ATI RN
Hematological System Questions
Question 1 of 5
A 9-year-old child with osteosarcoma is being admitted for cisplatin therapy. What is the best regimen for prevention of chemotherapy-induced nausea and vomiting (CINV)?
Correct Answer: C
Rationale: The correct answer is C: Granisetron, dexamethasone at 50% dosing, and aprepitant. Granisetron is a first-line antiemetic for CINV in chemotherapy. Dexamethasone at 50% dosing is effective in reducing nausea and vomiting. Aprepitant, a neurokinin-1 receptor antagonist, is recommended for moderate to high emetogenic chemotherapy regimens like cisplatin. This combination provides a comprehensive approach targeting different pathways involved in CINV. Choice A is incorrect because olanzapine is not typically used in pediatric patients for CINV prevention. Choice B is incorrect as aprepitant is preferred over olanzapine. Choice D is incorrect because excessive dexamethasone dosing can increase the risk of side effects without additional benefit.
Question 2 of 5
A 15-year-old girl with a history of osteosarcoma presents to survivor clinic for her first evaluation. Her mother complains that she does not listen well and is wondering if she may have trouble hearing. Which of the follow is true regarding platinum-associated hearing loss?
Correct Answer: D
Rationale: The correct answer is D. Platinum-associated hearing loss is due to the destruction of the cochlear hair cells. Platinum-based chemotherapy agents can cause ototoxicity, leading to sensorineural hearing loss by damaging the hair cells in the cochlea. This type of hearing loss affects the ability to hear high-frequency sounds first. Low-frequency volumes are typically preserved. Older age at exposure does not increase the risk of platinum-associated hearing loss. Conductive hearing loss is not typically associated with platinum chemotherapy. In summary, the correct answer is D because platinum-associated hearing loss affects the cochlear hair cells, leading to sensorineural hearing loss predominantly in high-frequency sounds.
Question 3 of 5
A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?
Correct Answer: C
Rationale: The correct answer is C: Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT. In this scenario, the patient achieved morphologic remission and MRD-negative status after the second course of chemotherapy. Performing a matched unrelated donor HSCT can provide the best chance for long-term disease control and potential cure by replacing the patient's hematopoietic system with healthy donor cells, reducing the risk of relapse. This approach combines the benefits of achieving remission with chemotherapy and the potentially curative effects of allogeneic HSCT. The other choices are suboptimal: A may lead to excessive toxicity, B may not be as effective in preventing relapse, and D may not be as curative as HSCT in this high-risk case.
Question 4 of 5
A 5-year-old girl with a previously normal CBC now presents in your office with a hemoglobin of 8.5 g/dL, corrected reticulocyte count of 0.1%, and mean corpuscular volume of 80 fl. White cells and platelets are normal in number and morphology. Bilirubin, LDH, BUN, creatinine, and urinalysis are normal. Direct and indirect antiglobulin tests are negative. Workup for infection, including parvovirus, is negative. Occult blood in her stools is negative. Physical examination is unremarkable. She has had no restriction in her energy or activities and the family agrees she is 'fine.' What is the most appropriate next step in management?
Correct Answer: C
Rationale: The correct answer is C: Observe serial hemoglobin values closely. This is the most appropriate next step in management for a 5-year-old girl with a hemoglobin of 8.5 g/dL, normal white cells, and platelets. Given the absence of symptoms or signs of acute illness, a conservative approach of close observation is warranted. This allows monitoring for any trends in hemoglobin levels and the need for intervention. Administering erythropoietin (choice A) is not indicated as the patient is clinically stable and does not have evidence of erythropoietin deficiency. Initiating a red cell transfusion (choice B) is not necessary at this point since the patient is asymptomatic and stable. Prescribing oral iron supplement (choice D) is not appropriate as the MCV is normal, and there is no evidence of iron deficiency anemia.
Question 5 of 5
A 3-year-old boy with X-linked chronic granulomatosis disease is day +25 after haploidentical bone marrow transplant (father donor) using posttransplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis. He engrafted on day +16 and was preparing for discharge when cytomegalovirus (CMV) was noted to be positive on PCR, and he developed a fever and mild rash. His counts have fallen to a WBC of 0.1 and he remains transfusion dependent. What diagnostic evaluations/treatments should you pursue?
Correct Answer: D
Rationale: Step-by-step rationale for why answer D is correct: 1. Send blood cultures: To rule out bacterial infection as a potential cause of fever and rash. 2. Start antibiotics: To cover for possible bacterial infection given the clinical presentation. 3. Treat CMV with foscarnet: As the patient is CMV positive on PCR and has developed symptoms, indicating active CMV infection. 4. Send rapid chimerism by STR: To assess for possible rejection post-transplant. Low or absent donor chimerism may indicate rejection. 5. If donor chimerism is low or absent: Consider the need for alternative donor for a second procedure to address rejection. Summary: - Choice A is incorrect because steroids for aGHVD are not indicated without confirming the diagnosis first. - Choice B is incorrect as the low blood counts are more suggestive of a different underlying cause rather than sepsis. - Choice C is incorrect as rapid FISH chimerism is not the standard method for assessing rejection