MCQS 295 –297 :A girl has had chronic anemia throughout childhood

Question:295
Correct Answer: J

Explanation:
Clinical manifestations of pituitary adenomas stem from endocrine dysfunction or from mass effect with invasion or compression of surrounding neural and vascular structures. Mass effects include headache, hypopituitarism, and visual loss. Headaches result from stretching of the diaphragma sellae and adjacent dural structures that transmit sensation through the first branch of the trigeminal nerve. Visual loss may be accompanied by optic disc pallor, loss of central visual acuity, and visual field defects, but papilledema is rare. Visual field abnormalities are caused by compression of the crossing fibers in the optic chiasm, first affecting the superior temporal quadrants and then the inferior temporal quadrants. Further expansion compromises the noncrossing fibers and affects the lower nasal quadrants and finally the upper nasal quadrants. Patients usually note blurring or dimming of vision. Formal visual field testing is important because some tumors affect only the macular fibers to cause central hemianopic scotomas that may be missed on routine screening. Although bitemporal hemianopia is most common, any pattern of visual loss is possible, including unilateral or homonymous hemianopia. There are a variety of methods of measuring the visual fields. A crude visual field test can be done by having the patient look straight ahead and count the fingers shown by the examiner from the side. More typically, however, visual fields are measured by a computerized assessment in a optometrist's or ophthalmologist's office. For this procedure, one eye is covered and the patient places his or her chin in a type of bowl. Then, when the patient sees lights of various intensities and at different locations, he or she pushes a button. This process produces a computerized map of the visual field.

 

Question:296
Correct Answer: C

Explanation:
SICKLING DISORDERS are syndromes associated with presence of hgb S, states where presence of Hgb S has effects on health/clinical state of the individual. This includes SS disease, and other disease states where Hgb S is associated with other abnormalities - eg, SC, SD, S- thalassemia - which enhances or promotes sickling phenomenon. The predominant disorder in incidence and clinical importance is Hgb SS disease - homozygous SS or sickle cell disease Nursing management of the child with sickle cell anemia is largely related to teaching and supporting the family and providing comfort and pain relief to the child during a sickle cell crises. Assessment of the child in sickle cell crisis involves all areas and systems that can be affected by circulatory obstruction, including vital signs, neurologic signs, vision, and hearing, as well as the respiratory, gastrointestinal, renal and musculoskeletal system. It is also important to assess the location and intensity of pain. Sickle cell crisis occurs spontaneously or with infections. The pain is severe in the bones, joints, back and abdomen. The temperature and white blood counts are elevated Polymerization leads to distortion of cell morphology, changes in viscosity, sludging, ischemia and ultimately, organ infarction. Initiation of vascular occlusion occurs most often at the precapillary arteriolar level. Reversibly sickled cells (RSC's) have normal shape and viscosity when oxygenated. Vasoocclusive events may be secondary to RSC's which slip into the microvasculature while oxygenated then become distorted and viscous as they become deoxygenated in vessel. Resultant increase in hypoxia and acidosis secondary to ischemia cause sickling, starting vicious cycle with an end result of organ damage. This effect ( viscosity) is responsible for majority of severe clinical features of sickling syndromes

 

Question:297
Correct Answer: F

Explanation:
Most squamous cell carcinomas arise centrally from either the main, lobar or segmental bronchi and ulcerate through the mucosa into the surrounding lung parenchyma.Their central location also tends to produces symptoms at an earlier stage than tumors located peripherally.Although symptoms tend not to be specific, most commonly a non-productive cough, they stem from the involvement of vital structures at the hilar area of the lung.Most patients, however, are detected by a routine chest radiograph, before they are symptomatic.Larger tumors are associated with chest pain, loss of appetite, loss of weight and dyspnea on exertion. Despite the fact that squamous cell carcinomas are rare in the periphery, they can cause a characteristic radiographical and clinical syndrome.They are the most common cause of the Pancoast or superior sulcus syndrome. Endobronchial squamous cell carcinoma commonly leads to bronchial obstruction and post obstructive pneumonia.The common radiologic manifestations of squamous cell carcinomas result from the partial or total bronchial obstructions which leads to pneumonia or atelectasis.One characteristic radiographic sign is the "S sign of Golden," which is due to the inability of the upper lobe to completely collapse.The tumor causes the bulging of the minor fissure on the right leading to a sigmoid shape. In situ carcinomas appear as a thickened area of stratified squamous cells with hyperchromatic nuclei, with or without nucleoli and eosinophilic cytoplasm.The squamous cells do not show maturation towards the surface (loss of polarity).Intercellular bridges are prominent.The key feature of in situ carcinoma which distinguishes it from invasive squamous cell carcinoma is the presence of an intact basement membrane without invasion into the lamina propria. Invasive squamous cell carcinoma exhibits similar features to those described above, but shows invasion through the basement membrane into the lamina propria. Hypercalcemia Hypercalcemia is the most common metabolic complication of cancer and occurs in 10% to 20% of patients with cancer at some point during their disease.42 If unrecognized or inadequately treated, hypercalcemia can be life-threatening.43 Roughly 80% of hypercalcemic episodes associated with malignancy are caused by solid tumors, particularly carcinoma of the lung, breast, and prostate.‘” Hematologic malignancies such as multiple myeloma, lymphoma, and leukemia comprise the remaining 20%.9 Mechanisms of hypercalcemia. Hypercalcemia associated with malignant disease results from two primary mechanisms, which may occur alone or in combination. First, hypercalcemia can result when tumor cells directly invade the bone and subsequently cause bone destruction. The second mechanism occurs in the absence of bony destruction and involves stimulation of osteoclasts by a variety of tumor-elaborated polypeptides possessing parathyroid hormone activity. Other chemical mediators implicated in the development of hypercalcemia of malignancy include E-series prostaglandins, parathormone, and osteoclast-activating factor.45 In addition, cancer patients are at high risk for hypercalcemia because of two other factors: 1) immobilization due to pain, weakness, or fractures; and, 2) dehydration resulting from vomiting and diarrhea associated both with tumor effect and chemotherapy. Clinical manifestations. Many patients present with the clinical triad of hypercalcemia consisting of back pain, constipation, and decreased alertness. Other common clinical features include anorexia, vomiting, polyuria, and hypertension, although a wide variety of symptoms and signs is possible. The severity of clinical findings correlates with the rate of development of hypercalcemia and the degree of serum calcium elevation. In cases of hypercalcemia of malignancy, calcium elevation generally occurs rapidly, and symptoms are usually prominent at relatively lower levels (12 mg/l to 14 mg/dL). The age of the patient, associated metabolic disturbances, and underlying medical illnesses also are important factors in determining the severity of symptoms.


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