NURS660 HEMATOLOGY LATEST UPDATE -

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NURS660 HEMATOLOGY LATEST UPDATE -

ACTUAL EXAM QUESTIONS WITH CORRECT

DETAILED (VERIFIED) ANSWERS/ GRADED A+

Treatment of DIET RELATED b12 deficiency - ANSWER - Oral Vit B12 1-2 mg PO daily sublingual is preferred route

Treatment of significantly low or pernicious anemia - ANSWER - Parenteral B12 1 mg daily for 7 days twice weekly for 1 week once a week for 3-6 weeks then monthly indefinitely

When would you repeat a CBC after starting B12 OR folate therapy for anemia? - ANSWER - 4 weeks

Is a patient more likely to have neuro symptoms with folate or B12 deficiency? - ANSWER - b12 folate is often asymptomatic until very severe except for glossitis

When would you order the lab values mama and homocysteine? How would you interpret/use them? - ANSWER - in a macrocytic, normochromic anemia, determining between B12/folate BOTH elevated = b12 ONLY homocysteine = folate

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2 Describe Wilms tumor (what it is, age group it is common in, prognosis) - ANSWER - solid tumor of the kidney, also called nephroblastoma usually diagnosed by 3 years of age good prognosis IF caught early (survival 90%)

What are some signs and symptoms of Wilms tumor? - ANSWER - mobile abdominal mass hematuria, hypertension, abdominal pain, fatigue, anemia, fever lung and liver meet most common

What is the reasoning behind not palpating a kidney mass in peds patients? - ANSWER

• if its Wilms tumor, this will cause seeding/spread of tumor cells

What is a normal iron level? - ANSWER - 50-160 not diagnostic in and of itself but coupled with an elevated TIBC is suggestive of IDA

What is a normal TBIC? How do you interpret this lab? - ANSWER - normal TBIC: 250-

• ability of cells to bind with iron.

if INCREASED: IDA because if there is MORE cells available to bind with iron, that means there is not enough iron saturating the cells and many are left without iron and therefore available

How do you treat IDA in adults? Med education? - ANSWER - oral elemental iron 150- 200mg in divided doses until anemia resolves take 30 min BEFORE food can cause black tarry stools Avoid dairy, ok to take with acidic things like absorbed acid/Vit C GI upset is common

Continue for 4-6 months until Ferritin >50 2 / 3

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What labs are most helpful in distinguishing an IDA from an anemia of chronic disease?

• ANSWER - TBIC + ferritin

TBIC will be LOW in anemia of chronic disease, elevated in IDA ferritin could also be helpful because it is normal or increased most of the other labs look pretty similar

Name the normal range of WBCs for an adult/peds patient - ANSWER - Adult: 4,500-

10,500

Peds age 6-18: 4,800-10,800

Your patient's WBC come back between 11-15k but they have no symptoms. What should you do next? - ANSWER - order a smear/diff on that sample and then repeat in 1 week and see what's going, look at risk factors, etc.

Your patient's WBC comes back >20k but they have no symptoms. What should you do? - ANSWER - recheck in 1 week heme referral if persistent

Neutrophilia refers to an ANC count of > than what? - ANSWER - 7700

Any time you have to repeat a CBC with diff due to abnormal numbers, make sure you order what with it? - ANSWER - a smear, esp. if you didn’t get the first time

Lymphocytosis refers to an ALC of? - ANSWER - >4000-5000

An ALC of >30-50k is concerning for... - ANSWER – leukemia

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