Nokea
"Red man syndrome "has been associated with rapid intravenous injection of * which of the following antibiotic?
- A. Vancomycin
- B. Clindamycin
- C. Cefoperazone
- D. Piperacillin
Correct Answer: A
Rationale: The correct answer is A: Vancomycin. Red man syndrome is a hypersensitivity reaction caused by rapid infusion of vancomycin. Vancomycin infusion releases histamine, leading to flushing, rash, and hypotension. Clindamycin (B), Cefoperazone (C), and Piperacillin (D) are not associated with red man syndrome. Clindamycin can cause pseudomembranous colitis, Cefoperazone can cause bleeding disorders, and Piperacillin can cause hypersensitivity reactions, but not red man syndrome.
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A patient with suprapubic pain and symptoms of urinary frequency and urgency has two negative urine cultures. What is one assessment finding that would indicate interstitial cystitis?
- A. Residual urine greater than 200 mL
- B. A large, atonic bladder on urodynamic testing
- C. A voiding pattern that indicates psychogenic urinary retention
- D. Pain with bladder filling that is transiently relieved by urination
Correct Answer: D
Rationale: The correct answer is D. Pain with bladder filling that is transiently relieved by urination is a classic symptom of interstitial cystitis. This pattern of pain is due to inflammation of the bladder lining, which worsens as the bladder fills with urine and improves temporarily after urination. This finding is specific to interstitial cystitis and not typically seen in other conditions.
Choices A, B, and C are incorrect:
A: Residual urine greater than 200 mL is more indicative of bladder outlet obstruction or neurogenic bladder dysfunction, not specifically interstitial cystitis.
B: A large, atonic bladder on urodynamic testing is suggestive of neurogenic bladder or bladder outlet obstruction, not interstitial cystitis.
C: A voiding pattern indicating psychogenic urinary retention is more likely related to psychological factors affecting bladder function, not interstitial cystitis.
Which of the following drug that acts by inhibiting HIV protease enzyme? *
- A. Lamivudine
- B. Efavirenz
- C. Stavudine
- D. Ritonavir
Correct Answer: D
Rationale: The correct answer is D: Ritonavir. Ritonavir is a protease inhibitor that works by inhibiting the HIV protease enzyme, which is crucial for viral replication. This action helps prevent the virus from spreading and multiplying in the body. Lamivudine (A), Efavirenz (B), and Stavudine (C) are not protease inhibitors and work through different mechanisms like nucleoside reverse transcriptase inhibition (Lamivudine and Stavudine) and non-nucleoside reverse transcriptase inhibition (Efavirenz). Therefore, they do not directly target the HIV protease enzyme like Ritonavir does.
A 60-year-old woman is undergoing a pelvic examination. During the examination, the nurse finds a mass in the pelvic region that is hard, irregular, and fixed. The nurse's most appropriate course of action would be to:
- A. Monitor the mass and perform routine follow-up.
- B. Refer the patient to a gynecologist for further evaluation.
- C. Obtain a biopsy of the mass to assess for malignancy.
- D. Perform a pelvic ultrasound to assess the mass.
Correct Answer: B
Rationale: The correct answer is B: Refer the patient to a gynecologist for further evaluation. Given the characteristics of the mass (hard, irregular, fixed), it raises concerns for possible malignancy. Referring the patient to a gynecologist allows for a specialist to conduct a thorough evaluation, which may include additional imaging studies and biopsies to determine the nature of the mass. Monitoring the mass (choice A) without further evaluation may delay potential diagnosis and treatment. Obtaining a biopsy (choice C) without proper evaluation by a specialist may not be appropriate at this stage. Performing a pelvic ultrasound (choice D) can provide additional information but may not be sufficient for a definitive diagnosis of malignancy.
The drug of choice for treatment and secondary prophylaxis against cryptococcal meningitis among AIDS patients is:
- A. Amphotericin B
- B. Flucytosine
- C. Fluconazole
- D. Ketoconazole
Correct Answer: C
Rationale: Step-by-step rationale:
1. Fluconazole is preferred due to its efficacy, safety, and tolerability in Cryptococcal meningitis.
2. It has better CNS penetration compared to other azoles.
3. It is less toxic than Amphotericin B and Flucytosine.
4. Ketoconazole is less effective and not recommended for this indication.
Summary:
- A: Amphotericin B is reserved for severe cases due to its toxicity.
- B: Flucytosine is used in combination therapy but not as the primary drug of choice.
- D: Ketoconazole is less effective and not preferred for Cryptococcal meningitis in AIDS patients.
Carol Carson was taught self breast examination (SBE) during her last hospitalization and tells you that she has been doing the examination every month without difficulty. Which statement by Mrs. Carson would indicate to you that she does NOT have a complete understanding of the self breast examination technique?
- A. I do the examination every month a few days after my period.
- B. I use my fingertips to examine all of the breast tissues.
- C. I begin the examination by inspecting my breasts with hands at my side.
- D. I especially check the upper, outer quadrants and under my arms.
Correct Answer: C
Rationale: The correct answer is C. Mrs. Carson's statement indicates a lack of understanding because she mentions beginning the examination by inspecting her breasts with hands at her side. The correct technique for self breast examination (SBE) involves inspecting the breasts visually in front of a mirror with hands on hips or raised above the head. This position allows for better visualization and palpation of the breast tissue. Starting the examination with hands at the sides may result in missing important areas for inspection. Choices A, B, and D are incorrect because they all align with proper SBE techniques such as timing the examination, using fingertips to examine all breast tissues, and focusing on specific areas like the upper, outer quadrants, and underarms.