Nokea
A 35-year old teacher on allopurinol 200 mg OM for the past year reports three recent gout attacks. BMI 27 kg/m2, BP 144/94 mm Hg. You notice tophi over both hands and elbows. You will now:
- A. Stop the allopurinol during this acute gout attack
- B. Start hydrochlorothiazide 25 mg OM for BP control
- C. Continue allopurinol despite the attack and aim to reduce uric acid <300 umol/L
- D. Advise to rest and avoid exercise for 3 months as he is having acute pain
Correct Answer: C
Rationale: Tophi, flares allopurinol stays, push uric <300; thiazides worsen, rest flops, losartan's late. Nurses hold this chronic crystal line.
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Which of the following statements on NAFLD is false?
- A. Weight loss is the prime way of management
- B. Long-term management is needed
- C. Patients should be referred to specialists for further evaluation
- D. Metformin should be used as first-line treatment in patients with NAFLD and diabetes mellitus
Correct Answer: D
Rationale: Weight loss (5-10%) is prime for NAFLD, long-term care is essential, and specialist referral aids complex cases all true. Statins manage dyslipidemia safely in NAFLD. Metformin, though first-line for diabetes, isn't for NAFLD itself lacking evidence for steatosis reversal making this false. Physicians must clarify this in chronic care planning.
Postoperative care at the completion of bimaxillary surgery:
- A. Is likely to be complicated by the presence of intermaxillary fixation (IMF).
- B. Involves awake rather than asleep extubation.
- C. Requires gentle removal of the tracheal tube to avoid damage of mandibular plates and screws.
- D. Involves reinsertion of a nasal tracheal tube when complicated by airway bleeding or obstruction requiring emergency reintubation.
Correct Answer: A
Rationale: Bimaxillary surgery's postoperative phase is complex. Intermaxillary fixation (IMF) aligns jaws but restricts mouth opening, complicating airway management, vomiting, and oral care raising aspiration or obstruction risks. Awake extubation is preferred, ensuring airway reflexes return, critical with IMF and swelling. Gentle tube removal prevents surgical site trauma (e.g., plates), though mandibular hardware is internal, less tube-accessible. Emergency reintubation may use nasal routes due to IMF, addressing bleeding/obstruction. HDU care is case-specific, not mandatory. IMF's presence drives tailored strategies, prioritizing airway security and patient stability in this high-risk recovery period.
Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the past year. He has no other known past medical history. When you probe, he is adherent to allopurinol except for missing it perhaps once or twice a month. His BMI 25 kg/m², BP 144/94 mm Hg. His last uric acid was one month ago, which was 405 mmol/L. He is having a gout attack now. He tells you that his gout attacks are usually aborted with colchicine TDS for two days. Whilst on colchicine, he does not experience diarrhoea except for one episode of loose stools, after which he stops colchicine. Which is the most appropriate next step?
- A. Start Hydrochlorothiazide for hypertension
- B. Start Losartan for hypertension
- C. Stop Allopurinol during this acute gout attack and start colchicine. Consider checking a baseline creatinine if not recently available
- D. Continue allopurinol at 200 mg OM despite the attack and start colchicine. Consider checking an updated uric acid level and creatinine two weeks after the attack resolves. If uric acid is >360, explain that allopurinol 200 mg OM is insufficient and needs to be up titrated
Correct Answer: D
Rationale: Gout mid-attack 405 uric acid on 200 mg allopurinol says it's not enough. Keep it rolling, add colchicine to quash the flare, then recheck labs post-calm to titrate up if >360. Stopping allopurinol spikes urate; HCTZ worsens gout; Losartan's fine but sidesteps; upping now risks confusion. Clinicians stick this path, steering chronic control smart.
During his internship at a general practice, a medical student is asked to check the blood glucose level in a 50-year-old patient with type 2 diabetes. The measurement is performed at a random moment and the carbohydrate intake has not been standardised before the measurement is taken. The result of the measurement is shown below. The general practitioner (GP) asks the student to report the result using standard medical terminology. Question: Which diagnosis is most consistent with the findings provided above?
- A. Hyperglycaemia
- B. Hypoglycaemia
- C. Hyperglycaemia with hyperosmolar state
- D. Normoglycaemia (euglycaemia)
Correct Answer: A
Rationale: Random high glucose in type 2 hyperglycaemia, no hypo, osmolar crash, or norm. Nurses call this, a chronic sugar spike.
A 10-year-old boy is being prepared for a bone marrow transplant. The nurse can determine that the child understands this treatment when he says:
- A. I'll be much better after this blood goes to my bones.
- B. I won't feel too good until my body makes healthy cells.
- C. This will help all of the medicine they give me to work better.
- D. You won't have to wear a mask and gown after my transplant.
Correct Answer: B
Rationale: A bone marrow transplant (BMT) replaces diseased marrow (e.g., in leukemia) with healthy stem cells, but recovery is slow new, functional blood cells take weeks to months to regenerate, during which the child may feel unwell due to immunosuppression and engraftment challenges. The statement I won't feel too good until my body makes healthy cells' shows the boy grasps this delay, reflecting realistic understanding critical for coping and consent in pediatric care. Feeling better immediately after infusion is inaccurate initial post-BMT phases often worsen symptoms. Enhancing medicine efficacy isn't the goal; BMT is the therapy. Masks and gowns persist post-transplant due to infection risk until immunity recovers. The nurse's validation of this insight ensures the child is prepared, aligning with oncology's focus on patient education and emotional support during complex treatments.