Nokea
A patient calls the clinic for instructions before having a Papanicolaou (Pap) smear. The most appropriate instructions from the nurse are:
- A. If you are menstruating, please use pads to avoid placing anything into the vagina.
- B. Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your appointment.
- C. If you suspect that you have a vaginal infection, please gather a sample of the discharge to bring with you.
- D. We would like you to use a mild saline douche before your examination. You may pick this up in our office.
Correct Answer: B
Rationale: The correct answer is B because avoiding intercourse, inserting anything into the vagina, or douching within 24 hours of the appointment helps ensure an accurate Pap smear result. Intercourse, vaginal products, and douching can introduce foreign substances or disrupt the natural vaginal flora, potentially affecting the test results. Option A is incorrect because using pads during menstruation is a general recommendation and not specific to a Pap smear appointment. Option C is incorrect because bringing a sample of discharge is not necessary for a Pap smear. Option D is incorrect because douching is not recommended before a Pap smear as it can alter the vaginal environment.
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A patient is being treated with furosemide and Digoxin because of CHF. She developed UTI. Which of the following antibiotics should NOT be prescribed?
- A. Cotrimoxazole
- B. Ciprofloxacin
- C. Gentamycin
- D. Ampicillin
Correct Answer: C
Rationale: The correct answer is C: Gentamycin. Gentamycin is known to have potential nephrotoxicity, which can exacerbate renal dysfunction caused by furosemide. It should be avoided in patients with CHF and UTI. Cotrimoxazole (A) can be used with caution, Ciprofloxacin (B) is generally safe, and Ampicillin (D) is a suitable choice for UTI treatment in this scenario.
The primary role of the phosphate buffer system is to?
- A. buffer stomach acid
- B. buffer carbonic acid formed by carbon dioxide
- C. limit pH changes caused by metabolic and fixed acids
- D. buffer the urine
Correct Answer: C
Rationale: The correct answer is C: limit pH changes caused by metabolic and fixed acids.
1. Phosphate buffer system consists of dihydrogen phosphate (H2PO4-) and hydrogen phosphate (HPO4^2-) ions, which can donate or accept H+ ions to maintain a stable pH.
2. Metabolic and fixed acids produced in the body can lead to pH changes. The phosphate buffer system helps to prevent drastic changes in pH by neutralizing excess H+ ions.
3. Options A, B, and D are incorrect because the phosphate buffer system is not specifically designed to buffer stomach acid, carbonic acid formed by carbon dioxide, or buffer the urine.
Which macrolide antibiotic that can be given once a day for 3 days for empirical treatment of ENT, respiratory and genital infections?
- A. Erythromycin
- B. Azithromycin
- C. Clarithromycin
- D. Roxithromycin
Correct Answer: B
Rationale: The correct answer is B: Azithromycin. It is preferred for short-term treatment due to its long half-life allowing once-daily dosing. Azithromycin has a broad spectrum of activity against many pathogens causing ENT, respiratory, and genital infections. It is well-tolerated and has fewer drug interactions. Other choices like A: Erythromycin have a higher frequency of dosing and more side effects. C: Clarithromycin and D: Roxithromycin are not typically given once daily for 3 days.
Acetazolamide is not frequently used as diuretic but the current indication is * in the treatment of:
- A. Liver cirrhosis
- B. CHF
- C. Glaucoma
- D. Kidney failure
Correct Answer: C
Rationale: Acetazolamide is a carbonic anhydrase inhibitor commonly used in treating glaucoma due to its ability to decrease intraocular pressure. The drug works by reducing the production of aqueous humor in the eye. This mechanism makes it an effective treatment for glaucoma. In contrast, liver cirrhosis (choice A) is typically managed with diuretics that act on the kidneys to reduce fluid accumulation. CHF (choice B) is commonly treated with loop diuretics to reduce fluid overload and improve cardiac function. Acetazolamide is not indicated for treating heart failure. Kidney failure (choice D) may require diuretics to manage fluid balance, but acetazolamide is not the first-line treatment in this condition. Therefore, the correct answer is C, as acetazolamide's current indication is in the treatment of glaucoma.
Thiazide diuretics may produce an increase in blood levels of uric acid and:
- A. Potassium
- B. BUN
- C. Urea
- D. Glucose
Correct Answer: D
Rationale: Thiazide diuretics can lead to hyperglycemia by reducing insulin sensitivity. This can result in increased blood glucose levels. Thiazides also elevate uric acid levels by reducing its excretion. Therefore, the correct answer is D (Glucose).
Incorrect choices:
A (Potassium) - Thiazides typically cause hypokalemia, not hyperkalemia.
B (BUN) and C (Urea) - Thiazides may cause a slight increase in BUN and serum creatinine levels due to reduced kidney function, but not as significantly as glucose levels.