Nokea
Achalasia is a risk factor for
- A. Squamous cell carcinoma
- B. Gastroesophageal reflux disease
- C. Esophageal atrophy
- D. Malabsorption syndromes
Correct Answer: A
Rationale: Achalasia is a motility disorder characterized by the inability of the lower esophageal sphincter to relax, resulting in difficulty swallowing and impaired movement of food from the esophagus into the stomach. Patients with achalasia have an increased risk of developing squamous cell carcinoma of the esophagus. This risk is due to chronic inflammation, stasis of food in the esophagus, and increased exposure of esophageal mucosa to irritants, all of which can contribute to the development of cancer over time. Gastroesophageal reflux disease (Choice B) is less likely to be associated with achalasia because the impaired esophageal motility in achalasia results in decreased, rather than increased, reflux of stomach contents into the esophagus. Esophageal atrophy (Choice C) and malabsorption syndromes (Choice D) are not directly related to achalasia.
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The commonest causative agent for pyelonephritis is
- A. Proteus vulgaris
- B. Escherichia coli
- C. Neisseria gonococcal
- D. Streptococcus faecalis
Correct Answer: B
Rationale: Escherichia coli is the most common causative agent for pyelonephritis.
Mrs. Maroldo is an 81-year-old female who presents for evaluation of pain in her left lower quadrant. She has had this pain before and says she usually takes antibiotics and it goes away. However, this time it seems worse, and she has had it for 4 days even though she says she started taking her leftover antibiotics from the last episode. She denies any nausea or vomiting but says she simply isnt hungry. She had a little diarrhea yesterday but no bowel movements today. She has a temperature of 100.9F and a pulse of 104 bpm, respirations of 20 breaths per minute, and a blood pressure of 9460 mm Hg. She has some discomfort to deep palpation in the left lower quadrant. The AGACNP suspects
- A. Irritable bowel syndrome
- B. Inflammatory bowel disease
- C. Diverticulitis
- D. Appendicitis
Correct Answer: C
Rationale: Mrs. Maroldo's presentation with left lower quadrant pain, fever, elevated heart rate, history of previous episodes of similar pain that improved with antibiotics, and recent diarrhea are all concerning for diverticulitis. Diverticulitis is an infection or inflammation of small pouches that can form in the wall of the colon, known as diverticula. The symptoms typically include localized abdominal pain, fever, elevated heart rate, and changes in bowel habits such as diarrhea or constipation. The discomfort to deep palpation in the left lower quadrant indicates inflammation in that area. The presence of fever, elevated heart rate, and low blood pressure suggests an infectious process requiring urgent evaluation and treatment. Further diagnostic tests such as a CT scan may be ordered to confirm the diagnosis and assess the extent of the inflammation. Appendicitis can also present with abdominal pain, but the location of the pain in the left lower quadrant makes diverticul
Complications of unrepaired cleft lip and palate include
- A. Pneumonia and retarded growth
- B. Mental retardation and blindness
- C. Failure to thrive and deafness
- D. Impaired speech and convulsions
Correct Answer: D
Rationale: Failure to thrive and impaired speech are common complications due to feeding and developmental issues with cleft lip and palate.
Occipito-posterior position: b) Define occipito-posterior position
- A. Fetus faces the mother's spine with head down
- B. Fetal head facing the mother's back
- C. Head facing the mother's pelvis, facing the back
- D. Both B and C
Correct Answer: B
Rationale: Occipito-posterior position occurs when the baby faces the mother's back with the head down.
P. T. is a 58-year-old female who is admitted with chest pain and shortness of breath and is found to have a large pulmonary embolus. Her systolic blood pressure is falling, and a diagnosis of obstructive shock is made. Cardiac pressure would likely demonstrate
- A. Elevated atrial and decreased ventricular pressures
- B. Elevated right-sided and decreased left-sided pressures
- C. Elevated left ventricular pressure and decreased cardiac output
- D. Elevated left ventricular pressure and decreased systemic vascular resistance
Correct Answer: B
Rationale: Obstructive shock, such as in this case of a large pulmonary embolus causing obstructive shock, results in a sudden increase in right ventricular afterload due to obstruction of blood flow. This leads to right heart failure and decreased left ventricular preload, ultimately resulting in decreased cardiac output. The elevated right-sided pressures will be reflected by elevated right atrial and ventricular pressures, while the left ventricular pressures will be decreased due to decreased preload. This commonly leads to a situation known as acute cor pulmonale, where the right heart becomes dilated and dysfunctional in response to the increased afterload.