Nokea
T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation?
- A. A temperature of 101.5°F
- B. A leukocyte count of 18,000/µL
- C. A palpable gallbladder
- D. A positive Murphy’s sign
Correct Answer: A
Rationale: The correct answer is A: A temperature of 101.5°F. A fever indicates an inflammatory response, which could be due to a complication like cholecystitis or cholangitis. Elevated leukocyte count (choice B) supports infection but is not as specific as a fever. Palpable gallbladder (choice C) may suggest inflammation but not necessarily a complication. A positive Murphy's sign (choice D) is indicative of gallbladder inflammation but does not directly indicate a complication requiring surgical evaluation.
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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.
Cord presentation is when the
- A. Umbilical cord lies in front of the presenting part after the membranes have ruptured.
- B. Umbilical cord lies in front of the presenting part before membranes have ruptured
- C. Umbilical cord is tied around the fetal neck.
- D. Umbilical cord has prematurely been detached.
Correct Answer: A
Rationale: The correct answer is A because cord presentation occurs when the umbilical cord lies in front of the presenting part after the membranes have ruptured. This can lead to compression of the cord during labor, affecting fetal oxygenation. Option B is incorrect as it describes cord prolapse, where the cord lies in front of the presenting part before membrane rupture. Option C describes nuchal cord, where the cord is wrapped around the fetal neck. Option D describes cord abruption, where the cord detaches prematurely from the placenta.
A specific clinical feature of respiratory distress syndrome includes
- A. Grunting on inspiration
- B. Grunting on expiration
- C. Flaring of the nostrils
- D. Neonatal tachycardia
Correct Answer: B
Rationale: The correct answer is B: Grunting on expiration. In respiratory distress syndrome, the infant may exhibit grunting on expiration due to the difficulty in maintaining lung inflation during exhalation. This is a compensatory mechanism to increase functional residual capacity. Grunting on inspiration (choice A) may be seen in other respiratory conditions. Flaring of the nostrils (choice C) is a sign of increased work of breathing but is not specific to respiratory distress syndrome. Neonatal tachycardia (choice D) can be a nonspecific sign of distress and is not a specific feature of respiratory distress syndrome.
Complications of occipito-posterior position:
- A. Prolonged labor, fetal distress, back pain
- B. Postpartum hemorrhage, uterine rupture, fetal death
- C. Cesarean delivery, low birth weight, infection
- D. All of the above
Correct Answer: A
Rationale: The correct answer is A because occipito-posterior position can lead to prolonged labor due to poor fetal positioning, causing maternal back pain. This can result in fetal distress as the baby may have difficulty descending through the birth canal. Postpartum hemorrhage, uterine rupture, fetal death (choices B and C) are not typically associated with occipito-posterior position. Therefore, choice A is the most appropriate answer.
R. S. is a 66-year-old female with Cushings syndrome due to an ACTH-producing pituitary tumor. The tumor is readily isolated by imaging, and the patient had an uneventful surgery. When seeing her in follow-up, the AGACNP anticipates
- A. Rapid reversal of symptoms, with good pituitary function
- B. Transient rebound release of remaining pituitary hormones
- C. Markedly improved dexamethasone suppression test
- D. Hyponatremia and compensatory SIADH
Correct Answer: B
Rationale: The correct answer is B: Transient rebound release of remaining pituitary hormones. After surgical removal of the ACTH-producing pituitary tumor in Cushing's syndrome, there may be a transient rebound release of remaining pituitary hormones due to relief of negative feedback from the tumor. This can lead to a temporary increase in pituitary hormone levels before normalization.
Rationale:
1. Rapid reversal of symptoms with good pituitary function (Choice A) is less likely as it takes time for the pituitary gland to recover and resume normal hormone production post-surgery.
2. Markedly improved dexamethasone suppression test (Choice C) is not expected immediately after surgery as it may take time for the hypothalamic-pituitary-adrenal axis to normalize.
3. Hyponatremia and compensatory SIADH (Choice D) are unlikely post-operatively in Cushing's syndrome as removal of the ACTH-producing tumor should lead to normalization of