Nokea
A grade II vibratory, mid-systolic murmur at the mid sternal border in a 4-year-old child that is louder when the child is supine is most likely which type of murmur?
- A. Pathologic murmur
- B. Pulmonary flow murmur
- C. Still's murmur
- D. Venous hum
Correct Answer: C
Rationale: A Still's murmur is characterized by a vibratory or musical low-grade sound, along the sternal border, which is louder when the child is supine or during inspiration.
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All of the following are true about a small VSD EXCEPT
- A. spontaneous closure is more common in muscular vs. membranous defects
- B. closure usually occurs in the first 2 years of life
- C. there is no risk of endocarditis
- D. pulmonary pressures are normal
Correct Answer: C
Rationale: Even small VSDs carry a risk of endocarditis until they close.
Mechanisms of dyspnea in left heart disease include all, except
- A. PVH and decreased lung compliance
- B. Respiratory muscle fatigue
- C. Elevated LV End diastolic pressure leads to decreased antegrade coronary blood flow
- D. Reverse 'Bernheim' effect
Correct Answer: C
Rationale: Elevated LV end-diastolic pressure does not typically lead to decreased antegrade coronary blood flow.
A male client who reports feeling chronically fatigued has a hemoglobin of 11.0 grams/dl (110mmol/L), hematocrit of 34%, and microcytic and hypochromic red blood cells (RBCs). Based on these findings, which dinner selection should the nurse suggest to the client?
- A. Cheese pasta and a lettuce and tomato salad
- B. Beef steak with steamed broccoli and orange slices
- C. Broiled white fish with a baked sweet potato
- D. Grilled shrimp and season rice with asparagus salad
Correct Answer: B
Rationale: The client's lab results indicate iron deficiency anemia. Beef steak is rich in iron, and vitamin C from orange slices enhances iron absorption, making this the best choice to address the anemia.
Biochemical abnormalities in a chronic carrier of hepatitis B are:
- A. Raised AST
- B. Low serum albumin
- C. Raised gamma GT
- D. Raised transferrin
Correct Answer: A
Rationale: The correct answer is A because chronic hepatitis B carriers often have raised AST (aspartate aminotransferase) due to liver inflammation. The other options are less specific or not typically associated with chronic hepatitis B.
Abnormal coloration of the urine (in the absence of haematuria) may be due to:
- A. Consumption of beetroot
- B. Treatment with co-danthramer
- C. Phenylketonuria
- D. Acute intermittent porphyria
Correct Answer: A
Rationale: Beetroot can cause red urine. Co-danthramer, phenylketonuria, and porphyria can also cause abnormal urine color, but beetroot is a common cause.