Nokea
Mr XYZ, a 60-year-old, smoker with DM, hypertension and CKD Stage 3 sees you for routine chronic review. He reports recurrent gout flares past five weeks of increasing intensity and duration which he assumes is due to frequent travel and lack of exercise. His current laboratory results are creatinine 106, eGFR 56, uric acid 400, HbA1c 7.3%, random hypocount 8.5 mmol/L. He is currently taking glipizide 5 mg BD, Metformin 250 mg BD, Amlodipine 5 mg OM. What is the most appropriate management in this patient?
- A. Offer dietary advice
- B. Prescribe NSAIDs and medical certificate (MC)
- C. Increased exercise frequency (e.g. jogging at least 3 times per week)
- D. Initiate urate lowering therapy using allopurinol with colchicine prophylaxis
Correct Answer: D
Rationale: Gout flares, uric acid 400, CKD 3 allopurinol with colchicine tames crystals, not just diet, NSAIDs, jogging, or smoke quit. Nurses start this chronic uric brake.
You may also like to solve these questions
One of the features of type 2 diabetes mellitus is the abnormally increased blood glucose values after meals. Question: What causes this abnormal rise of postprandial blood glucose?
- A. Insufficient glucose uptake in the liver due a shortage of Glut-2 transporters
- B. Insufficient glucose uptake in muscle tissue due to a defect in the Glut-4 transporters
- C. Insufficient glucose uptake in adipose tissue due to a defect in the intracellular insulin signal cascade
- D. Insufficient glucose uptake in muscle tissue due to a defect in the intracellular insulin signal cascade
Correct Answer: D
Rationale: Type 2's post-meal spike muscle's insulin signal jams, Glut-4 stalls, glucose piles up. Liver's Glut-2's fine, fat's minor, muscle's the big miss nurses peg this resistance core, a chronic uptake bust.
What is the average life expectancy in Canada?
- A. 60 years
- B. 70 years
- C. 80 years
- D. 90 years
Correct Answer: C
Rationale: Canada's life clock hits 80 78.5 for men, 82.7 for women in 2010 a longevity nurses bank on for chronic care spans. Lower guesses lag history; 90's a stretch. It shapes health goals, a timeline framing illness fights.
How many times more likely is a patient with diabetes to die from a cardiovascular condition compared with a patient without diabetes?
- A. 2-4x
- B. 8-10x
- C. 20-25x
- D. 40-50x
Correct Answer: A
Rationale: Diabetes doubles, quadruples CV death vessels rot, not wild leaps. Nurses brace for this, a chronic heart toll.
Pulmonary rehabilitation is one of the most effective interventions in the management of COPD. The primary goals of this program are to:
- A. Ensure the patient eats appropriately, takes their medication as prescribed and exercises every day.
- B. Involve the patient in the multidisciplinary team and knows how to manage their condition.
- C. Reduce symptoms, improved QOL, increase physical and emotional participation in everyday life.
- D. Prevent deterioration, avoid hospitalisation and support the carers.
Correct Answer: C
Rationale: Pulmonary rehabilitation (PR) is a cornerstone COPD intervention, emphasizing functional improvement over mere compliance. Ensuring diet, medication, and daily exercise is supportive but not PR's primary aim it's too prescriptive. Involving patients in teams and self-management is valuable, but PR's core is outcome-driven: reducing dyspnea, enhancing quality of life (QOL), and boosting physical/emotional engagement in daily activities via exercise, education, and psychosocial support. Preventing deterioration and hospitalization are benefits, not goals PR doesn't directly support carers. Evidence (e.g., GOLD guidelines) highlights PR's efficacy in symptom relief (e.g., breathlessness), QOL gains (e.g., St. George's Respiratory Questionnaire), and participation (e.g., 6-minute walk test), per multidisciplinary programs outlined in chronic care texts, making it a holistic, patient-centered strategy beyond disease containment.
When conventional routes of analgesia have been unsuccessful or are contraindicated for chronic pain syndromes, intrathecal drug delivery systems may be considered. Appropriate indications are likely to include:
- A. Patients with cancer-related pain in whom life expectancy is estimated to be >3 months.
- B. Chronic pancreatitis.
- C. Haematuria loin pain syndrome.
- D. Chronic low back pain.
Correct Answer: A
Rationale: Intrathecal drug delivery systems (IDDS) treat severe, refractory pain. Cancer pain with >3 months life expectancy justifies IDDS, balancing implantation risks with prolonged benefit shorter expectancy favors simpler methods. Chronic pancreatitis may respond, but evidence is weaker; it's not a primary indication. Haematuria loin pain syndrome (loin pain haematuria syndrome) is niche, rarely managed with IDDS due to limited data. Chronic low back pain often fails conservative treatment, but IDDS is reserved for extreme cases (e.g., failed back surgery syndrome), not routine. Chronic refractory angina is cardiac, not typically IDDS-eligible. Cancer pain's prevalence, severity, and responsiveness to intrathecal opioids/ziconotide make it the clearest indication, optimizing quality of life in palliative care.