RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Medical & Surgical Nursing
Easy
Gold standard in the diagnosis of leukemia is?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Explanation
- Bone marrow biopsy is the definitive 'gold standard' because it allows direct examination of the blood-forming tissue where leukemia originates.
- It is essential for confirming the diagnosis, identifying the specific type of leukemia (acute vs. chronic, myeloid vs. lymphoid), and quantifying the percentage of blast cells.
- A blast cell count of 20% or more in the marrow is the World Health Organization (WHO) criterion for diagnosing acute leukemia.
- The sample enables crucial ancillary tests like flow cytometry (immunophenotyping), cytogenetics (for chromosomal abnormalities), and molecular analysis, which guide treatment and prognosis.
Why Other Options Were Wrong
- Option A: This test is used to detect bacterial or fungal infections in the bloodstream (bacteremia), not cancer cells.
- Option C: An X-ray visualizes bone structure and density but cannot assess the cellular composition of the bone marrow where leukemia develops.
- Option D: This term is ambiguous. If it refers to a biopsy of the hard cortical bone, it is used for solid tumors. The correct procedure for leukemia is a bone marrow biopsy, which samples the soft inner marrow.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Diagnostic standard for leukemia to guide bedside assessment, documentation, and the next nursing action.
- Nurses are central to patient care during a bone marrow biopsy, involving pre-procedure education, ensuring informed consent, providing support and pain management during the procedure, and post-procedure monitoring for bleeding and infection.
- Understanding that this is the 'gold standard' helps the nurse effectively explain the rationale for this invasive procedure to anxious patients and their families.
- What if? If a patient has a critically low platelet count (severe thrombocytopenia), the risk of bleeding from the biopsy is high. The procedure might be delayed until the patient receives a platelet transfusion to make it safer.
How to Approach the Question
- First, identify the key terms in the question: 'gold standard' and 'leukemia'.
- Recall the basic pathophysiology of leukemia: it is a cancer of the blood-forming cells, which are located in the bone marrow.
- Logically connect the disease location with the diagnostic method. To definitively diagnose a disease of the bone marrow, a sample of the marrow itself is required.
- Evaluate the options based on this connection. 'Bone marrow biopsy' directly samples the tissue of interest.
- Eliminate the other options by considering their primary purpose: Blood culture (for infection), Bone X-ray (for bone structure), and a cortical Bone biopsy (for solid bone tumors).
Concept Tested & Keywords
- Concept Tested: Diagnostic standard for leukemia
- Stem keywords: Gold standard, diagnosis, leukemia
- Lead-in keywords: is?
- Negative lead-in flag: false
Question ID
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Reference Book
E6 Pathology-Vandana Puri & Kavita Gaur Textbook of Pathology and Genetics p. 408-410
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 118-120
E6 Medicine Davidson Principles Practice 24e p. 984-986
Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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