ATI RN
ATI Hematologic System Test Questions
Question 1 of 5
A 2-month-old infant is brought to your clinic with an extensive scaly rash on the scalp, which has been biopsied and shown to be Langerhans cell histiocytosis (LCH). You want to determine whether this patient has skin-only LCH or involvement of any of the 'high-risk' organs. The child has a normal CBC; normal liver enzymes and bilirubin; and a normal skeletal survey, skull films, and chest X ray. What other screening test will be important for finding involvement of a high-risk organ?
Correct Answer: D
Rationale: The correct answer is D: Serum albumin and total protein. In Langerhans cell histiocytosis (LCH), involvement of high-risk organs like the liver, spleen, and bone marrow can occur. Serum albumin and total protein levels can indicate liver involvement as hypoalbuminemia and hypoproteinemia can be seen in liver dysfunction. The other choices, A (Reticulocyte count), B (Erythrocyte sedimentation rate), and C (Alkaline phosphatase) are not specific for evaluating high-risk organ involvement in LCH. Reticulocyte count is related to red blood cell production, ESR is a nonspecific marker of inflammation, and alkaline phosphatase is commonly elevated in various conditions, not specific for high-risk organ involvement in LCH.
Question 2 of 5
An otherwise healthy 18-year-old female is diagnosed with high-risk neuroblastoma after presenting with fatigue and bony pain. Imaging findings demonstrate a left adrenal mass with multiple osseous metastases. She successfully completes standard therapy for high-risk neuroblastoma, but experiences several episodes of disease recurrence and ultimately dies of her disease 10 years after her initial diagnosis. During her treatment, her tumor was sent for molecular analysis. Of the following, what molecular aberration was most likely to have been detected?
Correct Answer: C
Rationale: The correct answer is C: ATRX mutation. In neuroblastoma, ATRX mutations are associated with poor prognosis and high-risk disease. ATRX gene mutations are commonly found in cases with aggressive behavior and poor outcomes, such as in this case where the patient experienced disease recurrence and ultimately died. ATRX mutations are linked to chromosomal instability and telomere dysfunction, which can contribute to tumor progression and resistance to therapy. A: ETV6-NTRK3 gene fusion is more commonly associated with infantile fibrosarcoma and secretory breast carcinoma, not neuroblastoma. B: PTPN11 mutations are typically seen in juvenile myelomonocytic leukemia and Noonan syndrome, not neuroblastoma. D: WT1 mutations are more commonly found in Wilms tumor and acute myeloid leukemia, not neuroblastoma. In summary, the ATRX mutation is the most likely molecular aberration detected in this patient with high-risk neuroblast
Question 3 of 5
A 9-year-old boy is being treated for standard-risk acute lymphoblastic leukemia. His treatment protocol calls for administration of intravenous methotrexate and intramuscular L-asparaginase during interim maintenance chemotherapy. What is the most appropriate sequence of drug administration?
Correct Answer: B
Rationale: The correct answer is B: Administer L-asparaginase immediately after the methotrexate infusion. This is the most appropriate sequence because methotrexate can impair the activity of L-asparaginase if administered together. By waiting to administer L-asparaginase after the methotrexate infusion, the efficacy of both drugs is maximized without interference. Administering L-asparaginase during the methotrexate infusion (Choice A) would lead to decreased effectiveness of L-asparaginase. Administering both drugs at the same time (Choice C) is not recommended due to potential drug interactions. Administering methotrexate 24 hours after the asparaginase (Choice D) does not optimize the synergistic effects of the drugs during interim maintenance chemotherapy.
Question 4 of 5
Which of the following alters the function of thrombin from a procoagulant protein to one that downregulates the formation of fibrinogen?
Correct Answer: D
Rationale: Thrombomodulin alters thrombin's function by binding to it and activating protein C. Activated protein C then inhibits factors Va and VIIIa, which are essential for the formation of fibrinogen. Protein C (choice A) also inhibits coagulation, but it doesn't directly alter thrombin's function. Protein S (choice B) enhances protein C's activity but doesn't directly affect thrombin. Antithrombin (choice C) inhibits thrombin and other coagulation factors, but it doesn't specifically alter thrombin's function to downregulate fibrinogen formation.
Question 5 of 5
A laboratory study is conducted to determine the optimal usage of platelets for transfusion. The blood bank inventory along with the transfusion records and medical records of subjects who were recipients of platelet transfusion are reviewed. Which of the following conclusions is most likely to be made from this study?
Correct Answer: B
Rationale: Step-by-step rationale for why answer B is correct: 1. Autoimmune thrombocytopenia is a condition where the body's immune system attacks and destroys its own platelets. 2. Platelet transfusions in patients with autoimmune thrombocytopenia are less likely to be successful due to the underlying immune response. 3. Reviewing transfusion records of subjects with this condition would likely show a pattern of unsuccessful platelet transfusions. 4. This conclusion is supported by medical knowledge and understanding of autoimmune thrombocytopenia. Summary: - Choice A is incorrect because frozen storage of platelets does not necessarily increase units available in the context of the study. - Choice C is incorrect as platelet units can carry a risk of transmission for hepatitis C infection. - Choice D is incorrect as the preference for pooled donor platelets over single-donor platelets is not a conclusion that can be drawn from the study.