Nokea
During his internship at a general practice, a medical student is asked to check the blood glucose level in a 30-year-old patient with type 1 diabetes. Acute glycaemic dysregulation is suspected in this patient. The patient asks if the student is going to take a capillary blood sample as shown in the picture below. Which of the following statements applies best in case of suspected acute dysregulation?
- A. The result will equal that of a finger prick sample
- B. The result will be higher than that of a finger prick sample
- C. The result will be lower than that of a finger prick sample
- D. One must not draw blood from this site in this case
Correct Answer: D
Rationale: Acute type 1 chaos no arm vein draw, finger prick's king for fast reads, not this site. Nurses skip this, a chronic crisis dodge.
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A child is seen in the pediatrician's office for complaints of bone and joint pain. Which other assessment finding may indicate leukemia?
- A. Abdominal pain
- B. Increased activity level
- C. Increased appetite
- D. Petechiae
Correct Answer: D
Rationale: Leukemia often presents with bone and joint pain due to marrow infiltration by leukemic cells, but petechiae small red or purple spots from minor bleeds under the skin are a key additional sign of bleeding tendencies from thrombocytopenia, a common leukemia consequence. This reflects bone marrow failure to produce adequate platelets, making it a critical finding for nurses to note during assessment. Abdominal pain might occur from organ enlargement (e.g., splenomegaly), but it's less specific and not a primary complaint here. Increased activity level and appetite contradict leukemia's typical fatigue and anorexia due to metabolic demands of proliferating cells and anemia. Recognizing petechiae prompts urgent blood work and referral, aligning with nursing's role in early detection of pediatric leukemia, ensuring timely intervention to manage this life-threatening condition effectively.
A public health nurse has formed an interdisciplinary team that is developing an educational program entitled 'Cancer: The Risks and What You Can Do About Them.' Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity?
- A. Disease prophylaxis
- B. Risk reduction
- C. Secondary prevention
- D. Tertiary prevention
Correct Answer: C
Rationale: Screening's the game here secondary prevention spots cancer early in symptom-free folks, like mammograms or colonoscopies, boosting survival odds. Prophylaxis (primary) stops it cold think vaccines or sunscreen. Risk reduction's broader, overlapping primary efforts (e.g., quit smoking). Tertiary's post-diagnosis care, minimizing damage. This program's focus on early catch aligns with secondary's core, a public health win in oncology to shift outcomes before symptoms scream.
In order to provide optimal management and prevent deterioration, the patient needs to be educated in selfmanagement of their condition. Which of the following are not elements of self-management?
- A. Engaging in activities that promote health
- B. Managing COPD by monitoring signs and symptoms
- C. Weekly visits with the medical practitioner
- D. Following a treatment plan
Correct Answer: C
Rationale: COPD self-care health habits, symptom checks, plan adherence empowers patients. Weekly doc visits? Overkill, not core self-management cuts reliance. Nurses teach this, a chronic autonomy boost.
Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the last year. He has no other known past medical history. When you probe, he is adherent to allopurinol except for missing it perhaps once or twice a month. His BMI is 25 kg/m², BP 144/94 mmHg. His last uric acid was one month ago, which was 405 mmol/L. He is having a gout attack now. He tells you that his gout attacks are usually aborted with colchicine TDS for two days. Whilst on colchicine, he does not experience diarrhoea except perhaps one episode of loose stools after which he stops colchicine. Which is the most appropriate next step?
- A. Start Hydrochlorothiazide for hypertension
- B. Start Losartan for hypertension
- C. Stop Allopurinol during this acute gout attack and start colchicine
- D. Continue allopurinol at 100 mg OM despite the attack and start colchicine
Correct Answer: B
Rationale: Current gout attack with uric acid 405 mmol/L (above target <360) on allopurinol 200 mg suggests undertreatment. Continue allopurinol (not stop) during flares, add colchicine TDS for acute relief, and address BP 144/94 with Losartan urate-lowering and cardioprotective, unlike HCTZ, which raises urate. Check creatinine and up-titrate allopurinol later. This balances acute and chronic management effectively.
In the year 2012, appropriate statements regarding complications of percutaneous cervical cordotomy in the UK include:
- A. Estimates of complication rates are based on pooled data in a national registry.
- B. Complications are similar to those after open surgical cordotomy.
- C. Rates of major complications such as death and paralysis are between 1 in 10000 and 1 in 1000.
- D. Persistent postural hypotension is uncommon.
Correct Answer: D
Rationale: In 2012, UK percutaneous cervical cordotomy (PCC) complication data were limited, not pooled nationally case series or institutional reports dominated. PCC's minimally invasive nature yields fewer complications (e.g., no wound infections) than open cordotomy's extensive approach. Major complications like death or paralysis are rare (<1%), below 1-in-1000 estimates, due to precise imaging and technique. Persistent postural hypotension is uncommon, linked to rare sympathetic disruption (e.g., Horner's syndrome), resolving typically. Headaches occur but aren't persistent. The low incidence of sustained hypotension reflects PCC's targeted spinothalamic focus, sparing autonomic pathways, making it a safer palliative option versus historical benchmarks.