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 genetic alterations, including RELA fusions. The fusion of RELA gene is a hallmark genetic abnormality observed in certain subtypes of ependymomas, aiding in the diagnosis. Conversely, choices A, B, and D are associated with other types of brain tumors such as pilocytic astrocytoma (A), melanoma (B), and diffuse intrinsic pontine glioma (D), respectively. These genetic alterations are not characteristic of ependymomas, making them incorrect choices in this context.
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: 1. Nevoid basal cell carcinoma syndrome is also known as Gorlin syndrome, caused by mutations in SUFU. 2. SUFU gene regulates the Hedgehog signaling pathway, implicated in medulloblastoma development. 3. Desmoplastic nodular medulloblastoma is commonly seen in Gorlin syndrome. 4. PTEN is associated with Cowden syndrome, CDKN2A with melanoma, and SMARCB1 with rhabdoid tumors, not typically seen in Gorlin 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: The correct answer is C: Reversible inhibition of cyclooxygenase 1. NSAIDs work by reversibly inhibiting cyclooxygenase enzymes, particularly COX-1 and COX-2, which are involved in the synthesis of prostaglandins. In this case, reversible inhibition is crucial because it allows for the temporary suppression of prostaglandin production, leading to pain relief and anti-inflammatory effects. Explanation of other choices: A: Irreversible inhibition of cyclooxygenase 1 - This is incorrect because NSAIDs typically do not irreversibly inhibit COX-1. B: Irreversible inhibition of cyclooxygenase 2 - This is incorrect because NSAIDs do not irreversibly inhibit COX-2. D: Reversible inhibition of cyclooxygenase 2 - This is incorrect because while NSAIDs can inhibit COX-2, the primary target is COX-1 for their therapeutic effects.
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. A malignancy of hematopoietic origin does not inherently make general anesthesia unsafe. This is because anesthesia risk is typically influenced by factors such as airway patency, respiratory function, and cardiac status. Choices A, B, and C all indicate potential complications that could make general anesthesia unsafe, such as airway obstruction due to a large mediastinal mass (A), compromised tracheal cross-sectional area (B), and impaired respiratory function (C). These factors would necessitate careful consideration and potential modifications in the anesthesia plan to ensure patient safety.
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: The correct answer is C because obtaining bone marrow under general anesthesia carries inherent risks that make it greater than minimal-risk. Here's a step-by-step rationale: 1. General anesthesia poses risks such as allergic reactions, breathing problems, and potential complications, making the procedure more than minimal-risk. 2. Even though bone marrow assessments are routine for leukemia patients, the use of general anesthesia elevates the risk level. 3. The fact that the results are not shared with the treating oncologist and no therapeutic interventions are based on them indicates that the procedure is solely for research purposes, emphasizing the risk-benefit analysis. 4. Choice A is incorrect because the use of general anesthesia increases the procedure's risk level beyond routine. 5. Choice B is incorrect as the focus should be on the inherent risks of general anesthesia, not just the number of procedures performed. 6. Choice D is irrelevant to the risk assessment of the specific procedure and does not address the immediate safety concerns associated with general anesthesia.