You are treating a patient with localized osteosarcoma of the distal femur with methotrexate, doxorubicin, and cisplatin (MAP) chemotherapy. At week 10 of treatment, the patient undergoes complete resection of the tumor. Pathology demonstrates 40% necrosis. Which of the following represents the most appropriate further therapy?

Correct Answer: D

Rationale: Rationale: The correct answer is D, continuing with MAP chemotherapy. The 40% necrosis rate indicates a good response to the current regimen. Continuing MAP ensures completion of the planned therapy and maximizes the benefit of the initial treatment's response. Choice A (Ifosfamide and etoposide) and B (MAPIE) are not indicated as the response to MAP was favorable. Choice C (Gemcitabine docetaxel) is not the standard of care for osteosarcoma. Continuing with MAP is the most appropriate option for this patient.

Correct Answer: C

Rationale: The correct answer is C: Excessive alcohol consumption. Excessive alcohol intake can lead to hematologic health problems such as anemia and abnormal blood clotting. Alcohol interferes with the production of red blood cells and impairs the function of platelets. Therefore, documenting excessive alcohol consumption is crucial in assessing a client's risk for hematologic issues. Explanation for why other choices are incorrect: A: Family history of military excellence - This choice is irrelevant to hematologic health problems and does not pose a risk factor. B: Diet low in iron and protein - While a poor diet can contribute to hematologic issues, this specific choice does not directly indicate a risk factor for hematologic problems. D: Family history of allergies - Allergies are not directly related to hematologic health problems, so this choice is not relevant in this context.

Correct Answer: A

Rationale: Step-by-step rationale: 1. Subcutaneous injection of heparin is avoided due to the risk of hematoma formation at the injection site. 2. This statement is false because heparin is commonly administered subcutaneously for prophylaxis of thromboembolic events. 3. The preferred route for heparin administration is subcutaneous or intravenous. 4. Therefore, choice A is the false statement. Summary: - Choice A is incorrect as heparin is commonly given subcutaneously. - Choice B is incorrect as heparin is not stored in mast cells but in specialized granules in mast cells. - Choice C is correct as heparin binds to plasma antithrombin III to inhibit thrombin. - Choice D is correct as protamine sulfate can reverse heparin's anticoagulant effects in case of overdose.

Correct Answer: C

Rationale: The correct answer is C: Trypanosoma brucei gambiense. This is the most probable causative organism because the patient's presentation of fever and posterior cervical lymphadenopathy over a prolonged period aligns with the chronic infection caused by Trypanosoma brucei gambiense, which leads to African Trypanosomiasis (sleeping sickness). Trypanosoma cruzi (choice A) causes Chagas disease, which typically presents with acute symptoms such as fever and swelling at the site of infection. Trypanosoma brucei rhodesiense (choice B) causes acute African Trypanosomiasis with a more rapid progression compared to gambiense. Leishmania donovani (choice D) causes visceral leishmaniasis, which presents with prolonged fever, splenomegaly, and pancytopenia, but not typically with cervical lymphadenopathy.

Correct Answer: C

Rationale: The correct answer is C: Quinine and clindamycin. Quinine is considered safe for use in pregnancy to treat malaria, as it has been used for many years without significant adverse effects. Clindamycin is also safe for use in pregnancy and can be used in combination with quinine to treat malaria. Atovaquone and proguanil (choice A) are not recommended for use in pregnancy due to limited safety data. Quinine and doxycycline (choice B) is not suitable for pregnant women as doxycycline is contraindicated during pregnancy. Primaquine (choice D) is not recommended for use during pregnancy as it can cause harm to the fetus.