ATI RN
ATI Hematologic System Test Questions
Question 1 of 5
A 13-year-old Hispanic girl is found to have a WBC count of 6,500/mm3 with 40% Auer rod–containing granular blasts that, by flow cytometry, express very bright CD33 but are negative for human leukocyte antigen–DR isotype (HLA-DR). She is oozing blood around her peripheral IV site. Coagulation studies reveal an international normalized ratio (INR) of 3.4, a fibrinogen of 170, and a markedly elevated D-dimer. Marrow aspirate shows nearly 90% blasts with a similar morphology. You send the marrow to the fluorescence in situ hybridization (FISH) lab and request STAT testing for the most likely recurrent genetic abnormality based on the clinical presentation. How do you plan to initiate therapy?
Correct Answer: B
Rationale: The correct answer is B: Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support. Rationale: 1. The clinical presentation describes acute promyelocytic leukemia (APL), characterized by Auer rod-containing blasts, coagulopathy (elevated INR, D-dimer), and CD33 positivity. ATRA is the standard treatment for APL. 2. ATRA induces differentiation of leukemic promyelocytes, reducing the risk of disseminated intravascular coagulation (DIC) and bleeding. 3. Aggressively managing the coagulopathy with blood product support is crucial to prevent hemorrhagic complications. Summary: A: Not needed as the clinical presentation already suggests APL. Lumbar puncture is not indicated for APL diagnosis. C: Dexamethasone and hydroxyurea are not standard treatments for APL. Immediate ATRA therapy is preferred. D
Question 2 of 5
A patient is scheduled for upcoming surgery. He is on nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. You are being asked what to do with his medications for the surgery. What is the mechanism of action of NSAIDS?
Correct Answer: C
Rationale: Step 1: NSAIDs inhibit cyclooxygenase (COX) enzymes to reduce prostaglandin synthesis. Step 2: Reversible inhibition means the effect is temporary and can be reversed. Step 3: COX-1 inhibition leads to GI side effects, which can be concerning in surgery. Step 4: COX-2 inhibition is more targeted for inflammation but can still pose cardiovascular risks. Step 5: Reversible COX-1 inhibition allows for temporary discontinuation before surgery to minimize bleeding risk. Summary: Choice C is correct as reversible COX-1 inhibition allows for safer management pre-surgery compared to irreversible inhibition in choices A and B, and COX-2 inhibition in choice D.
Question 3 of 5
A 14-year-old boy presents with cough, shortness of breath, and difficulty lying down. His face and neck swell when his arms are raised. Chest x-ray reveals a large mediastinal mass. A tissue diagnosis is desired. A biopsy is performed with local anesthesia because the anesthesiologist thinks that the patient has a very high general anesthesia risk. Which of the following findings does not make general anesthesia unsafe?
Correct Answer: D
Rationale: The correct answer is D because a malignancy of hematopoietic origin does not inherently increase the risk of general anesthesia. Hematopoietic malignancies such as leukemia or lymphoma do not directly impact the respiratory system or airway, unlike the other choices. A: Tumor size affecting transthoracic diameter can compress airways, leading to respiratory compromise. B: Tracheal cross-sectional area affects air flow and can be a concern during intubation. C: Peak expiratory flow rate indicates respiratory function; lower values suggest increased risk under general anesthesia. Therefore, D is the correct answer as it does not pose a direct risk to general anesthesia.
Question 4 of 5
A leukemia investigator plans to obtain bone marrow under general anesthesia to measure minimal residual disease (MRD) and to see if this time point can predict early relapse. The specimen will be obtained at a time point when otherwise no bone marrow would be sampled. The results are not shared with the treating oncologist, and no therapeutic interventions are decided or based on the results. Which of the following statements is most accurate about this intervention?
Correct Answer: C
Rationale: Step 1: General anesthesia carries inherent risks, making the procedure more than minimal-risk. Step 2: The absence of therapeutic interventions based on results does not make the procedure low-risk. Step 3: Performing an additional procedure does not automatically make it minimal-risk. Step 4: Not sharing results with the treating oncologist may raise ethical concerns. Summary: Choice C is correct because the use of general anesthesia increases the risk level of the procedure, making it greater than minimal-risk. Choices A, B, and D are incorrect as they do not adequately address the specific risk associated with the use of general anesthesia in this scenario.
Question 5 of 5
A 7-year-old boy presents with recent onset of vomiting and lethargy. Blood smear shows increased neutrophils with a left shift and 8% abnormal cells. Bone marrow contains 60% of the same cells. Flow cytometry shows that the cells are TdT–, CD10+, CD19+, CD20+, sIg+. What is the most likely diagnosis?
Correct Answer: A
Rationale: The correct answer is A: Burkitt leukemia/lymphoma. The key features in the case are increased neutrophils with a left shift, presence of abnormal cells in blood and bone marrow, and flow cytometry showing TdT–, CD10+, CD19+, CD20+, sIg+. These findings are consistent with Burkitt leukemia/lymphoma, a highly aggressive B-cell neoplasm. The presence of CD10, CD19, and CD20, along with sIg positivity, points towards a B-cell origin. Additionally, the characteristic translocation t(8;14) involving c-Myc oncogene is commonly seen in Burkitt lymphoma. The absence of TdT expression rules out T-cell ALL (Choice C). Hematogones (Choice D) are normal precursor B-cells found in bone marrow, but they do not typically present with the clinical features described. B-cell ALL (Choice B) lacks the specific features seen in this case