Hematopoietic
The majority of serum alpha fetoprotein is produced by the: a) Fetal liver b) Maternal liver c) Placenta d) Fetal neural tube
A - Alpha fetoprotein (AFP) is produced mainly by the growing fetal liver. A small amount comes from the mother's liver, but by the end of the first trimester, most of the AFP is produced by the fetal liver.
During the physical exam of a 60-year-old adult, the nurse practitioner performs an abdominal exam. The nurse practitioner is checking the left upper quadrant of the abdomen. During percussion, an area of dullness is noted beneath the lower left ribcage. Which of the following is a true statement regarding the spleen? a) The spleen is not palpable in the majority of healthy adults b) The spleen is 8 to 10 cm in the left midaxillary line at its longest axis c) The spleen is 2 to 6 cm between the 9th and 11thribs on the left midaxillary line d) The splenic size varies depending on the patient's gender
A - The spleen is located in the left upper quadrant of the abdomen under the diaphragm and is protected by the lower ribcage. In the majority of adults, it is not palpable. The spleen's longest axis is 11 to 20 cm. Any spleen larger than 20 cm is enlarged. The best test for evaluating splenic (or hepatic) size is the abdominal ultrasound. Disorders that can cause splenomegaly include mononucleosis, sickle cell disease, congestive heart failure, bone marrow cancers (myeloma, leukemia), and several other diseases.
Which of the following tests would you recommend to patients to confirm the diagnosis of beta thalassemia or sickle cell anemia? a) Hemoglobin electrophoresis b) Bone morrow biopsy c) Peripheral smear d) Reticulocyte count
A -Patients with the diagnosis of beta thalassemia and/or sickle cell anemia would be screened using hemoglobin electrophoresis to identify the blood disorder.
The sentinel nodes (Virchow's nodes) are found at the: a) Right axillary area b) Left supraclavicular area c) Posterior cervical chain d) Submandibular chain
B - The sentinel nodes are found at the supraclavicular area of the chest. They are the first lymph nodes that a cancer lesion will drain into. Therefore, when cancer is diagnosed, these nodes are biopsied to see whether the cancer has spread into the lymph system.
Lead poisoning can cause which type of anemia? a) Mild macrocytic anemia b) Normocytic anemia c) Microcytic anemia d) Mild hemolytic anemia
C - Anemias can be classified according to the mean corpuscular volume (MCV) into microcytic, normocytic, and macrocytic anemias. A microcytic anemia is defined by an MCV of less than 80 fL. The differential diagnosis of a microcytic anemia includes iron-deficiency anemia (IDA), thalassemias; anemia of chronic disease (ACD); and sideroblastic anemias, including lead poisoning. Lead causes anemia by mimicking healthful minerals such as calcium, iron, and zinc. It is absorbed by the bones, where it interferes with the production of red blood cells. This absorption can also interfere with calcium absorption, which is needed to keep the bones healthy.
Beta thalassemia minor is considered a: a) Macrocytic anemia b) Normocytic anemia c) Microcytic anemia d) Hemolytic anemia
C - Beta thalassemia minor is a genetic disorder in which the bone marrow produces small, pale, red blood cells in which mild hypochromic, microcytic anemia occurs.
The red blood cells in pernicious anemia will show: a) Microcytic and hypochromic cells b) Microcytic and normochromic cells c) Macrocytic and normochromic cells d) Macrocytic and hypochromic cells
C- Anemias resulting from vitamin B12 or folate deficiency are sometimes referred to as macrocyticor megaloblastic anemia because red blood cells are larger than normal. A diagnosis of pernicious anemia first requires demonstration of megaloblastic anemia with a complete blood count (CBC) with differential that evaluates the mean corpuscular volume (MCV), as well the mean corpuscular hemoglobin concentration (MCHC). Pernicious anemia is identified with a high MCV (macrocytic) and a normal MCHC (normochromic).
All of the following conditions are associated with an increased risk of normocytic anemia except: a) Rheumatoid arthritis b) Systemic lupus erythematosus c) Polymyalgia rheumatica d) Pregnancy
D - Mild normocytic anemia is associated with chronic autoimmune or inflammatory disorders and chronic infection. Its exact mechanism is unknown. Pregnancy does not cause normocytic anemia, but it may cause several other types of anemia: iron-deficiency anemia (microcytic anemia, which can develop in some women who have very low ferritin levels), folate-deficiency anemia (macrocytic anemia), and vitamin B12 deficiency (also a macrocytic anemia).
Which of the following is a true statement about the effect of aspirin on platelet function? a) The effect on platelets is reversible b) The effect on platelets is reversible and lasts only 1 week c) The effect on platelet function is minimal d) The effect on platelet function is irreversible and lasts 7-10 days
D - The use of aspirin affects platelet function, is irreversible, and can last up to 7-10 days.
Which of the following findings is seen in a patient with folate-deficiency anemia? a) Microcytic and hypochromic red blood cells b) Microcytic and normochromic red blood cells c) Normal size and color of the red blood cells d) Macrocytic and normochromic red blood cells
D - Vitamin B12-deficiency adversely affects myelin, leading to neuropathy. The most common cause of B12-deficiency anemia is pernicious anemia. Anemia resulting from vitamin B12 or folate deficiency is referred to as macrocytic or megaloblastic anemia because the red blood cells (RBCs) are larger than normal. Deficiency in folate and B12 does not affect the color of RBCs (normochromic). The RBCs have large cytoplasm because folate and B12 are necessary for normal DNA synthesis and cytoplasmic maturation. The mean corpuscular volume (MCV) measures the size of the RBCs. An MCV greater than 100 is seen in macrocytic anemias (folate or B12-deficiency anemia). The mean corpuscular hemoglobin concentration (MCHC) is a measure of color, but number values are not used on the exam. Instead, color is described as normochromic or hypochromic.
Koilonychia is associated with which of the following conditions? a) Lead poisoning b) Beta thalassemia trait c) B12 deficiency anemia d) Iron-deficiency anemia
D- Koilonychia is also known as spoon-shaped nails. The finger nails are thin and have a concave shape. Koilonychia is associated with severe iron-deficiency anemia.
Multiple myeloma is a malignancy of the:White blood cells (WBC) a) Red blood cells (RBC) b) Plasma cells c) Platelets
c- Myeloma is a cancer of the plasma cells (or mature B-cells/ lymphocytes) that affects the bone marrow. Plasma cells produce antibodies and reside mainly in the bone marrow. Signs and symptoms are bone pain, fractures, hypercalcemia, depressed immunity, and anemia. The bone marrow produces white blood cells (neutrophils, lymphocytes, eosinophils, basophils), red blood cells, and platelets. The typical patient is an adult who is age 60 years or older.
What is the best diagnostic test for thalassemia? a) CBC b) MCV c) Hemoglobin electrophoresis d) Bone marrow biopsy
c- The gold standard for diagnosis of thalassemia (or sickle cell anemia) is the hemoglobin electrophoresis.
Which of the following laboratory tests would you order for an older diabetic man with the following complete blood count (CBC) results: hemoglobin = 11 g/dL, hematocrit = 38%, mean corpuscular volume (MCV) = 105 fL, and normal reticulocyte count? a) Serum ferritin and a peripheral smear b) Hemoglobin electrophoresis c) Serum folate acid and B12 level d) Schilling test
c- The patient has macrocytic anemia (MCV 102). The differential diagnoses are B12 deficiency and folate deficiency anemia. Initial test is the serum folate and B12 level. Other tests for macrocytic/megaloblastic anemias are the peripheral smear, methylmalonic acid, and homocysteine level. If B12 deficiency, order anti-parietal antibodies to check for pernicious anemia.
Which of the following findings is associated with B12 deficiency anemia? a) Spoon-shaped nails and pica b) Bradycardia c) Purpura rash d) Tingling and numbness of both feet
d- Vitamin B12 deficiency anemia can cause nerve cell damage if not treated. Symptoms of B12 deficiency anemia may include tingling or numbness in fingers and toes, difficulty walking, mood changes or depression, memory loss, disorientation, and dementia.