You are caring for a patient with a large localized Ewing sarcoma of the soft tissues of the arm. The surgeon believes that the tumor can be resected without amputation but asks whether you can give some chemotherapy to shrink the tumor before surgery. Which of the following would you tell the surgeon?

Correct Answer: B

Rationale: Step 1: Agreeing to wait until week 12 of therapy before resection allows chemotherapy to shrink the tumor, making surgery easier and potentially less extensive. Step 2: Waiting until week 12 also helps assess the tumor's response to chemotherapy, guiding further treatment decisions. Step 3: Choosing not to delay the resection until week 12 may risk more extensive surgery or complications due to the tumor's size. Step 4: Opting for radiotherapy regardless of tumor resection status at week 12 is not advisable as unnecessary radiation exposure should be avoided unless absolutely necessary.

Correct Answer: D

Rationale: The correct answer is D because educating the client about the procedure is crucial for informed consent, reducing anxiety, and promoting cooperation during the scan. This empowers the client to understand what to expect and how to prepare. Assessing for shellfish allergies (A) is not directly related to the scan. Placing the client on radiation precautions (B) is unnecessary as the exposure is minimal, and sedating the client (C) should only be considered if medically indicated, not as a routine practice.

Correct Answer: C

Rationale: The correct answer is C: Crimean Congo virus. This is because Crimean Congo virus is a tick-borne virus known to cause acute viral hemorrhagic fever. Tick bite history increases suspicion for this virus. A: Hantavirus is transmitted through rodent feces and urine. B: Rift Valley virus is transmitted through mosquito bites. D: Marburg virus is transmitted through contact with infected animals.

Correct Answer: C

Rationale: The correct answer is C: Factor VIII. Factor VIII is not dependent on vitamin K for its synthesis, so its levels will not be affected by vitamin K deficiency. Factor II, VII, and IX are all vitamin K-dependent factors, so their levels will decrease with vitamin K deficiency, leading to impaired blood clotting. This is due to the role of vitamin K in the post-translational modification of these factors, which is necessary for their activation. Therefore, Factor VIII is the only factor that will not be affected by vitamin K deficiency.

Correct Answer: C

Rationale: The correct answer is C: Lymphocyte count. In the International Prognostic Index for Non Hodgkin's Lymphoma, the criteria are based on the number of extranodal sites, LDH level, and performance status. Lymphocyte count is not included in the IPI criteria because it does not play a significant role in predicting the prognosis of Non Hodgkin's Lymphoma. Lymphocyte count is not a commonly used parameter in prognostic scoring systems for this type of cancer. Therefore, the absence of lymphocyte count as a criteria in the IPI is justified.