Nokea
A neonate of a smear-negative mother just before birth receives BCG as usual.
- A. TRUE
- B. FALSE
- C. -
- D. -
Correct Answer: A
Rationale: The correct answer is A: TRUE. This is because BCG vaccination for newborns is recommended even if the mother is smear-negative for tuberculosis, as it helps protect the newborn from severe forms of TB. Smear status of the mother does not impact the need for BCG vaccination in the neonate. Choice B is incorrect as it falsely implies that BCG should not be given in this scenario. Choices C and D are not applicable as they do not provide any information.
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Mechanism of labor in left occipito-posterior position:
- A. Descent, engagement, flexion, internal rotation
- B. Extension, engagement, internal rotation, external rotation
- C. Flexion, descent, external rotation
- D. Descent, engagement, extension
Correct Answer: A
Rationale: The correct answer is A: Descent, engagement, flexion, internal rotation. In left occipito-posterior position, the fetus descends into the pelvis, engages in the maternal pelvis, undergoes flexion to fit through the birth canal, and internally rotates to align with the pelvis for delivery.
Choice B (Extension, engagement, internal rotation, external rotation) is incorrect because extension is not typically seen in occipito-posterior positions. Choice C (Flexion, descent, external rotation) is incorrect because external rotation is not part of the mechanism in this position. Choice D (Descent, engagement, extension) is incorrect because extension is not typically seen in this position.
Bruised and oedematous appearance of the uterus, associated with placenta abruption is collectively referred to as
- A. Wernicke’s encephalopathy
- B. Uterine prolapse
- C. Couvelaire uterus
- D. Asherman’s syndrome
Correct Answer: C
Rationale: The correct answer is C: Couvelaire uterus. This condition refers to the bruised and edematous appearance of the uterus associated with placental abruption. Placental abruption occurs when the placenta separates from the uterine wall prematurely, leading to bleeding and a compromised blood supply to the uterus. The bruised appearance is due to blood infiltrating the myometrium.
Explanation for other choices:
A: Wernicke’s encephalopathy - This is a neurological disorder caused by thiamine deficiency, not related to uterine issues.
B: Uterine prolapse - This is the descent or herniation of the uterus into or beyond the vaginal canal, not related to placental abruption.
D: Asherman’s syndrome - This is characterized by intrauterine adhesions or scar tissue, typically a result of uterine surgery, not associated with placental abruption.
The AGACNP is covering an internal medicine service and is paged by staff to see a patient who has just pulled out his ET tube. After the situation has been assessed, it is clear that the patient will go into respiratory failure and likely die if he is not reintubated. The patient is awake and alert and is adamant that he does not want to be reintubated. The AGACNP is concerned that there is not enough time to establish a DNRthe patient needs to be reintubated immediately and already is becoming obtunded. Which ethical principles are in conflict here?
- A. Veracity and beneficence
- B. Beneficence and nonmalfeasance
- C. Autonomy and beneficence
- D. Justice and autonomy
Correct Answer: C
Rationale: The correct answer is C: Autonomy and beneficence. Autonomy refers to the patient's right to make their own decisions regarding their healthcare. In this case, the patient is refusing reintubation, exercising his autonomy. However, beneficence, the duty to act in the patient's best interest, also comes into play as the patient's refusal could lead to respiratory failure and death. The conflict arises from balancing the patient's autonomy with the healthcare provider's duty to provide beneficial care.
Choices A, B, and D are incorrect because they do not accurately capture the ethical conflict present in the scenario. Veracity (A) refers to truthfulness, which is not the primary issue here. Nonmalfeasance (B) is the duty to do no harm, which is not directly relevant to the conflict between the patient's autonomy and the need for beneficial care. Justice (D) relates to fairness in resource allocation and is not the primary issue in this case.
Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except
- A. Gamma-aminobutyric acid (GABA)
- B. Ammonia
- C. False neurotransmitters
- D. Serotonin
Correct Answer: D
Rationale: The correct answer is D: Serotonin. Serotonin is not a primary chemical mediator of hepatic encephalopathy. The main chemical mediators involved in hepatic encephalopathy are A: Gamma-aminobutyric acid (GABA), B: Ammonia, and C: False neurotransmitters. GABA plays a role in inhibiting neurotransmission, ammonia is a key factor in the pathogenesis of hepatic encephalopathy, and false neurotransmitters are produced due to altered amino acid metabolism in the liver. Serotonin is not a key player in the development of hepatic encephalopathy, hence it is the correct answer.
The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal
- A. Increased MCV
- B. Increased Hgb
- C. Increased platelets
- D. Increased albumin
Correct Answer: B
Rationale: Step 1: Post-splenectomy, platelet count typically drops temporarily, leading to a risk of bleeding.
Step 2: To compensate, the body increases hemoglobin (Hgb) levels to maintain oxygen-carrying capacity.
Step 3: Therefore, on postoperative day 2, an increased Hgb level is expected.
Summary: A is incorrect because MCV is not typically affected in this scenario. C is incorrect because platelet count usually decreases post-splenectomy. D is incorrect as albumin levels are not directly impacted by splenectomy for ITP.