Unit4: Ch 24 (Porth's 5th Ed) - Disorders of White Blood Cells and Lymphoid Tissues

Question 1

Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia?
A)Growth factors and cytokines
B)Neutrophils and eosinophils
C)T lymphocytes and natural killer cells
D)Natural killer cells and granulocytes

Answer 1

Ans: A
Feedback:
The identification and characterization of the various growth factors and cytokines have led to their use in treating a wide range of diseases like bone marrow failure, hematopoietic neoplasms, infectious diseases, and congenital and myeloproliferative disorders. Neutrophils are primarily responsible for maintaining normal host defenses against invading bacteria, cell debris, or foreign substances. Eosinophils increase in number during allergic reactions and parasitic infections. T lymphocytes are involved in cell-mediated immunity. Natural killer cells participate in innate or natural immunity, and their function is to destroy foreign cells. Granulocytes are phagocytic cells.

Question 2

A 12-year-old boy has contracted a bacterial infection at school, and his body has responded by increasing leukocyte production. Place the following components of white blood cell production in the correct chronological order. Use all the options.
A)Myeloblast
B)Promyelocyte
C)Myeloid stem cell
D)Metamyelocyte
E)Neutrophil

Answer 2

Ans: C, A, B, D, E
Feedback:
Granulocytes like neutrophils derive from the myeloid stem cells. The immature precursor cells for each of the cell lines are called blast cells. Myeloblasts, which are the granulocytic precursor cells, have round to oval nuclei, with delicate chromatin and a blue to gray cytoplasm. During the next stage of development, the myeloblasts are transformed into promyelocytes with similar nuclei, but with a cytoplasm containing many primary granules. In the subsequent metamyelocyte stage, the nuclei distort and become arc like, producing the band developmental stage. Metamyelocytes mature into neutrophils.

Question 3

Which of the following statements most accurately conveys an aspect of lymphatic system activity?
A) B- and T-lymphocyte development begins in the bone marrow and ends in the peripheral lymphoid structures.
B) B cells and macrophages are released from the bone marrow in their completed state.
C) Stem cells in the lymph nodes initiate and regulate the process of white cell synthesis.
D) Leukocytes bypass vascular circulation and are distributed instead by the lymphatic system.

Answer 3

Ans: A
Feedback:
While both precursor B and T lymphocytes begin their development in the bone marrow, they migrate to peripheral lymphoid structures to complete the differentiation process. Stem cells are not located in the lymph nodes, and circulation of white cells is not exclusive to the lymphatic circulatory system.

Question 4

A 44-year-old male hospital client with a diagnosis of end-stage acquired immunodeficiency syndrome (AIDS) has been placed on neutropenic precautions that limit his interaction with visitors, staff, and other clients. What is the underlying rationale for these precautions?
A) His antibody-mediated immunity is compromised by his low production of neutrophils.
B) Neutropenia limits the ability of his CD4 helper cells to present antigens.
C) Insufficient levels of neutrophils make him particularly susceptible to infections.
D) Cyclic neutropenia limits his body’s ability to fight various infections

Answer 4

Ans: C
Feedback:
A decrease in the number of neutrophils places an individual at risk for infection. Neutrophils are not directly involved in the antibody-mediated immune process, and his neutropenia is infection related, not cyclic.

Question 5

Which of the following patients has an absolute neutrophil count that is critically low and that the standard of care would recommend they be placed on neutropenic precautions?
A) A patient on long-term steroids for rheumatoid arthritis with WBC of 7000
B) A 37-year-old patient with leukemia being treated with chemotherapy with ANC of 400
C) A 65-year-old prostate cancer patient receiving radiation therapy with neutrophil count of 2000
D) A 75-year-old renal failure patient receiving Epogen for anemia with hemoglobin level of 9.7.

Answer 5

Ans: B
Feedback:
Neutrophils constitute the majority of blood leukocytes and play a critical role in host defense mechanisms against infections. The ANC is supposed to be 1000/μL, and if the ANC is less than 500 cells/mm3, the person is generally put on neutropenic precautions in the hospital to protect him or her from the environment. A patient on long-term steroids for rheumatoid arthritis with WBC of 7000 has a normal WBC count; a prostate cancer patient receiving radiation therapy with neutrophil count of 2000 has a normal neutrophil count; a renal failure patient receiving Epogen for anemia with hemoglobin level of 9.7 is associated with RBCs and not neutrophils.

Question 6

A patient with rheumatoid arthritis has been diagnosed with a secondary
immune-associated neutropenia called Felty syndrome. The nurse has had to research this and found that she should be assessing this patient for which of the following manifestations of Felty syndrome. Select all that apply.
A) Upper left quadrant pain on palpation
B) An area of diminished breath sounds related to pneumonia
C) Intermittent pain that radiates from the flank to the groin
D) Swelling and pain in all joints when put through full range of motion
E) Headache that worsens when exposed to bright lights

Answer 6

Ans: A, B
Feedback:
Felty syndrome, a variant of rheumatoid arthritis (RA), is a triad of splenomegaly (upper left quad pain), recurrent pulmonary infections (diminished breath sounds), and neutropenia. Intermittent pain that radiates from the flank to the groin is usually associated with kidney stone pain. Swelling and pain in all joints when put through full range of motion are also associated with rheumatoid arthritis.

Question 7

A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms?
A) The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.
B) Viruses are killing some of his B cells and becoming incorporated into the genome of others.
C) The EBV inhibits the maturation of white cells within his peripheral lymph nodes.
D) The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

Answer 7

Ans: B
Feedback:
B lymphocytes all of which have receptors for the EBV that causes mononucleosis. Infection of the B cells may take one of two forms—it may kill the infected B cell, or it may become incorporated into its genome. Lysis of neutrophils or inhibition of white cell maturation or differentiation is not a central component of mononucleosis etiology

Question 8

A 16-year-old female has been brought to her primary care physician by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the physician to rule out infectious mononucleosis?
A) The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.
B) Her liver and spleen are both enlarged.
C) Blood work reveals an increased white blood cell count.
D) Chest auscultation reveals crackles in her lower lung fields bilaterally

Answer 8

Ans: D
Feedback:
While fever, enlarged lymph nodes, splenomegaly, hepatomegaly, and leukocytosis would suggest mononucleosis, adventitious lung sounds are not associated with the disease.

Question 9

A 40-year-old male client is shocked to receive a diagnosis of mature B-cell lymphoma and is doing research on his diagnosis on the Internet. Which of the following statements that he reads on various Web sites is most reliable?
A) “Like most forms of Hodgkin lymphoma, mature B-cell lymphoma often requires radiation treatment.”
B) “Doctors are able to diagnose mature B-cell lymphoma by the presence of Reed-Sternberg cells.”
C) “Unlike many other lymphomas, mature B-cell lymphoma is often self-limiting, and treatment is focused on symptoms.”
D) “The lymph nodes are usually affected, and often the spleen and bone marrow.”

Answer 9

Ans: D
Feedback:
The NHL subtypes of mature B-cell lymphoma may affect the lymph nodes, spleen, or bone marrow. It is not a type of Hodgkin lymphoma, and Reed-Sternberg cells would indicate Hodgkin lymphoma. It is not self-limiting and necessitates active treatment

Question 10

Which of the following statements by a client of a cancer center who has a new diagnosis of non-Hodgkin lymphoma (NHL) demonstrates a sound understanding of the diagnosis and treatment of the health problem?
A) “They confirmed my diagnosis with a lymph node biopsy, and I’ll get radiation treatment soon because it’s fairly early stage.”
B) “They took a sample of my lymph nodes, and I’ll be having surgery soon that will hopefully cure my lymphoma
C) “My blood work came back positive for NHL, and I’m meeting with my
oncologist to discuss chemotherapy soon.”
D) “Since the tests show NHL, I’m going to pursue my options for palliative care because I’m committed to dying with dignity.”

Answer 10

Ans: A
Feedback:
Lymph node biopsy is often used to provide a diagnosis of NHL, and radiation is a common treatment, especially in early stages of the disease. Surgery is not a noted treatment modality, and while blood work may help with staging, it is not a common source of a confirming diagnosis. Treatment options do exist, and palliative care would be premature

Question 11

A patient has visited his physician because he found an enlarged lymph node along the mediastinal border. When questioned, the physician may be alerted to a possible diagnosis of Hodgkin lymphoma (HL) if the patient also displays: Select all that apply.
A) yeast infection in the mouth.
B) night sweats.
C) unexplained pruritus.
D) joint swelling.
E) sore throat with pustules on tonsils

Answer 11

Ans: B, C
Feedback:
Most people with HL present with painless enlargement of a single node or group of nodes. The initial lymph node involvement typically is above the level of the diaphragm. Mediastinal masses are frequent and discovered on routine chest x-ray. There may be complaints of chest discomfort with cough or dyspnea. Additional symptoms include fevers, chills, night sweats, and weight loss. Pruritus and intermittent fevers associated with night sweats are classic symptoms of HL. Yeast infections and joint swelling are not associated with HL. Sore throat with pustules on tonsils is associated with strep throat

Question 12

60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma?
A) Her neoplasm originates in secondary lymphoid structures.
B) The lymph nodes involved are located in a large number of locations in the lymphatic system.
C) The presence of Reed-Sternberg cells has been confirmed.
D) The woman complains of recent debilitating fatigue

Answer 12

Ans: B
Feedback:
While NHLs tend to be multicentric, Hodgkin lymphoma tends to involve a single node or group of nodes. The presence of Reed-Sternberg cells would indicate Hodgkin lymphoma, and both NHL and Hodgkin lymphoma involve secondary lymphoid structures and would cause fatigue

Question 13

A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered
A) interleukin cells.
B) BRCA-1.
C) Philadelphia.
D) PSA.

Answer 13

Ans: C Feedback:
One of the more studied translocations is the Philadelphia chromosome, which was the first chromosomal abnormality identified in cancer. Cytokines or chemical messengers, such as interleukin (IL)-1, IL-4, IL-6, and interferon, act synergistically to support the functions of the growth factors. BRCA is a genetic test for breast cancer testing. BRCA mutations place the female at risk for developing cancers of the breast and ovary; PSA stands for prostate-specific antigen. It is a protein produced by prostate cells and is utilized to screen for prostate cancer.

Question 14

Which of the following assessments and laboratory findings would be most closely associated with acute leukemia?
A) High blast cell counts and fever
B) Decreased oxygen partial pressure and weight loss
C) Increased serum potassium and sodium levels
D) Increased blood urea nitrogen and bone pain

Answer 14

Ans: A
Feedback:
Acute leukemia is often marked by a fever as well as leukostasis. Changes in oxygen saturation, electrolytes, and BUN would be less closely associated with ALL and AML

Question 15

Which of the following individuals would most likely possess normal plasma cell synthesis and fully differentiated myeloid and lymphoid cells?
A) A 7-year-old boy with a diagnosis of acute lymphocytic leukemia (ALL)
B) A 70-year-old male who has acute myelogenous leukemia (AML)
C) A 58-year-old female with HIV and multiple myeloma
D) A 78-year-old male who has been diagnosed with chronic lymphocytic leukemia (CLL)

Answer 15

Ans: D
Feedback:
Chronic leukemia is associated with proliferation of myeloid and lymphoid cells that are better differentiated than in cases of acute leukemia. Multiple myeloma would denote abnormalities of the plasma cells

Question 16

A patient diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be
A) dexamethasone, a corticosteroid.
B) cisplatin, a chemotherapeutic.
C) vincristine, a Vinca alkaloid.
D) doxorubicin, a cytotoxic antibiotic

Answer 16

Ans: A
Feedback:
Complications of CLL include thrombocytopenia and may require treatment with corticosteroids or splenectomy. None of the other medications are used for treatment of CLL

Question 17

A 70-year-old woman has received a diagnosis of chronic myelogenous leukemia (CML) after a clinical investigation sparked by the presence of leukocytosis in her routine blood work. What clinical course should her care provider tell her to expect?
A) “You can expect your blood results, fatigue, and susceptibility to infection to gradually worsen over a few years.”
B) “You could remain the chronic stage of CML for several years before it accelerates and culminates in a crisis.”
C) “It’s likely that this will give you chronic fatigue and malaise for the rest of your life, but that will probably be the extent of your symptoms.”
D) “Unfortunately, your leukemia will likely enter a crisis mode within a few weeks if we don’t treat it immediately.”

Answer 17

Ans: B
Feedback:
The clinical course of CML is commonly divided into three phases: (1) a chronic phase of variable length, (2) a short accelerated phase, and (3) a terminal blast crisis phase.
Persons in the early chronic phase of CML generally are asymptomatic, but without effective treatment, most will enter the accelerated phase within 4 years

Question 18

A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause?
A) Accelerated CML
B) Stage A Hodgkin disease
C) Infectious mononucleosis
D) CLL

Answer 18

Ans: A Feedback:
Typically, CML follows a triphasic course: (1) a chronic phase of variable length, (2) a short accelerated phase, and (3) a terminal blast crisis phase. The onset of the chronic phase is usually slow with nonspecific symptoms. Anemia causes weakness, easy fatigability, and exertional dyspnea. The accelerated phase is characterized by enlargement of the spleen and progressive symptoms. Persons with Hodgkin disease are commonly designated as stage A if they lack constitutional symptoms and stage B if significant weight loss, fevers, pruritus, or night sweats are present. In cases of infectious mononucleosis, most persons seek medical attention for severe pharyngitis, which usually is most severe on days 5 through 7 and persists for a total of 7 to 14 days. CLL is mainly a disorder of older persons: fewer than 10% of those who develop the disease are younger than 50 years of age. Men are affected twice as often as women.

Question 19

In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?
A) A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated
B) A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges
C) An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever
D) A 70-year-old woman whose blood work reveals large numbers of immature granulocytes

Answer 19

Ans: A
Feedback:
The main sites involved in multiple myeloma are the bones and bone marrow. In addition to the abnormal proliferation of marrow plasma cells, there is proliferation and activation of osteoclasts that lead to bone resorption and destruction. This increased bone resorption predisposes the individual to pathologic fractures and hypercalcemia. Many patients also present with renal insufficiency. Leukostasis, susceptibility to infection, and disorders of granulocyte development are not hallmarks of multiple myeloma

Question 20

A 30-year-old male's blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man's most likely diagnosis?
A) Acute myelogenous leukemia
B) Multiple myeloma
C) Acute lymphocytic leukemia
D) Hodgkin lymphoma

Answer 20

Ans: B
Feedback:
One of the characteristics resulting from the proliferating osteoclasts in multiple myeloma is the unregulated production of a monoclonal antibody referred to as the M protein. In most cases, the M protein is either IgG or IgA. This phenomenon is not present in cases of CML, ALL, or Hodgkin lymphoma.