ATI RN
ATI Hematologic System Test Questions
Question 1 of 5
An 8-year-old boy undergoes a resection of a tumor in the right cerebrum next to the lateral ventricle (supratentorial). The pathologist feels the histology is most consistent with an ependymoma. The tumor is sent for advanced molecular and genetic testing. Which of the following findings would further support a diagnosis of ependymoma?
Correct Answer: C
Rationale: The correct answer is C: RELA fusion. Ependymomas are known to have specific molecular characteristics, with RELA fusion being a common genetic alteration associated with these tumors. The fusion of RELA gene is a key genetic event in the pathogenesis of supratentorial ependymomas. This fusion leads to the activation of the NF-κB signaling pathway, which is important in the development and progression of ependymomas. Now, let's summarize why the other choices are incorrect: A: BRAFKIAA1549 fusion - This fusion is typically associated with pilocytic astrocytomas, not ependymomas. B: BRAFV600E mutation - This mutation is commonly found in other types of brain tumors like pleomorphic xanthoastrocytomas and gangliogliomas, not ependymomas. D: H3K27M mutation - This mutation is typically seen in diffuse midline gliomas, such as diffuse
Question 2 of 5
You are seeing a 12-year-old boy in the survivorship program who presented at 2 years old with a desmoplastic nodular medulloblastoma. You note the child recently underwent germline genetic testing and was found to have nevoid basal cell carcinoma syndrome. In which gene is the child most likely to have a pathogenic variant?
Correct Answer: C
Rationale: Rationale: The correct answer is C: SUFU. Nevoid basal cell carcinoma syndrome, also known as Gorlin syndrome, is associated with pathogenic variants in the SUFU gene. SUFU is a tumor suppressor gene involved in the sonic hedgehog signaling pathway, which plays a role in medulloblastoma and basal cell carcinoma development. PTEN (A) is associated with Cowden syndrome, CDKN2A (B) with familial atypical multiple mole melanoma syndrome, and SMARCB1 (D) with rhabdoid tumor predisposition syndrome, but not specifically linked to nevoid basal cell carcinoma syndrome.
Question 3 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 4 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 5 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.