Nokea
Ms. Carpenter is a 28-year-old female who presents in significant pain she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic?
- A. Temperature > 102°F
- B. White blood cell count > 14,000 cells/µL
- C. Vomiting
- D. Hematuria
Correct Answer: A
Rationale: The correct answer is A: Temperature > 102°F. A high fever in the context of right lower quadrant colicky pain raises concern for ureteral colic, which is often caused by kidney stones. Fever may indicate infection or obstruction, requiring urgent medical attention. Choices B, C, and D are incorrect because they are common findings in cases of ureteral colic but are not as specific to raise the index of suspicion. White blood cell count elevation and hematuria are common with kidney stones, while vomiting is a common symptom due to severe pain. However, fever is a more concerning sign that necessitates prompt evaluation.
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M. T. is a 71-year-old female who presents for evaluation of a lump on her chest. She denies any symptomsthere is no pain, erythema, edema, ecchymosis, or open areasit is just a lump. She has no idea how long it has been there and just noticed it a few weeks ago. Physical examination reveals a round, smooth, flesh-colored tumor. It is firm but not hard it has smooth borders. It measures 6 cm in diameter and is non-tender to palpation. The AGACNP suspects that this is a classic presentation of the most common chest wall tumor known as a
- A. Neurolemma
- B. Lipoma
- C. Hemangioma
- D. Lymphangioma
Correct Answer: B
Rationale: The correct answer is B: Lipoma. A lipoma is a common benign tumor made of fat cells. In this case, the patient's presentation of a painless, soft, round, flesh-colored lump with smooth borders is consistent with a lipoma. The absence of symptoms like pain, erythema, or tenderness further supports this diagnosis. Lipomas are usually non-tender to palpation and can grow to a significant size. The other choices (A, C, D) are not the correct answers because they do not align with the characteristics described in the patient's presentation. Neurolemma is associated with nerve sheath tumors, hemangioma with blood vessel tumors, and lymphangioma with lymphatic vessel tumors, none of which match the clinical findings in this case.
The lie is defined as unstable when it keeps varying after
- A. 36 weeks gestation
- B. 42 weeks gestation
- C. 38 weeks gestation
- D. 40 weeks gestation
Correct Answer: A
Rationale: The correct answer is A (36 weeks gestation) because at this point in pregnancy, the fetus has reached a stable lie position. Before 36 weeks, fetal lie can vary due to the ample space in the uterus. After 36 weeks, the fetus tends to settle into a consistent head-down or breech position, making the lie stable. Choices B, C, and D are incorrect as they are past the point where the lie typically stabilizes, leading to less variability in fetal positioning.
What are the key indicators for cesarean section during labor?
- A. Fetal distress
- B. Failure to progress
- C. Breech presentation
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D, as all three choices are key indicators for cesarean section during labor. Fetal distress indicates the baby is not tolerating labor well. Failure to progress may lead to complications for the mother or baby. Breech presentation increases the risk of complications during vaginal delivery. Therefore, all three indicators warrant consideration for a cesarean section to ensure the safety of both the mother and the baby.
Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?
- A. High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplant
- B. There is a strong interest in developing corticosteroid-free posttransplant protocols
- C. Better results are demonstrated in corticosteroid-free protocols for second-transplant recipients
- D. Evidence supports corticosteroid-free rejection protocols
Correct Answer: A
Rationale: The correct answer is A. High-dose initial steroids are tapered off over a period of 4 to 6 weeks posttransplant. This is because corticosteroids are used initially to prevent rejection and then gradually tapered to minimize side effects. Choice B is incorrect as it states a general interest but does not address the specific protocol for corticosteroid use. Choice C is incorrect as there is no evidence suggesting better results in corticosteroid-free protocols for second-transplant recipients. Choice D is incorrect as there is no strong evidence supporting corticosteroid-free rejection protocols in posttransplant patients.
Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse tracking and scarring. Today Jasmine has a distinct inability to turn her neck without pain, throat pain, and a temperature of 102.1F. She appears ill and has foul breath. In order to evaluate for a deep neck space infection, the AGACNP orders
- A. Anteroposterior neck radiography
- B. CT scan of the neck
- C. White blood cell (WBC) differential
- D. Aspiration and culture of fluid
Correct Answer: D
Rationale: The correct answer is D: Aspiration and culture of fluid. Given Jasmine's history of injection drug use, neck pain, inability to turn her neck, elevated temperature, and foul breath, there is a high suspicion of a deep neck space infection. Aspiration and culture of fluid from the affected area will help identify the causative organism and guide appropriate antibiotic therapy. This procedure is essential for definitive diagnosis and management of deep neck infections.
A: Anteroposterior neck radiography is not the most appropriate initial diagnostic test for evaluating deep neck space infections as it may not provide detailed information on the extent or nature of the infection.
B: CT scan of the neck may provide valuable information regarding the extent of the infection, but aspiration and culture of fluid are crucial for identifying the causative organism.
C: White blood cell (WBC) differential may show signs of inflammation, but it does not provide specific information on the causative organism of the infection.