Nokea
In which of the following patients is chemical or surgical castration likely to prolong survival?
- A. A 78-year-old man with advanced dementia and prostate cancer metastatic to the bone.
- B. A 78-year-old man who had a radical prostatectomy 10 years earlier and now has a PSA level of 5.7 ng/mL. A year ago it was 0.1 ng/mL. A bone scan is negative and an abdomen-pelvis computed tomography (CT) is negative.
- C. A 78-year-old man who had a radical prostatectomy and external beam radiation therapy 10 years earlier now has a PSA level of 24.5 ng/mL. A CT scan of the pelvis shows an enlarged pelvic lymph node, and a bone scan is positive in the pelvis.
- D. A 78-year-old man with prostate cancer limited to the prostate with a Gleason score of 6.
Correct Answer: C
Rationale: The correct answer is C. In this scenario, the patient had a radical prostatectomy and external beam radiation therapy, indicating aggressive treatment. Despite this, the PSA level is high (24.5 ng/mL), suggesting biochemical recurrence and possible metastasis. The positive bone scan and enlarged pelvic lymph node indicate disease progression beyond the prostate. Chemical or surgical castration, such as androgen deprivation therapy, can help delay disease progression and prolong survival by reducing the levels of testosterone that fuel prostate cancer growth.
Summary:
A: In advanced dementia and metastatic bone disease, castration is unlikely to impact survival as the disease is already advanced.
B: A rising PSA level post-radical prostatectomy with negative imaging indicates biochemical recurrence, but without evidence of metastasis, making castration less beneficial.
D: Prostate cancer limited to the prostate with a Gleason score of 6 is low risk and may not benefit significantly from castration as it is less likely to progress rapidly.
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A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?
- A. Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.
- B. Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.
- C. Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.
- D. Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.
Correct Answer: C
Rationale: The correct answer is C because tenderness in the right upper quadrant with inspiration points towards Murphy's sign, indicative of cholecystitis. This sign is elicited by palpating the right upper quadrant while the patient takes a deep breath. This maneuver causes the gallbladder to descend and come into contact with the inflamed peritoneum, reproducing pain and halting inspiration. Choices A, B, and D do not describe physical examination findings specific to cholecystitis such as Murphy's sign or tenderness in the right upper quadrant with inspiration. Therefore, they are incorrect.
Upon arriving at a scene where a patient has been involved in a minor car accident, she reports feeling faint and states that she has a history of diabetes. Given this information, what is the primary concern that the patient is expressing?
- A. Her blood sugar levels are likely unstable
- B. She is experiencing a headache
- C. She has a history of hypertension
- D. She is feeling nauseous
Correct Answer: A
Rationale: The correct answer is A: Her blood sugar levels are likely unstable. Given the patient's history of diabetes and feeling faint after a minor car accident, the primary concern is hypoglycemia, which can occur due to stress or delayed food intake. Symptoms may include feeling faint, weakness, and confusion. It is important to address this immediately as untreated hypoglycemia can lead to serious complications.
Choice B is incorrect as a headache is not typically a primary concern for a diabetic patient feeling faint. Choice C is incorrect as hypertension is not directly related to the symptoms described. Choice D is incorrect as nausea is not a typical symptom of hypoglycemia in this context. It is crucial to focus on the patient's diabetic history and potential hypoglycemia in this scenario.
Which is a true statement about varicose veins?
- A. They are due to congenital valve deformities
- B. They are usually diagnosed on clinical presentation
- C. They are not affected by pregnancy
- D. They are more symptomatic during ovulation
Correct Answer: B
Rationale: The correct answer is B because varicose veins are usually diagnosed based on clinical presentation, such as visible, bulging veins and symptoms like pain or swelling. This is because varicose veins are often easily visible and cause noticeable symptoms.
A: Varicose veins are not typically due to congenital valve deformities but rather develop over time due to weakened vein walls and valves.
C: Varicose veins can be affected by pregnancy due to hormonal changes and increased pressure on the veins.
D: Varicose veins may not necessarily be more symptomatic during ovulation; symptoms can vary based on individual factors.
During the breast examination of a perimenopausal woman, the NP detects a bloody spontaneous discharge from the right nipple. This indicates further evaluation:
- A. Fibroadenoma
- B. Polycystic breast disease
- C. An intraductal papilloma
- D. Pituitary prolactinoma
Correct Answer: C
Rationale: The correct answer is C: An intraductal papilloma. Bloody spontaneous discharge from the nipple in a perimenopausal woman is concerning for an intraductal papilloma, which is a benign growth in the milk ducts. Further evaluation with imaging studies and possibly a biopsy is necessary to rule out malignancy.
Choice A: Fibroadenoma is a common benign breast tumor but does not typically present with bloody discharge.
Choice B: Polycystic breast disease is not associated with bloody discharge and is characterized by multiple fluid-filled cysts in the breast tissue.
Choice D: Pituitary prolactinoma is a benign tumor of the pituitary gland that can cause elevated prolactin levels leading to nipple discharge, but it is not typically bloody and would not present with spontaneous discharge from the nipple.
A patient presents with decreased hearing related to antibiotic use. Which class of antibiotics is this?
- A. Aminoglycosides
- B. Beta-lactams
- C. Cephalosporins
- D. Macrolides
Correct Answer: A
Rationale: The correct answer is A: Aminoglycosides. Aminoglycosides can cause ototoxicity, resulting in decreased hearing. They are known to damage the sensory cells in the inner ear. Beta-lactams (B) and Cephalosporins (C) are not associated with hearing loss. Macrolides (D) can rarely cause hearing loss but are not as commonly linked to ototoxicity as aminoglycosides.