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According to the American College of Cardiology Foundation and the American Heart Association (ACCFAHA), the recommendation regarding antiplatelet therapy in patients with cardiovascular disease preoperatively is that
- A. Antiplatelet therapy should be held for 10 days preoperatively
- B. Cardiac consultation is required before an operation in patients who are on antiplatelet therapy
- C. Medications should be continued unless concerns about hemostasis are significant
- D. Antiplatelet therapy should be initiated in all high-risk cardiac procedures
Correct Answer: B
Rationale: Step-by-step rationale for why choice B is correct:
1. The ACCF/AHA recommends cardiac consultation before an operation for patients on antiplatelet therapy to assess the risk of bleeding versus thrombotic events.
2. Cardiac consultation helps determine the necessity of continuing, modifying, or stopping antiplatelet therapy.
3. This individualized approach ensures optimal perioperative management based on the patient's cardiovascular risk profile.
4. Choice A is incorrect as stopping antiplatelet therapy for 10 days can increase the risk of thrombotic events.
5. Choice C is incorrect as it oversimplifies the decision-making process without considering the patient's specific risks.
6. Choice D is incorrect because initiating antiplatelet therapy in all high-risk cardiac procedures may not be necessary for every patient.
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Neonatal injury to nerve roots C8 & T1 causes one of the following
- A. Erb’s palsy
- B. Klumpke’s palsy
- C. Phrenic injury
- D. Radial palsy
Correct Answer: B
Rationale: The correct answer is B: Klumpke's palsy. Neonatal injury to nerve roots C8 & T1 leads to Klumpke's palsy, characterized by paralysis of the lower arm and hand muscles. This occurs due to damage to the lower trunk of the brachial plexus. Erb's palsy (choice A) involves C5 & C6 nerve roots, causing weakness in the shoulder and upper arm. Phrenic injury (choice C) affects the diaphragm, leading to breathing difficulties. Radial palsy (choice D) results from damage to the radial nerve, causing wrist drop and weakness in forearm muscles. Klumpke's palsy specifically matches the description of injury to nerve roots C8 & T1.
Neoadjuvant chemotherapy treatment for cancer is given to facilitate surgical resection. When the outcomes of cancer therapies are evaluated, the terms complete response and partial response often are used. Partial response means that
- A. 50% of the patients treated with a given regimen demonstrate remission
- B. 50% of the patients treated survive to the 5-year point
- C. The tumor mass has reduced by > 50%
- D. In 50% of cases, the tumor converts from unresectable to resectable
Correct Answer: D
Rationale: The correct answer is D because in the context of neoadjuvant chemotherapy, a partial response means converting an unresectable tumor to a resectable one. This is crucial as it allows for successful surgical removal of the tumor. Choices A, B, and C do not accurately define partial response in the context of cancer therapy. A, stating 50% of patients demonstrating remission, is not specific to the change in resectability. B, mentioning 50% survival at 5 years, is more related to overall survival rather than the response to treatment. C, stating a reduction in tumor mass by >50%, does not necessarily imply a change in resectability status. Therefore, option D is the most appropriate definition of partial response in the given scenario.
R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as cramping but has become more constant over the last day. She reports constipation over the last few days but admits that for as long as she can remember she has had variable bowel habits. Her vital signs are normal, but physical examination reveals some tenderness in the left lower quadrant. Which diagnostic test is most likely to support the leading differential diagnosis?
- A. CT scan with IV, oral, and rectal contrast
- B. CBC with WBC differential
- C. Colonoscopy
- D. Barium enema
Correct Answer: D
Rationale: The correct diagnostic test for the patient is a barium enema. This test is commonly used to evaluate the colon and rectum for conditions such as colonic obstruction, inflammatory bowel disease, or colorectal cancer. In this case, the patient's presentation of left lower quadrant pain with a history of constipation and variable bowel habits suggests a possible colonic obstruction, which can be visualized through a barium enema. A CT scan with contrast may be helpful in some cases but may not provide as clear a view of the colon as a barium enema. CBC with WBC differential is a general blood test and would not directly aid in diagnosing colonic issues. Colonoscopy, while a valuable tool for evaluating the colon, may not be suitable for this patient initially due to the acute nature of the presentation and the need to first rule out a potential obstruction.
Based upon an understanding of the normal relationship between gastrin levels and acid secretion, the AGACNP recognizes that which of the following combinations is almost diagnostic of gastrinoma?
- A. Hypogastrinemia and acid hyposecretion
- B. Hypergastrinemia and acid hyposecretion
- C. Hypogastrinemia and acid hypersecretion
- D. Hypergastrinemia and acid hypersecretion
Correct Answer: A
Rationale: The correct answer is A: Hypogastrinemia and acid hyposecretion. Gastrinoma is a tumor that secretes excessive gastrin, leading to hypergastrinemia and increased acid secretion. However, due to a negative feedback mechanism, chronic exposure to high gastrin levels can cause downregulation of gastrin receptors on parietal cells, leading to decreased acid secretion. Therefore, in gastrinoma, despite high gastrin levels, acid secretion may be reduced due to this negative feedback loop. Choices B, C, and D are incorrect because they do not align with the expected relationship between gastrin levels and acid secretion in gastrinoma.
TB in pregnancy predisposes a mother to premature labour due to
- A. Poor maternal appetite
- B. Severe anaemia experienced
- C. Adverse reactions of anti-TB drugs
- D. The fever experienced
Correct Answer: D
Rationale: The correct answer is D. TB in pregnancy can lead to premature labor due to the fever experienced. Fever increases the risk of premature labor by triggering uterine contractions. Poor maternal appetite (A) and severe anemia (B) may impact the mother's health but are not directly linked to premature labor. Adverse reactions of anti-TB drugs (C) could potentially affect the mother's health but are not a direct cause of premature labor.