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A 25-year-old just had a colonoscopy and was diagnosed with Crohn disease. Which of the following symptoms is consistent with this diagnosis?
- A. Right lower quadrant cramping
- B. Severe bloody diarrhea
- C. Nausea and vomiting
- D. Mostly affects the rectum
Correct Answer: A
Rationale: The correct answer is A: Right lower quadrant cramping. Crohn's disease commonly presents with abdominal pain, particularly in the right lower quadrant. Choice B, severe bloody diarrhea, is more characteristic of ulcerative colitis, another type of inflammatory bowel disease. Choice C, nausea and vomiting, are not typical symptoms of Crohn's disease. Choice D is incorrect as Crohn's disease can affect any part of the gastrointestinal tract, not just the rectum.
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In which patient is alpha-1 antitrypsin deficiency the likely cause of chronic obstructive pulmonary disease?
- A. A 30-year-old who has smoked for 3 years
- B. A 65-year-old man who worked as a taxi driver most of his life
- C. A 70-year-old woman who smoked for 40 years
- D. A 50-year-old with exposure to secondhand smoke
Correct Answer: A
Rationale: The correct answer is A. Alpha-1 antitrypsin deficiency is a genetic condition that can lead to COPD at a young age, even in light smokers. Choice B is less likely as the patient's occupation does not directly correlate with alpha-1 antitrypsin deficiency. Choice C, a 70-year-old woman with a long smoking history, is more likely to have COPD due to smoking rather than alpha-1 antitrypsin deficiency. Choice D, exposure to secondhand smoke, is not a common cause of alpha-1 antitrypsin deficiency-related COPD.
Which of the following women are at highest risk for the development of endometrial cancer?
- A. A 50-year-old postmenopausal woman with a history of high-risk human papillomavirus
- B. A 45-year-old woman who is obese and has menstrual irregularities with periods of amenorrhea and infrequent periods.
- C. A 40-year-old woman who is overweight and has hypertension.
- D. A 55-year-old woman who smokes.
Correct Answer: B
Rationale: The correct answer is B. Obesity and irregular menstrual cycles, including periods of amenorrhea and infrequent periods, are significant risk factors for the development of endometrial cancer. Choice A is less likely as postmenopausal status reduces the risk. Choice C is not directly associated with a high risk of endometrial cancer. Choice D, smoking, is more strongly linked to other types of cancers like lung cancer rather than endometrial cancer.
In gout, a man has developed large, hard nodules around his toes and elbows. The phase of gout he is in is:
- A. asymptomatic.
- B. acute flare.
- C. the intercritical period.
- D. chronic gout.
Correct Answer: D
Rationale: The man's presentation of large, hard nodules around his toes and elbows is indicative of tophi formation, which is characteristic of chronic gout. Tophi are deposits of uric acid crystals that can develop over time in untreated or poorly managed gout. During the chronic phase of gout, tophi can form in joints, soft tissues, and organs. Asymptomatic refers to a phase where there are no symptoms present. Acute flare is characterized by sudden and severe joint pain and inflammation. The intercritical period is the time between gout attacks when the patient is symptom-free.
Which of the following outcome criteria is appropriate for a client with dementia?
- A. The client will return to an established schedule for activities of daily living.
- B. The client will learn new coping mechanisms to handle anxiety.
- C. The client will seek out resources in the community for support.
- D. The client will follow an established schedule for activities of daily living.
Correct Answer: D
Rationale: The correct answer is D. For clients with dementia, following an established schedule for activities of daily living is appropriate as it helps maintain routine and structure, which can be beneficial for their condition. Choice A has been rephrased to align better with the context of dementia care. Choice A is incorrect as expecting a return to a previous level of self-functioning may not be realistic for clients with dementia. Choice B is not the most appropriate outcome criteria as handling anxiety, while important, may not be the primary focus when working with clients with dementia. Choice C, seeking out resources in the community for support, is also important but may not be as directly related to the day-to-day care and management of activities for a client with dementia.
A patient is diagnosed with type 2 diabetes mellitus. Which of the following is a common initial treatment strategy?
- A. Insulin therapy
- B. Lifestyle modification and metformin
- C. Sulfonylureas
- D. Thiazolidinediones
Correct Answer: B
Rationale: The correct answer is B: Lifestyle modification and metformin. When managing type 2 diabetes mellitus, initial treatment often involves lifestyle changes such as adopting a healthy diet and increasing physical activity, along with the oral medication metformin. Insulin therapy (choice A) is usually reserved for cases where lifestyle changes and oral medications are not sufficient to control blood sugar levels. Sulfonylureas (choice C) and thiazolidinediones (choice D) are also oral medications used in diabetes management, but they are not typically recommended as first-line treatments due to various side effects and considerations in type 2 diabetes management.