Nokea
Gamekeeper's thumb involves an injury to which of the following structures?
- A. Medial collateral ligament
- B. Ulnar collateral ligament
- C. Transverse carpal ligament
- D. Triangular fibrocartilage complex
Correct Answer: B
Rationale: Gamekeeper's thumb results from injury to the ulnar collateral ligament of the thumb MCP joint.
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The nurse is performing an abdominal examination and detects a bruit over the renal arteries. What is the most likely cause of this finding?
- A. Normal vascular sound.
- B. Renal artery stenosis.
- C. Aortic aneurysm.
- D. Increased peristalsis.
Correct Answer: B
Rationale: A bruit over the renal arteries suggests renal artery stenosis, a narrowing of the blood vessels that supply the kidneys.
You are observing a patient with heart failure and notice that there are pauses in his breathing. On closer examination, you notice that after the pauses the patient takes progressively deeper breaths and then progressively shallower breaths, which are followed by another apneic spell. The patient is not in any distress. You make the diagnosis of:
- A. Ataxic (Biot's) breathing
- B. Cheyne-Stokes respiration
- C. Kussmaul's respiration
- D. COPD with prolonged expiration
Correct Answer: B
Rationale: Cheyne-Stokes respiration is characterized by cycles of progressively deeper and shallower breathing, often seen in patients with heart failure.
A 62-year-old woman has been followed by you for 3 years and has had recent onset of hypertension. She is still not at goal despite three antihypertensive medicines, and you strongly doubt nonadherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. What would you do next?
- A. Add a fourth medicine
- B. Refer to nephrology
- C. Get a CT scan
- D. Listen closely to her abdomen
Correct Answer: D
Rationale: At this point, it is important to consider secondary causes for this woman's hypertension because of its severity, rapidity of progression, and lack of response to therapy. While you will most likely add a fourth medicine, it is important to carefully examine the abdomen for the presence of renal artery bruits. These are usually heard best in the upper quadrants. It may be necessary to have the patient hold her breath, to have a very quiet room, and to listen with the diaphragm for a very soft, high-pitched sound with systole. It may also help to simultaneously feel the patient's pulse (a bruit with both a systolic and diastolic component is very specific for a significant blockage, while a lone systolic bruit may not be abnormal). Obtaining a CT scan is not likely to be useful, and you may save the delay, expense, and inconvenience of a nephrology referral if you can hear a bruit.
The nurse is assessing the vital signs of a 20-year-old male marathon runner and documents the following vital signs: temperature–36° C; pulse–48 beats per minute; respirations–14 breaths per minute; blood pressure–104/68 mm Hg. Which statement is true concerning these results?
- A. The patient is experiencing tachycardia.
- B. These are normal vital signs for a healthy, athletic adult.
- C. The patient's pulse rate is not normal—his physician should be notified.
- D. On the basis of these readings, the patient should return to the clinic in 1 week.
Correct Answer: B
Rationale: Athletes often have lower resting heart rates due to their increased cardiovascular efficiency.
A physical therapist evaluates a patient with peripheral arterial disease (PAD). Which symptom is MOST likely during exercise?
- A. Leg pain relieved by rest
- B. Muscle spasms during activity
- C. Swelling in the distal extremities
- D. Numbness and tingling
Correct Answer: A
Rationale: Intermittent claudication, or leg pain relieved by rest, is a hallmark symptom of PAD.