Nokea
An HIV-positive patient presents to the ED complaining of shortness of breath and non-productive cough. Chest x-ray shows diffuse interstitial infiltrates, and O2 saturation is 85% on room air. All of the following statements regarding this patient's probable diagnosis are TRUE, EXCEPT
- A. Pneumocystis carinii pneumonia (PCP) is the most common opportunistic infection in AIDS patients
- B. Pentamidine isothionate is an effective alternate therapy to TMP-SMX
- C. A normal chest x-ray rules out acute PCP infection
- D. 65% of patients relapse within 18 months
Correct Answer: H
Rationale: PCP top AIDS bug, pentamidine swaps TMP-SMX, relapse hits, steroids for hypoxia; normal CXR misses 20%. Nurses nix this chronic x-ray lie.
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Percutaneous cervical cordotomy:
- A. Is performed under general anaesthesia.
- B. Occurs by entry of a needle into the intervertebral foramen between cervical vertebrae C4 and C5.
- C. Involves thermoablation of the anterior spinothalamic tract.
- D. Is performed on the same side as the pain.
Correct Answer: C
Rationale: Percutaneous cervical cordotomy (PCC) relieves cancer pain via targeted nerve destruction. It's done under local anesthesia with sedation, not general, to monitor patient response (e.g., pain relief, side effects) during stimulation. The needle enters at C1-C2, not C4-C5, targeting the lateral spinothalamic tract contralateral to the pain not the anterior tract explicitly, though terminology varies. Thermoablation destroys pain fibers, confirmed by test stimulation. It's performed opposite the pain side due to crossed spinothalamic pathways. Complete numbness isn't typical; sensory loss is partial. Thermoablation's specificity using radiofrequency to interrupt pain transmission defines PCC's efficacy, minimizing damage to adjacent motor tracts while achieving analgesia.
A 30yr NZ man goes to PNG, takes 300 mg chloroquine weekly for 2 weeks prior and 4 weeks post his trip. 3/12 later gets febrile/sweats/maleana with malaria parasites on film. The following is true
- A. He took 1/2 the normal dose of chloroquine
- B. If he took primaquine for 2/52 this wouldn't have happened
- C. Assume chloroquine resistance and treat accordingly
- D. This is probably p. falciparum
Correct Answer: C
Rationale: PNG malaria chloroquine's 250 mg norm, resistance rife, not dose, primaquine, or falciparum lock. Nurses switch this chronic resistant fix.
Mr Yee two months later. At your last visit he did not want colchicine prophylaxis as he did not want to take 'too many tablets'. He has started and is adherent to his urate lowering agent. Last month, his uric acid had decreased to 390 mmol/L. He had a gout flare last week, hence he came to your clinic today to ask about colchicine prophylaxis. Which is correct advice regarding colchicine prophylaxis?
- A. Offer to start colchicine at 500 mcg once daily or alternate days as gout prophylaxis as his renal function is abnormal
- B. Colchicine cannot help to reduce the frequency of flares especially during the first six months of Urate lowering therapy
- C. Tell him that if he is started on clarithromycin, he does not need to inform his doctor or pharmacist that he is on colchicine regularly as colchicine can have drug interactions
- D. Regular colchicine prophylaxis in someone with normal renal function and regular monitoring can lead to renal failure
Correct Answer: A
Rationale: With eGFR 55 mL/min and a recent flare despite uric acid dropping to 390 mmol/L, colchicine prophylaxis at 500 mcg daily or alternate days is appropriate, adjusting for reduced renal clearance to prevent toxicity. Flares are common early in ULT as urate mobilizes, and colchicine reduces this, contrary to the false claim it can't help. Clarithromycin interacts dangerously with colchicine (CYP3A4 inhibition), requiring disclosure. Colchicine doesn't cause renal failure with monitoring; toxicity does. This dose suits chronic gout management safely.
A 45 year old man, BMI 35 but otherwise healthy and normotensive has an urinary albumin excretion of 30 mg in 24 hours. Which is the correct action to take?
- A. Reduce weight
- B. It can be observed over 3 months for improvement
- C. Refer him to a nephrologist
- D. Treatment is required
Correct Answer: A
Rationale: Albumin 30 microalbuminuria's dawn, weight loss curbs it; watch, refer, treat, ignore lag. Nurses nudge this chronic kidney shield.
The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient?
- A. These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies
- B. These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer
- C. Try not to be concerned about these symptoms. Every patient feels this way after having radiation therapy
- D. Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying
Correct Answer: A
Rationale: Radiation zaps energy fatigue and weakness are par for the course, tied to inflammation and repair in treated tissues. Saying this, plus promising lab and imaging checks, reassures him it's expected, not a red flag, and keeps him in the loop. Blaming cancer alone dodges the treatment link, unsettling him. Dismissing it as universal or a good sign' feels flippant normal cells die too. Nurses in oncology lean on honesty and vigilance, easing fears while tracking for worse issues like anemia or infection.