Nokea
You are seeing a 2-year-old girl with new onset of fever and bronchitis. She has maculopapular rash and hepatosplenomegaly. Blood smear shows leukocytosis (100,000/mm3), anemia, and thrombocytopenia. Ancillary tests include fetal hemoglobin of 80% and normal blood karyotype. What is the most likely diagnosis?
- A. Leukemoid Reaction
- B. Acute lymphoblastic leukemia (ALL)
- C. Chronic myeloid leukemia (CML)
- D. Juvenile myelomonocytic leukemia (JMML)
Correct Answer: D
Rationale: The most likely diagnosis in this case is Juvenile myelomonocytic leukemia (JMML). JMML is a rare myelodysplastic/myeloproliferative neoplasm seen in young children. The clinical presentation of fever, rash, hepatosplenomegaly, leukocytosis, anemia, and thrombocytopenia is consistent with JMML. The presence of fetal hemoglobin of 80% is a key finding in JMML, as it is a distinguishing feature. Additionally, a normal blood karyotype rules out chromosomal abnormalities commonly seen in other leukemias. Leukemoid reaction (Choice A) is characterized by a reactive increase in leukocyte count due to an underlying condition, but it does not explain the other findings in this case. Acute lymphoblastic leukemia (ALL - Choice B) primarily affects lymphoid cells, not myeloid cells as seen in this case. Chronic myeloid leukemia (C
You may also like to solve these questions
An older adult patient is receiving a transfusion of packed red blood cells after being injured in a car accident. On assessment, the nurse notes a new finding of bounding pulse, crackles, and increasing dyspnea. What should the nurse do first, after stopping the transfusion?
- A. Assess vital signs.
- B. Raise the head of the bed.
- C. Encourage the patient to deep breathe and cough.
- D. Administer pm diphenhydramine (Benadryl) as ordered.
Correct Answer: B
Rationale: The correct answer is B: Raise the head of the bed. This action is crucial in managing the potential complication of fluid overload in the patient receiving a blood transfusion. Elevating the head of the bed helps reduce venous return to the heart, decreasing preload and cardiac workload. This can alleviate symptoms like dyspnea and crackles associated with fluid overload. Assessing vital signs (choice A) is important but should follow positioning the patient appropriately. Encouraging deep breathing and coughing (choice C) may exacerbate the patient's respiratory distress. Administering diphenhydramine (choice D) is not indicated for the symptoms described.
You receive a phone call that a 3-year-old patient on long-term warfarin therapy for congenital heart disease has an international normalized ratio (INR) of 5.8. On further history, you learn the patient and several family members have had recent gastrointestinal illnesses, but the patient is recovering. His mother reports he is not experiencing bleeding symptoms. Which of the following interventions would be most reasonable in this clinical scenario?
- A. Hold 1 to 2 doses of warfarin and recheck INR
- B. Administer oral vitamin K therapy
- C. Administer fresh frozen plasma (FFP)
- D. Administer recombinant factor VIIa
Correct Answer: A
Rationale: The correct answer is A: Hold 1 to 2 doses of warfarin and recheck INR. In this scenario, the patient's elevated INR of 5.8 indicates an increased risk of bleeding due to excessive anticoagulation. Since the patient is not experiencing bleeding symptoms and is recovering from gastrointestinal illness, temporarily holding 1 to 2 doses of warfarin is the most reasonable intervention to prevent bleeding complications while allowing the INR to normalize. Rechecking the INR after holding the doses will help assess the patient's response to the intervention. Choices B, C, and D are incorrect because administering oral vitamin K therapy, FFP, or recombinant factor VIIa are more aggressive interventions that are not warranted in this case where the patient is asymptomatic and recovering from a transient illness.
When reviewing the chemistry panel of a newly diagnosed patient with acute lymphoblastic leukemia who is lethargic, complaining of flank pain, and experiencing nausea and vomiting, which of the following would you expect to see?
- A. Potassium 4.5 mmol/L, phosphorus 8 mg/dL, uric acid 7 mg/dL, calcium 9.0 mg/dL, BUN 12 mg/dL
- B. Potassium 6.5 mmol/L, phosphorus 8 mg/dL, uric acid 9 mg/dL, calcium 10 mg/dL, BUN 14 mg/dL
- C. Potassium 4 mmol/L, phosphorus 9 mg/dL, uric acid 10 mg/dL, calcium 10 mg/dL, BUN 10 mg/dL
- D. Potassium 7 mmol/L, phosphorus 12 mg/dL, uric acid 10 mg/dL, calcium 7 mg/dL, BUN 25 mg/dL
Correct Answer: D
Rationale: Step-by-step rationale:
1. Lethargy, flank pain, nausea, vomiting in leukemia can suggest tumor lysis syndrome (TLS).
2. TLS can cause hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and elevated BUN.
3. Choice D has the highest potassium, phosphorus, uric acid, and BUN levels, and the lowest calcium level.
4. Therefore, choice D is the most consistent with the expected lab findings in tumor lysis syndrome.
Summary:
- Choice A has normal potassium, phosphorus, uric acid, calcium levels, and lower BUN.
- Choice B has high potassium but normal phosphorus, uric acid, calcium, and slightly elevated BUN.
- Choice C has low potassium, normal phosphorus, and elevated uric acid, calcium, and BUN.
- Choice D aligns most closely with the expected lab findings in tumor lysis syndrome due to the pattern of
Non thrombocytopenic purpura is seen in all except:
- A. vasculitis
- B. uraemia
- C. hereditary haemorrhagic telangiectasia
- D. SLE
Correct Answer: D
Rationale: The correct answer is D: SLE. Non-thrombocytopenic purpura refers to purpura without low platelet count. In SLE, thrombocytopenia is common, leading to purpura. A: Vasculitis can cause non-thrombocytopenic purpura due to vessel inflammation. B: Uraemia can lead to non-thrombocytopenic purpura due to vascular damage. C: Hereditary haemorrhagic telangiectasia presents with telangiectasias and recurrent epistaxis, not purpura.
In the laboratory diagnosis of leishmaniasis, the expected parasite stage in vitro is
- A. Amastigote
- B. Promastigote
- C. Trypomastigote
- D. Schizont
Correct Answer: B
Rationale: The correct answer is B: Promastigote. In the laboratory diagnosis of leishmaniasis, the expected parasite stage in vitro is the promastigote form. This is because the promastigote form is the stage of the parasite that lives in the sandfly vector and is transmitted to humans, causing infection. In vitro, the promastigote form can be cultured and studied for diagnostic purposes.
Incorrect choices:
A: Amastigote - This is the intracellular form of the parasite found in mammalian hosts and not typically used for laboratory diagnosis.
C: Trypomastigote - This form is typically associated with Trypanosoma species, not Leishmania.
D: Schizont - This term is used for malaria parasites, not Leishmania parasites.
In summary, the promastigote form is the most relevant stage for laboratory diagnosis of leishmaniasis due to its presence in the sandfly vector and its ability to