ATI RN
Anatomy of Hematologic System Questions
Question 1 of 5
When should autologous hematopoietic stem cell transplantation be used, and what are the common cancers it is used for?
Correct Answer: B
Rationale: The correct answer is B because autologous hematopoietic stem cell transplantation should be used when it can provide a survival benefit over chemotherapy. This approach is particularly beneficial for certain cancers such as neuroblastoma and relapsed lymphoma. - Choice A is incorrect because the indication for autologous transplantation is not solely based on the need for high-dose therapy, but rather on providing a meaningful survival benefit over chemotherapy. The listed cancers are not the most common ones treated with this approach. - Choice C is incorrect because the graft-versus-tumor effect is actually desired in some cases of autologous transplantation, and the listed cancers are not the most common ones treated with this approach. - Choice D is incorrect because the purpose of autologous transplantation is not to avoid extensive chemotherapy but to provide a survival benefit. The listed cancers are not the most common ones treated with this approach.
Question 2 of 5
Which statement is correct regarding lymphocyte counts in infants versus adults?
Correct Answer: C
Rationale: The correct answer is C: T-cell numbers in infants are higher than in adults. This is because infants have a relatively higher proportion of T-cells compared to adults due to their underdeveloped immune system. T-cell numbers decrease with age as the immune system matures and adapts to the environment. Rationale: 1. T-cells play a crucial role in the immune response, especially in infants who rely heavily on cellular immunity. 2. NK-cell numbers do not follow the pattern described in option A, as they are important in early immune responses. 3. B-cell numbers do not decline with age as stated in option B, as they are responsible for antibody production throughout life. 4. Option D is incorrect as infants actually have higher lymphocyte counts compared to adults due to their developing immune system.
Question 3 of 5
A 2-year-old girl has a diagnosis of overall stage IV favorable histology Wilms' tumor with pulmonary metastases and local stage III disease due to finding positive lymph nodes. After she completes 6 weeks of vincristine/dactinomycin/doxorubicin (DD4A) chemotherapy, restaging shows complete resolution of some but not all lung nodules. Tumor genetic testing reveals combined loss of heterozygosity for 1p and 16q. Which of the following would be the most appropriate treatment plan?
Correct Answer: D
Rationale: The correct answer is D because the patient has residual lung nodules after initial chemotherapy, indicating a need for intensified treatment. Adding cyclophosphamide and etoposide to the chemotherapy regimen can improve outcomes in patients with combined loss of heterozygosity for 1p and 16q. Radiation to both the lungs and flank targets all remaining disease sites effectively. Choice A is incorrect because it does not address the need for intensified treatment with additional agents or radiation to the lungs, where residual disease remains. Choice B is incorrect as it only includes radiation to the flank and not the lungs, which are still harboring disease. Choice C is incorrect because although it adds cyclophosphamide and etoposide, it does not include radiation to the lungs, which is necessary for comprehensive disease control.
Question 4 of 5
You have a new patient consult in clinic this morning. The referral packet includes the newborn screen report, which is flagged abnormal hemoglobinopathy screen, F, A, Bart's, refer to hematology, and a complete blood count done at 4 years of age with a hemoglobin of 10 g/dL and an MCV of 68. The pediatrician has informed the parents the child has some form of alpha thalassemia. The older brother had the same newborn screen results but had a normal complete blood count when checked. The mother wants to know why her second child has an abnormal complete blood count when she and her husband do not have any blood problems. How would you respond to the child's mother?
Correct Answer: A
Rationale: The correct answer is A because both parents are silent carriers, each passing a deleted alpha globin allele to their child, resulting in a trans-deletion genotype alpha thalassemia trait. This explanation aligns with the child's abnormal complete blood count and the family history. Choice B is incorrect because it states that the mother has cis deletion alpha thalassemia, which is not supported by the information provided. Choice C is incorrect as it suggests a new spontaneous mutation causing alpha thalassemia in the child, which is not consistent with the genetic inheritance pattern described. Choice D is incorrect because it claims both parents carry cis deletions in the alpha globin gene cluster, which contradicts the scenario where the parents are silent carriers.
Question 5 of 5
A 4-year-old girl with a history of recurrent epistaxis and easy bruising is referred to you for evaluation. She is found to have a prolonged PTT and a factor VIII level that is less than 1%. Both parents have a history of excessive bleeding. She is admitted with a severe episode of epistaxis, and your colleague orders 40 IU/kg of recombinant factor VIII. Her epistaxis resolves initially but within an hour starts again at the same severity as before. What is the best next step?
Correct Answer: A
Rationale: The correct answer is A: Infuse a von Willebrand factor concentrate. In this scenario, the 4-year-old girl has a history of recurrent epistaxis and easy bruising, indicative of a bleeding disorder. The prolonged PTT and factor VIII level less than 1% suggest a deficiency in von Willebrand factor (VWF) or factor VIII. When the initial dose of recombinant factor VIII did not completely resolve the epistaxis, it indicates a possible deficiency in VWF activity. Therefore, the best next step is to infuse a von Willebrand factor concentrate to address the VWF deficiency, which should help control the bleeding. Summary: - Option B (Give another dose of recombinant factor VIII concentrate) is not the best choice because the initial dose did not fully resolve the bleeding, indicating a different factor may be deficient. - Option C (Call otorhinolaryngology to pack her nose) addresses the symptom but does not