism may occur under which condition?
- A. Multiple deficiency of pituitary hormones
- B. Kalman's syndrome
- C. Turner syndrome
- D. Radiotherapy of the testicles in boys
Correct Answer: C
Rationale: Turner syndrome causes ovarian failure with high gonadotrophins.
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: In Hodgkin lymphoma, B symptoms include (a) fever higher than 38°C for at least 3 consecutive days, (b) greater than 10% unexplained weight loss over the preceding 6 months, and (c) drenching night sweats. The correct answer is '10% weight loss in past 6 months' as it fits the B symptom criteria, whereas fever to 39°C for only 1 day does not meet the 3-day requirement.
A 9-week-old infant is scheduled for cleft lip repair. Which information is most important for the nurse to convey to the surgeon before transporting the infant to the surgical suite?
- A. Red blood cell count of 2.3 million/mm3
- B. White blood cell count of 10,000/mm3
- C. Weight gain of 2 pounds since birth
- D. Urine specific gravity is 1.011
Correct Answer: A
Rationale: A low RBC count (2.3 million/mm3) indicates anemia, a critical preoperative concern affecting oxygenation and surgical safety.