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A 40 year old patient is presented with unilateral palpebral edema and ipsilateral lymphadenopathy. He later develops megaesophagus and megacolon as complications. Which of the following vector is responsible for this parasitic infection?
- A. Glossina morsitans
- B. Ixodes scapularis
- C. Rhodnius prolixus
- D. Simulium damnosum
Correct Answer: C
Rationale: The correct answer is C: Rhodnius prolixus. This vector is responsible for transmitting Trypanosoma cruzi, causing Chagas disease. The initial symptoms of unilateral palpebral edema and lymphadenopathy are characteristic of Chagas disease. The complications of megaesophagus and megacolon are also common manifestations of chronic Chagas disease. Glossina morsitans (A) transmits African trypanosomiasis (sleeping sickness), Ixodes scapularis (B) transmits Lyme disease, and Simulium damnosum (D) transmits onchocerciasis (river blindness), so they are not associated with the symptoms described.
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A nurse is caring for a patient with Hodgkin lymphoma at the oncology clinic. The nurse should be aware of what main goal of care?
- A. Cure of the disease
- B. Enhancing quality of life
- C. Controlling symptoms
- D. Palliation
Correct Answer: A
Rationale: The correct answer is A: Cure of the disease. The main goal of care for a patient with Hodgkin lymphoma is to achieve a cure whenever possible. This is because Hodgkin lymphoma is a potentially curable cancer with appropriate treatment. Achieving a cure means eradicating the cancer cells completely and preventing its recurrence in the future. This is the most desirable outcome for the patient's long-term health and well-being.
Incorrect choices:
B: Enhancing quality of life - While improving the patient's quality of life is important, the primary goal in treating Hodgkin lymphoma is to cure the disease.
C: Controlling symptoms - Symptom management is important in providing comfort to the patient, but the main goal is to cure the disease.
D: Palliation - Palliative care focuses on relieving symptoms and improving quality of life in patients with advanced or incurable diseases. For Hodgkin lymphoma, the main goal is to aim for a cure rather than palliation.
Mr XY was found to be anemic. During history taking, he informed his doctor that he was a strict vegetarian who did not consume any meat, fish or milk products.
- A. Iron deficiency
- B. Vitamin B12 deficiency
- C. Defects in erythropoietin production
- D. Calcium-deficiency
Correct Answer: B
Rationale: Correct Answer: B (Vitamin B12 deficiency)
Rationale:
1. Mr. XY is a strict vegetarian, avoiding meat, fish, and milk products.
2. Vitamin B12 is mainly found in animal products, crucial for red blood cell production.
3. Vegetarians at risk of B12 deficiency due to limited dietary sources.
4. Anemia can result from B12 deficiency, leading to decreased red blood cell production.
Summary:
A: Iron deficiency - Possible but less likely since vegetarian diets can still provide iron.
C: Defects in erythropoietin production - Unrelated to diet, more related to kidney function.
D: Calcium-deficiency - Not directly related to anemia; more associated with bone health.
A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?
- A. Uncontrolled bleeding
- B. Myocardial infarction
- C. Respiratory depression
- D. Decreased renal perfusion
Correct Answer: A
Rationale: Rationale: Aspirin is an antiplatelet medication that inhibits platelet aggregation, increasing the risk of uncontrolled bleeding during surgical procedures. By taking aspirin, the client's blood clotting ability is impaired, leading to potential excessive bleeding during and after surgery. This can result in complications such as prolonged bleeding, hematoma formation, and delayed wound healing. Therefore, the correct answer is A: Uncontrolled bleeding.
Summary:
- B: Myocardial infarction is not directly related to taking aspirin; it is actually used to prevent heart attacks.
- C: Respiratory depression is not a common complication associated with aspirin use.
- D: Decreased renal perfusion is not a typical risk of taking aspirin; it primarily affects the cardiovascular system.
A patient is scheduled for upcoming surgery. He is on nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis. You are being asked what to do with his medications for the surgery. What is the mechanism of action of NSAIDS?
- A. Irreversible inhibition of cyclooxygenase 1
- B. Irreversible inhibition of cyclooxygenase 2
- C. Reversible inhibition of cyclooxygenase 1
- D. Reversible inhibition of cyclooxygenase 2
Correct Answer: C
Rationale: Step 1: NSAIDs inhibit cyclooxygenase (COX) enzymes to reduce prostaglandin synthesis.
Step 2: Reversible inhibition means the effect is temporary and can be reversed.
Step 3: COX-1 inhibition leads to GI side effects, which can be concerning in surgery.
Step 4: COX-2 inhibition is more targeted for inflammation but can still pose cardiovascular risks.
Step 5: Reversible COX-1 inhibition allows for temporary discontinuation before surgery to minimize bleeding risk.
Summary: Choice C is correct as reversible COX-1 inhibition allows for safer management pre-surgery compared to irreversible inhibition in choices A and B, and COX-2 inhibition in choice D.
A 9-month-old boy has been referred to you for the evaluation of an enlarged abdomen. Imaging studies show a large liver mass (PRETEXT III). Alfa-fetoprotein is 98 ng/mL, and a CT scan of the lungs show bilateral lung metastases. A needle biopsy is performed, and you are planning to review the specimen with the pathologist. Which of the following diagnoses are you suspecting?
- A. Pure fetal histology hepatoblastoma
- B. Embryonal sarcoma of the liver
- C. Fibrolamellar hepatocellular carcinoma
- D. Small cell undifferentiated hepatoblastoma
Correct Answer: D
Rationale: The correct answer is D: Small cell undifferentiated hepatoblastoma. In hepatoblastoma, the presence of lung metastases indicates a high-risk tumor. The small cell undifferentiated subtype is more aggressive with a poorer prognosis compared to other subtypes. The AFP level is lower than typically seen in hepatoblastoma, but still within the range for this diagnosis. Pure fetal histology hepatoblastoma (choice A) is less common and usually associated with a better prognosis. Embryonal sarcoma of the liver (choice B) is a distinct entity with different histological features. Fibrolamellar hepatocellular carcinoma (choice C) typically occurs in older children and has a different imaging appearance.