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Mrs. Carpenter is a 59-year-old female who presents with an acute myocardial infarction. She is acutely short of breath and has coarse rales on auscultation. Physical examination reveals a grade VVI systolic murmur, loudest at the point of maximal impulse with radiation to the midaxillary line. The AGACP recognizes
- A. Acute mitral valve regurgitation
- B. Acute aortic valve regurgitation
- C. Acute cardiac tamponade
- D. Acute pulmonary embolus
Correct Answer: A
Rationale: The correct answer is A: Acute mitral valve regurgitation. The presence of a grade VVI systolic murmur that radiates to the midaxillary line suggests mitral valve involvement. Mitral regurgitation leads to acute onset of symptoms such as dyspnea and pulmonary congestion, indicated by coarse rales on auscultation. The murmur is loudest at the point of maximal impulse due to eccentric regurgitation jet. Acute aortic valve regurgitation (B) typically presents with a diastolic murmur. Acute cardiac tamponade (C) would present with Beck's triad and pulsus paradoxus. Acute pulmonary embolus (D) would present with sudden onset dyspnea and pleuritic chest pain.
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Intraperitoneal uterine rupture involves
- A. A tear of endometrium, myometrium & peritoneum
- B. A tear of the endometrium, myometrium & basal layer
- C. A tear of the endometrium, capsular layer & myometrium
- D. A tear of the endometrium, spongy layer & myometrium only
Correct Answer: A
Rationale: The correct answer is A because intraperitoneal uterine rupture involves a tear that goes through all layers of the uterus - endometrium, myometrium, and peritoneum. This type of rupture extends beyond the muscular layer of the uterus and into the peritoneal cavity. Choices B, C, and D are incorrect as they do not include the peritoneum, which is a key component of intraperitoneal uterine rupture. Therefore, choice A is the correct answer as it accurately describes the layers involved in this type of rupture.
What are the symptoms of a urinary tract infection (UTI) during pregnancy?
- A. Painful urination
- B. Increased frequency of urination
- C. Lower abdominal pain
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D (All of the above) because during pregnancy, UTI symptoms include painful urination, increased frequency of urination, and lower abdominal pain. Painful urination is a common symptom due to inflammation of the urinary tract. Increased frequency of urination is caused by the pressure of the growing uterus on the bladder. Lower abdominal pain can also occur due to the infection. Therefore, all these symptoms are indicative of a UTI during pregnancy. Other choices are incorrect as they do not encompass the comprehensive range of symptoms typically seen in a UTI during pregnancy.
R. R. is a 61-year-old male patient who presents with a chief complaint of fever and urinary symptoms. He was in his usual state of good health when for no apparent reason he developed pain in his back and perineal region, as well as fever and chills. He presents as septic. He had urinary hesitancy and decreased stream but now reports that he has not passed urine in more than 12 hours. Palpation of the lower abdomen is consistent with bladder distention. The AGACNP knows that which of the following is contraindicated in this circumstance?
- A. Digital prostate examination
- B. Urinary catheterization
- C. Fluoroquinolone antibiotics
- D. Drainage of prostate abscess
Correct Answer: C
Rationale: The correct answer is C: Fluoroquinolone antibiotics. In this case, the patient presents with signs of sepsis and urinary retention, which are indicative of a possible prostatic abscess. Administering fluoroquinolone antibiotics could potentially mask the symptoms and delay further evaluation and treatment of the abscess. This can lead to worsening infection and sepsis. Therefore, the AGACNP should avoid prescribing fluoroquinolones until further evaluation is done to confirm or rule out a prostatic abscess.
Incorrect choices:
A: Digital prostate examination - This could help in assessing the prostate for abscess or other abnormalities.
B: Urinary catheterization - Necessary to relieve bladder distention and assess urine output.
D: Drainage of prostate abscess - If confirmed, drainage would be the appropriate intervention to address the abscess.
The AGACNP is counseling a patient about various methods of tumor biopsy. Which of the following is not an accurate statement?
- A. Incisional biopsy is preferred to excisional biopsy when possible
- B. Core needle biopsy has a higher rate of false positive than does fine needle aspiration
- C. Fine needle aspiration does not allow grading of tumors
- D. Core needle and incisional biopsies are virtually identical in terms of false results
Correct Answer: C
Rationale: Correct Answer: C - Fine needle aspiration does not allow grading of tumors.
Rationale:
1. Fine needle aspiration (FNA) collects cells for cytology evaluation, not tissue for grading.
2. Grading requires evaluation of tissue architecture, which is not possible with FNA.
3. FNA is useful for diagnosis but not for determining tumor grade.
Summary:
A: Incorrect - Excisional biopsy is preferred over incisional biopsy to obtain the entire tumor for diagnosis and grading.
B: Incorrect - Core needle biopsy has a lower false positive rate compared to fine needle aspiration.
D: Incorrect - Core needle and incisional biopsies differ in the amount of tissue sampled and potential for false results.
Chemical diabetes mellitus is a classification based on
- A. Symptom are absent and abnormal specific laboratory results
- B. Presence of symptoms and abnormal specific laboratory results
- C. Previous congenital abnormalities and unexplained stillbirth
- D. Previous birth of a baby weighing >4.3kg and spontaneous abortion
Correct Answer: A
Rationale: The correct answer is A: Symptom are absent and abnormal specific laboratory results. Chemical diabetes mellitus refers to a condition where there are abnormal specific laboratory results indicating diabetes without the presence of any symptoms. This classification is based on objective data from laboratory tests rather than subjective symptoms. Choices B, C, and D are incorrect as they do not align with the definition of chemical diabetes mellitus, which focuses on laboratory results rather than symptoms, congenital abnormalities, or pregnancy outcomes.