Nokea
A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon?
- A. Direct reaction
- B. Consensual reaction
- C. Near reaction
- D. Accommodation
Correct Answer: B
Rationale: The correct term for the phenomenon described is "Consensual reaction" (Choice B). This occurs because the optic nerves from both eyes are connected, causing stimulation of one eye to result in a simultaneous response in the other eye due to the consensual pupillary reflex. The other choices are incorrect because:
A: Direct reaction refers to the pupil directly exposed to light contracting.
C: Near reaction refers to the pupillary response when focusing on a near object.
D: Accommodation refers to the ability of the eye to adjust focus for near and far objects, not pupil constriction.
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Which of the following anatomic landmark associations is correct?
- A. 2nd intercostal space for needle insertion in tension pneumothorax
- B. T6 for lower margin of endotracheal tube
- C. Sternal angle marks the 4th rib
- D. 5th intercostal space for chest tube insertion
Correct Answer: D
Rationale: The correct answer is D because the 5th intercostal space is the recommended location for chest tube insertion to drain the pleural space effectively. This space is ideal as it allows for adequate drainage without causing injury to vital structures.
A: The 2nd intercostal space is actually used for needle decompression in tension pneumothorax.
B: T6 is the level at which the tip of the endotracheal tube should ideally lie to ensure proper placement and ventilation.
C: The sternal angle corresponds to the 2nd rib, not the 4th rib, making this association incorrect.
In summary, choice D is correct as it aligns with the standard practice for chest tube insertion, while choices A, B, and C are incorrect due to their association with different anatomic landmarks and procedures.
Even though older adults are less likely to get counseled for smoking cessation, they have which one of the following?
- A. The same quit rates as younger individuals
- B. Approximately 50% better quit rates than younger individuals
- C. Approximately 25% better quit rates than younger individuals
- D. Much lower quit rates than younger individuals
Correct Answer: C
Rationale: The correct answer is C: Approximately 25% better quit rates than younger individuals. Older adults tend to have higher quit rates compared to younger individuals due to factors like increased motivation, life experience, and health concerns. Older adults often have more resources and support systems in place to help them quit smoking successfully. Choice A is incorrect because older adults do not necessarily have the same quit rates as younger individuals. Choice B is also incorrect as the difference in quit rates is not as high as 50%. Choice D is incorrect as older adults do not generally have much lower quit rates than younger individuals.
Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?
- A. Sigmoid mass
- B. Tumor in the abdominal wall
- C. Hernia
- D. Enlarged bladder
Correct Answer: D
Rationale: Rationale for D (Enlarged bladder): The presentation of a smooth lower abdominal mass that is minimally tender and associated with dullness to percussion above the symphysis pubis suggests an enlarged bladder. This is a common finding in elderly individuals due to various reasons such as urinary retention or bladder outlet obstruction. The location and characteristics of the mass align with an enlarged bladder.
Summary of other choices:
A: Sigmoid mass - Unlikely as sigmoid mass typically presents with different characteristics such as irregular shape and may not cause dullness to percussion above the symphysis pubis.
B: Tumor in the abdominal wall - Less likely as tumors in the abdominal wall would have a different presentation and wouldn't be associated with urinary symptoms.
C: Hernia - Less likely as hernias typically manifest with a bulge that can be reduced and may not cause dullness to percussion above the symphysis pubis.
When palpating the prostate gland during the rectal exam, the prostate feels tender, swollen, boggy, and warm. This finding is consistent with:
- A. A normal prostate gland
- B. Acute bacterial prostatitis
- C. Benign prostatic hyperplasia
- D. Carcinoma of the prostate
Correct Answer: B
Rationale: The correct answer is B: Acute bacterial prostatitis. This is because the symptoms of tenderness, swelling, bogginess, and warmth are indicative of an acute inflammatory process, which is commonly seen in acute bacterial prostatitis. This condition typically presents with localized prostate tenderness and inflammation due to a bacterial infection. Other choices are incorrect because: A) A normal prostate gland should not exhibit these signs of inflammation. C) Benign prostatic hyperplasia is typically asymptomatic or may present with obstructive urinary symptoms, not acute inflammatory signs. D) Carcinoma of the prostate usually does not present with acute inflammatory findings on palpation.
Which of the following medications is commonly prescribed for patients with hypertension and chronic kidney disease?
- A. Lisinopril
- B. Furosemide
- C. Metoprolol
- D. Spironolactone
Correct Answer: A
Rationale: The correct answer is A: Lisinopril. Lisinopril is an ACE inhibitor commonly prescribed for patients with hypertension and chronic kidney disease. It helps to reduce blood pressure and protect the kidneys by dilating blood vessels and improving blood flow. Furosemide (B) is a diuretic used to treat fluid retention but not specifically indicated for chronic kidney disease. Metoprolol (C) is a beta-blocker primarily used for heart conditions. Spironolactone (D) is a potassium-sparing diuretic and is not the first-line treatment for hypertension in patients with chronic kidney disease.