ATI RN
ATI Hematologic System Quizlet Questions
Question 1 of 5
You are consulted on a 4-year-old girl who is newly diagnosed with standard-risk pre-B acute lymphoblastic leukemia. After reviewing her previous complete blood examinations, you note she has had a platelet count ranging from 80,000 to 100,000 cells/mcL over the past 2 years. Her father mentions that he has also been told he has mild thrombocytopenia. You suspect the child may have a cancer predisposition syndrome. Which sample should you send for analysis, and which gene is most likely implicated?
Correct Answer: B
Rationale: The correct answer is B: Skin fibroblasts to evaluate the ETV6 gene. 1. ETV6 gene mutations are associated with inherited thrombocytopenia, making it a likely candidate in this case. 2. Skin fibroblasts are needed for genetic analysis as they provide a reliable sample for detecting genetic mutations. 3. RUNX1 gene mutations are also linked to thrombocytopenia but are more commonly associated with familial platelet disorder with predisposition to acute myeloid leukemia. 4. Buccal swabs are not ideal for evaluating genetic mutations related to thrombocytopenia as they may not provide sufficient genetic material for accurate testing.
Question 2 of 5
A 3-year-old boy is referred to you for evaluation of right leukocoria. Funduscopic examination under anesthesia reveals a large amelanotic mass occupying more than two-thirds of the vitreous space in his right eye, with massive retinal detachment, consistent with group E retinoblastoma. The left eye is normal. An MRI confirms the funduscopic findings and shows no extraocular disease. What is the most appropriate next step in the management of this child's disease?
Correct Answer: A
Rationale: The correct answer is A: Enucleation. In this case, the child has a group E retinoblastoma in the right eye, with massive retinal detachment. Enucleation, or surgical removal of the eye, is the most appropriate next step as the tumor is extensive and poses a risk of metastasis. Enucleation helps prevent spread of the cancer to other parts of the body and provides the best chance for cure. Systemic chemotherapy (B) and brachytherapy (C) are not ideal for such advanced cases due to the high risk of metastasis. Needle biopsy (D) is not recommended as the diagnosis is already confirmed by funduscopic examination and MRI.
Question 3 of 5
Your patient with relapsed high-risk neuroblastoma returns to your care after travelling to an outside institution for [131]I-MIBG therapy. In the weeks following [131]I-MIBG therapy, what adverse events directly attributable to this therapy will the patient most likely encounter?
Correct Answer: A
Rationale: The correct answer is A: Myelosuppression requiring growth factor and blood product support. Rationale: 1. [131]I-MIBG therapy targets neuroblastoma cells but can also affect bone marrow, leading to myelosuppression. 2. Myelosuppression can result in low blood cell counts, necessitating growth factors and blood product support. 3. Severe mucositis (B) is not a common adverse event of [131]I-MIBG therapy. 4. Hemorrhagic cystitis (C) is more commonly associated with certain chemotherapies, not [131]I-MIBG. 5. Symptomatic hypothyroidism (D) is a potential long-term side effect, not an immediate consequence following [131]I-MIBG therapy.
Question 4 of 5
A 12-year-old patient with localized osteosarcoma is being treated with cisplatin, doxorubicin, and high-dose methotrexate. The pain at his primary site rapidly resolves after initiation of chemotherapy. After tumor resection, pathology reveals the tumor was greater than 95% necrotic. You want to continue cisplatin, doxorubicin, and high-dose methotrexate. Which of the following is the best answer regarding the evaluations that should be performed to monitor for toxicity in patients receiving cisplatin, doxorubicin, and high-dose methotrexate?
Correct Answer: C
Rationale: The correct answer is C: Complete blood count, creatinine, serum magnesium, audiogram, and echocardiogram. This choice includes essential monitoring tests for potential toxicities associated with cisplatin, doxorubicin, and high-dose methotrexate. Here's the rationale: 1. Complete blood count: To monitor for hematologic toxicities such as anemia, neutropenia, and thrombocytopenia. 2. Creatinine: To assess renal function, as cisplatin can cause nephrotoxicity. 3. Serum magnesium: Methotrexate can cause hypomagnesemia, necessitating monitoring. 4. Audiogram: Doxorubicin can lead to hearing loss, thus an audiogram is needed for early detection. 5. Echocardiogram: Doxorubicin can cause cardiotoxicity, so an echocardiogram helps in monitoring cardiac function. Each of the other choices lacks one or more essential monitoring tests
Question 5 of 5
Which of the following characteristics are similar with respect to Factor VIII and von Willebrand factor (vWF)?
Correct Answer: C
Rationale: Step-by-step rationale: 1. Factor VIII and vWF are present in normal to high relative amounts in newborns due to the physiological adaptation to the low levels at birth. 2. Both Factor VIII and vWF play crucial roles in the coagulation cascade, but their levels decrease after birth. 3. The other choices are incorrect because: - A: Factor VIII is primarily made in endothelial cells and vWF is made in endothelial cells and platelets, not megakaryocytes. - B: Thrombin activates Factor VIII but not vWF, which is activated by shear stress. - D: Factor VIII is stored in Weibel-Palade bodies, but vWF is stored in platelets and endothelial cells, not in the Weibel-Palade bodies.