Post-shift report. Which patient to assess first?

Correct Answer: A

Rationale: The correct answer is A because a 20-year-old with possible acute myeloid leukemia (AML) who just arrived requires immediate assessment for potential critical conditions. AML is an aggressive cancer that can rapidly progress, necessitating timely intervention. The other choices are incorrect because aplastic anemia (B) and lymphedema (C) are chronic conditions that do not typically require immediate assessment. The patient refusing chemo for lymphoma (D) also does not pose an immediate threat compared to the urgency of assessing a new patient with possible AML.

Correct Answer: A

Rationale: The correct answer is A: Alpha and beta. Hemoglobin A in normal adults consists of two alpha and two beta globin polypeptide chains. This is the most common form of hemoglobin in adults. The other choices (B: Alpha and epsilon, C: Alpha and delta, D: Alpha and brotherton) are incorrect because epsilon, delta, and brotherton are not the typical polypeptide chains found in adult hemoglobin. Hemoglobin F contains gamma and alpha chains, not epsilon or delta. Brotherton is not a known polypeptide chain in hemoglobin.

Correct Answer: C

Rationale: The correct answer is C: Rhodnius prolixus. This insect is a vector for Trypanosoma cruzi, causing Chagas disease. Palpebral edema, lymphadenopathy, and megaesophagus are common manifestations. Glossina morsitans transmits African Trypanosomiasis (sleeping sickness) with different symptoms. Ixodes scapularis transmits Lyme disease. Simulium damnosum transmits Onchocerciasis (river blindness). Thus, Rhodnius prolixus is the correct vector based on the provided symptoms.

Correct Answer: B

Rationale: The correct answer is B: Glutathione reduction. NADPH generated from the pentose phosphate pathway in RBCs is crucial for maintaining reduced glutathione levels, which helps protect cells from oxidative damage. Glutathione is an important antioxidant in cells that helps neutralize harmful reactive oxygen species. This process is essential for the protection of RBCs from oxidative stress and maintains their structural integrity. A: Fatty acid synthesis - NADPH is indeed required for fatty acid synthesis, but in RBCs, the primary role of NADPH is in maintaining redox balance rather than fatty acid synthesis. C: ATP formation - NADPH is not directly involved in ATP formation, as ATP is mainly produced through processes like glycolysis and oxidative phosphorylation. D: Oxygen radical removal - While NADPH is involved in reducing oxidative stress, its primary role in RBCs is to maintain glutathione levels for antioxidant defense rather than directly removing oxygen radicals.

Correct Answer: C

Rationale: Schistocytes are fragmented red blood cells formed due to mechanical trauma in the circulation. In the context of microangiopathic hemolytic anemia (MAHA), such as in thrombotic thrombocytopenic purpura or hemolytic uremic syndrome, schistocytes are commonly seen due to the presence of microthrombi in small vessels. This mechanical destruction of red blood cells leads to the characteristic appearance of schistocytes on peripheral blood smear. Therefore, the correct answer is C. Sickle cell trait (choice A) and thalassemia (choice B) do not typically present with schistocytes. In immune thrombocytopenic purpura (ITP) (choice D), the destruction of platelets by autoantibodies does not typically cause schistocytes formation.