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.

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.

Correct Answer: D

Rationale: The correct answer is D: DAT positive for C3. This finding suggests complement-mediated hemolysis, which is consistent with a transfusion reaction known as transfusion-related acute lung injury (TRALI). TRALI presents with respiratory distress, fever, and chills due to immune complexes activating the complement system. A: Spherocytes indicate hemolysis, which is not specific to TRALI. B: Gram-negative Bacillus suggests bacterial contamination, leading to sepsis, not TRALI. C: Bilateral pulmonary infiltrates are seen in transfusion-associated circulatory overload (TACO), not TRALI.

Correct Answer: C

Rationale: The correct answer is C because the ex-28 week premature infant requiring NICU-level care for necrotizing enterocolitis has the greatest risk of hospital-acquired venous thromboembolism. Premature infants have inherent hypercoagulability due to immature coagulation factors and increased risk of endothelial injury from central lines or catheters. Necrotizing enterocolitis further increases the risk of venous stasis due to decreased gut perfusion. Choice A: The 3-day-old full-term infant admitted for hyperbilirubinemia is less likely to have significant risk factors for thrombosis compared to a premature infant with necrotizing enterocolitis. Choice B: The 6-month-old male admitted for respiratory syncytial virus is less likely to have prolonged immobilization or other significant risk factors compared to a premature infant in the NICU. Choice D: The 7-year-old male with acute lymphoblastic leukemia has a higher risk of thromb

Correct Answer: D

Rationale: The correct answer is D: MAP. In localized osteosarcoma, the response to preoperative chemotherapy is evaluated based on the percentage of tumor necrosis. A necrosis of 40% is considered a good response. The standard of care after surgery is to continue with the same chemotherapy regimen to complete the course. Continuing with MAP in this case is important to ensure that any remaining cancer cells are effectively treated. Option A (IE) and option B (MAPIE) are not indicated as they are different regimens and not the standard of care for this scenario. Option C (Gemcitabine docetaxel) is also not the appropriate choice as it is not the standard treatment protocol for localized osteosarcoma.