Please answer all 6 questions correctly, thank you. Daphoene Haemon (DH), an eig

Question

Please answer all 6 questions correctly, thank you.

Daphoene Haemon (DH), an eight-year-old girl, has been battling various illnesses since her birth. Developmental disabilities have left DH with moderate learning disabilities and physical manifestations such as incomplete extra thumbs on each hand. DH is well below the normal body weight for her age; her head and eyes appear too small for her little body. She has been monitored closely by a cardiologist, her heart doctor, because of a problem with the valves in her heart. Recently, DH has suffered continual sinus, skin, and ear infections. Bleeding had also become an issue for her recently; even minor injuries bled profusely and her nose and gums bled spontaneously, without even a sneeze or the use of dental floss.

DH and her parents are accustomed to sitting in doctors' office waiting rooms together. However, the news from the doctor was particularly awful this time. A recent blood test that her pediatrician had ordered suggested that DH had developed acute myeloid leukemia (AML). AML is a cancer of white blood cells and bone marrow that usually affects adults in the fourth or fifth decade of life. Is cancer the reason for DH's poor health, or is there some common thread that links all of her maladies into one underlying disorder? Follow DH's case as her appointment with a pediatric oncology (cancer) specialist quickly becomes an emergency.

DH's pediatrician wanted input from the oncologist before confirming a diagnosis of acute myeloid leukemia (AML), as this type of leukemia is not commonly found in children. As you would expect, DH's parents had a long list of questions and concerns for yet another medical specialist. The pediatrician did not want to scare the family, but AML needs immediate attention. The bottom line, according to the pediatrician, was that if DH did have AML, she would need to be treated quickly or her life would be in grave danger. Arrangements were made for DH and her family to see an oncologist that very same afternoon.

DH's parents were hopeful that there had been some mistake with the blood tests. In addition to confirming the acute myeloid leukemia diagnosis, the cause of her recurring infections was at the top of their list of questions. Could AML also cause fatigue or the bleeding gums and nosebleeds? DH was also recently much more easily fatigued and short of breath while doing her usual activities. Could AML explain all of DH's recent medical issues?

Question 1: DH has been referred to an oncologist because it appears that she has developed acute myeloid leukemia, which affects both the formed elements and the plasma of the blood. Damage to the formed elements can cause all of the following except:

A) decreased production of antibodies.

B) low levels of oxygen in the blood.

C) increased time for blood to clot.

D) difficulty in transporting hormones and waste products.

Question 2: The oncologist anticipated that DH might need to be hospitalized for close monitoring and treatment of AML. The diagnosis certainly explained the recurring infections, bleeding, and fatigue. The blood tests also indicated that DH had a form of anemia in which the few visible red blood cells had an abnormal appearance. This was no surprise to the oncologist, as anemia is common in bone marrow cancer such as AML.

Unfortunately, DH's condition had deteriorated quickly during the course of the day. By the time the oncologist saw her, she looked quite ill and was only able to open her eyes briefly to answer some simple questions. The oncologist quickly gave DH's parents as much information as she could while making preparations to send DH to the hospital.

DH likely has hemolytic anemia, which results in the destruction and death of erythrocytes. Under normal circumstances, what is the body's response to decreased numbers of erythrocytes?

A) Decreased levels of erythropoietin.

B) Increased macrophage activity in the sinusoids of the spleen.

C) Red bone marrow is converted into yellow bone marrow.

D) Increased production of reticulocytes.

Question 3: DH's parents asked the oncologist to explain the complete blood count (CBC) in terms that they could understand. They had previously been told that a high white blood cell count just meant that DH had an infection. They are confused when the oncologist tells them the high white blood cell count indicates AML. The oncologist explained that DH's white blood cell count was much higher than what would be expected with an infection alone. DH could have an infection as well, but one thing was certain—DH needed to be admitted to the hospital. She needed a complete work up of her condition, a treatment plan for AML, blood transfusions, possibly antibiotics, and close monitoring. The oncologist needed more information, and she wasn't sure they had much time to sort this case out.

It is possible that DH has septicemia, or a blood infection. Which of the following typically occurs in order to produce the elevated numbers of leukocytes needed to fight the infection?

A) Cell division in the lymphoid cell line will increase in order to produce the five types of leukocytes.

B) Myeloblasts and lymphoblasts revert to hematopoietic stem cells in order to produce more leukocytes.

C) Increased production of band cells.

D) Myeloblasts will differentiate into lymphocytes.

Question 4: More extensive blood work was performed once DH was settled in the pediatric oncology wing of University Hospital. A bone marrow biopsy was also quickly performed, so the results could be interpreted and used to formulate a treatment plan for DH. DH's blood was typed and cross matched in the probable event that she would need transfusions. There was concern that she might also need platelet transfusions to prevent further bleeding. DH's parents were obviously frightened by the urgency with which the oncology team performed their tasks. The oncologist was doing her best to keep them informed, but it was difficult. The pediatric oncology service had counselors knowledgeable in the field that could assist with family communication.

DH has thrombocytopenia, a condition in which the number of platelets in the blood has dropped. She may need platelet transfusions to replace these critical components of the blood. All of the following could cause a reduction in platelets except:

A) abnormally shaped nuclei in the platelets that shorten the lifespan to 3-5 days.

B) chemotherapy that inhibits mitosis.

C) low levels of thrombopoietin.

D) death or loss of cells in the myeloid cell line.

Question 5: DH didn't feel very well. She ached all over but she seemed to like the attention from the nursing staff and the young doctors who visited with her oncologist early in the morning. She missed her parents when they were away from her hospital room. The nurses were in her room constantly changing the dressing from where the bone marrow biopsy was taken.

The biopsy site was still oozing blood and had been since the procedure was performed. DH's nurse contacted the oncologist, who had already contacted DH's parents for their consent to administer both plasma containing clotting factors and platelets. DH would need to be stabilized before the oncology team would be able to treat the AML.

The blood plasma that was transfused into DH's body contained clotting factors. Which of the following statements is false with regard to the coagulation cascade?

A) The intrinsic pathway begins when factor XII is activated by exposed collagen found in damaged blood vessels.

B) The extrinsic pathway begins when damaged subendothelial cells display tissue factor on their plasma membranes.

C) Prothrombin must be converted into its active form, thrombin, in the common pathway, which is required to convert fibrinogen into its active form, fibrin.

D) The intrinsic pathway must be completed before the extrinsic pathway can initiate the process that synthesizes fibrin.

Question 6: Although DH had been put on a ventilator to assist with her respiration and she was continuously receiving intravenous fluids, her vital signs were becoming unstable. The oxygen saturation in her tissues was dropping, her heart rate was elevated, and her blood pressure was becoming dangerously low. DH needed functional erythrocytes to carry oxygen that her plasma did not contain. The typed and cross-matched blood the medical team was waiting for would not be ready in time. DH needed to be transferred to the pediatric intensive care unit (PICU) immediately. Her condition was rapidly declining.

DH's blood type was A+, and four units of blood had been ordered for her, but there was a delay at the blood bank. The oncology unit had an emergency supply of O- blood. One unit of type O- blood began transfusing while DH was transferred. A second and third bag of O- blood was prepared for transfusion as well. DH's parents were beginning to panic when the oncologist met them and escorted them to the PICU waiting room. The next few hours would be critical, and there was a possibility that DH would not survive the night.

Which of the following statements is false regarding the ABO and Rh blood groups?

A) Erythrocytes that display Rh antigens on their plasma membranes are Rh+, while erythrocytes that do not display Rh antigens are Rh-.

B) Erythrocytes that do not display A, B, or Rh on their plasma membranes are blood type O-.

C) Erythrocytes that display A, B, and Rh antigens on their plasma membranes are blood type AB+.

D) The ABO blood group features two antibodies found on erythrocyte plasma membranes: the A antibody and the B antibody. The presence or absence of these antibodies results in four possible ABO types.

Explanation / Answer

1.D difficulty in transporting hormones and waste products.- Hormones are the chemical substances that travel via the bloodstream to their target organs and does not require the formed bodies which are nothing but the cell constituent( WBC, RBC, thrombocytes)

2.D Increased production of reticulocytes.Reticulocyte is nothing but immature Erythrocytes which mature after 1-2 days of circulation.

3 D Increased production of band cells. indicates an infection in progress.

4. A. abnormally shaped nuclei in the platelets that shorten the lifespan to 3-5 days.

5 D .The intrinsic pathway must be completed before the extrinsic pathway can initiate the process that synthesizes fibrin.-both extrinsic and intrinsic pathways activate the "final common pathway" of factor X, thrombin and leading to fibrin synthesis.

6.D D) The ABO blood group features two antibodies found on erythrocyte plasma membranes: the A antibody and the B antibody. The presence or absence of these antibodies results in four possible ABO types.-- it is the presence or the absence of both or either of the A and B antigens on erythrocytes

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