Nokea
A patient with chronic hepatic encephalopathy is being discharged home. Discharge teaching centers upon long-term management strategies to prevent ammonia accumulation. Teaching for this patient includes instruction about
- A. Lactulose taken 20 g PO daily
- B. Spironolactone taken 100 mg PO daily
- C. Protein intake of 50 g daily
- D. Zolpidem taken 10 mg PO qhs.
Correct Answer: C
Rationale: The correct answer is C: Protein intake of 50 g daily. In hepatic encephalopathy, reducing protein intake helps decrease ammonia production. Excessive ammonia leads to neurological symptoms. Lactulose (choice A) is correct for hepatic encephalopathy as it helps eliminate ammonia through the gut. Spironolactone (choice B) is a diuretic and not indicated for hepatic encephalopathy. Zolpidem (choice D) is a sleep aid and not relevant to managing ammonia accumulation. In summary, choice C is correct because it directly targets the underlying issue of ammonia accumulation in hepatic encephalopathy, while the other choices do not address this specific concern.
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The MAIN function of surfactant factor is to
- A. Prevent alveoli of the lungs from collapsing
- B. Initiate breathing of the neonate at birth
- C. Enhance maturity of respiratory centre in the brain
- D. Regulate breathing immediately the baby is born
Correct Answer: A
Rationale: The correct answer is A: Prevent alveoli of the lungs from collapsing. Surfactant reduces surface tension in the alveoli, preventing them from collapsing during exhalation and maintaining lung compliance. B, C, and D are incorrect because surfactant primarily affects lung mechanics, not the initiation of breathing, maturity of the respiratory center, or immediate regulation of breathing upon birth.
The drug of choice in the management of eclampsia is
- A. Phenobarbitone
- B. Calcium gluconate
- C. Magnesium sulphate
- D. Sodium bicarbonate
Correct Answer: C
Rationale: The correct answer is C: Magnesium sulphate. It is the drug of choice in managing eclampsia due to its ability to prevent and control seizures. Magnesium sulfate is a central nervous system depressant that reduces neuronal excitability and neuromuscular transmission, thus preventing seizures. It also helps in lowering blood pressure and preventing complications. Phenobarbitone (A) is not the first-line treatment for eclampsia. Calcium gluconate (B) is used for calcium deficiency, not eclampsia. Sodium bicarbonate (D) is used to correct acidosis, not for managing eclampsia.
The progression of coronary artery plaque formation can lead to a variety of pathologic conditions. When subtotal plaque disruption occurs resulting in vasoconstriction, platelet activation, and embolization, it most commonly causes which clinical phenomenon?
- A. Endothelial cell dysfunction
- B. Prinzmetal’s angina
- C. Transmural myocardial infarction
- D. Non-ST elevation myocardial infarction
Correct Answer: C
Rationale: The correct answer is C: Transmural myocardial infarction. Subtotal plaque disruption leads to vasoconstriction, platelet activation, and embolization, causing complete occlusion of a coronary artery. This results in ischemia of the entire thickness of the myocardial wall, leading to transmural myocardial infarction. Endothelial cell dysfunction (A) is an early event in atherosclerosis but does not directly result from subtotal plaque disruption. Prinzmetal's angina (B) is caused by transient coronary artery spasm rather than plaque disruption. Non-ST elevation myocardial infarction (D) involves incomplete blockage of a coronary artery and typically does not result from subtotal plaque disruption.
What are common complications of multiple gestations?
- A. Premature labor
- B. Twin-to-twin transfusion syndrome
- C. Preeclampsia
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D: All of the above. Multiple gestations are at higher risk for complications such as premature labor, where contractions start before 37 weeks, leading to preterm birth. Twin-to-twin transfusion syndrome can occur in identical twins sharing a placenta, causing unequal blood flow. Preeclampsia, characterized by high blood pressure and organ damage, is more common in multiple pregnancies. Therefore, all choices A, B, and C are correct as they are common complications associated with multiple gestations.
The engaging diameter in a face presentation is
- A. Sub-mento vertical diameter
- B. Sub-mento bregmatic diameter
- C. Mento vertical diameter
- D. Sub-occipito bregmatic diameter
Correct Answer: A
Rationale: The engaging diameter in a face presentation is the sub-mento vertical diameter. This is the correct answer because it represents the distance from the tip of the chin (mentum) to the highest point on the skull (vertex), which is the most critical diameter for the face to descend through the pelvis during childbirth.
Choice B (Sub-mento bregmatic diameter) is incorrect because it represents the distance from the tip of the chin to the anterior fontanelle, not the highest point on the skull.
Choice C (Mento vertical diameter) is incorrect because it refers to the distance from the chin to the base of the skull, not the highest point on the skull.
Choice D (Sub-occipito bregmatic diameter) is incorrect because it represents the distance from the base of the skull to the anterior fontanelle, not involving the chin.