Nokea
The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal
- A. Increased MCV
- B. Increased Hgb
- C. Increased platelets
- D. Increased albumin
Correct Answer: A
Rationale: The correct answer is A: Increased MCV. Following splenectomy, there is a compensatory increase in red blood cell production, leading to an increase in Mean Corpuscular Volume (MCV) due to the release of larger, younger red blood cells into circulation. This is known as stress erythropoiesis.
Summary:
B: Increased Hgb - Hgb levels may not necessarily increase post-splenectomy as it depends on factors such as bleeding or hydration status.
C: Increased platelets - Platelet count is not expected to increase immediately post-splenectomy.
D: Increased albumin - Albumin levels are not directly influenced by splenectomy for idiopathic thrombocytopenia purpura.
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In which form of hypospadias should circumcision be deferred in order to preserve the prepuce for later surgical repair?
- A. Ventral displacement
- B. Proximal displacement
- C. Midscrotal hypospadias
- D. Meatus proximal to the corona
Correct Answer: A
Rationale: The correct answer is A: Ventral displacement. In ventral displacement hypospadias, the urethral opening is located on the underside of the penis, making it necessary to defer circumcision to preserve the prepuce for later surgical repair. Preserving the prepuce in this case is important for reconstructive surgery to correct the hypospadias. Choices B, C, and D do not require deferring circumcision as the location of the urethral opening does not impact the need for prepuce preservation for future surgical repair.
The major causative organism of urinary tract infection during puerperium is:
- A. Staphylococcus pyogenes
- B. Anaerobic streptococci
- C. Clostridium welchii
- D. Escherichia coli
Correct Answer: D
Rationale: The correct answer is D: Escherichia coli. During puerperium, the most common causative organism of urinary tract infection is E. coli. This is because E. coli is a normal flora in the gastrointestinal tract and can ascend to the urinary tract due to factors like hormonal changes, reduced bladder tone, and trauma during delivery. Staphylococcus pyogenes (Choice A), Anaerobic streptococci (Choice B), and Clostridium welchii (Choice C) are not typically associated with urinary tract infections during puerperium. Staphylococcus pyogenes is more commonly known for causing skin infections, Anaerobic streptococci are not commonly implicated in urinary tract infections, and Clostridium welchii is associated with gas gangrene, not urinary tract infections.
In myelodysplastic syndromes, the primary indications for splenectomy include
- A. Major hemolysis unresponsive to medical management
- B. Severe symptoms of massive splenomegaly
- C. Sustained leukocyte elevation above 30,000 cells/µL
- D. Portal hypertension
Correct Answer: D
Rationale: The correct answer is D: Portal hypertension. In myelodysplastic syndromes, splenectomy is indicated primarily for portal hypertension due to extramedullary hematopoiesjson in the spleen, leading to increased blood flow and pressure in the portal vein. This can alleviate symptoms such as ascites and variceal bleeding. Choices A, B, and C are incorrect as major hemolysis, massive splenomegaly, and sustained leukocyte elevation are not primary indications for splenectomy in myelodysplastic syndromes.
enna is a 41-year-old female who presents to the emergency room complaining of sudden hearing loss. She is generally very healthyshe denies any significant medical history, and her only daily medication is a combined oral contraceptive. She does admit that she is just getting over a head cold, but other than that she offers no relevant history. A comprehensive history and physical examination results in a diagnosis of sudden sensorineural hearing loss (SSHL) of unknown origin. The AGACNP knows that the next step in the patients management should include
- A. Acyclovir
- B. Furosemide
- C. Warfarin
- D. Hyperbaric oxygen
Correct Answer: D
Rationale: The correct answer is D: Hyperbaric oxygen. SSHL is a medical emergency that requires prompt intervention. Hyperbaric oxygen therapy increases oxygen delivery to the inner ear, potentially reversing the hearing loss. Acyclovir (A) is used for viral infections, not SSHL. Furosemide (B) is a diuretic used for treating fluid retention, not SSHL. Warfarin (C) is an anticoagulant and is not indicated for SSHL. In summary, hyperbaric oxygen is the appropriate choice for managing SSHL due to its potential to improve oxygen delivery to the inner ear.
A characteristic of monozygotic twins is that
- A. They are always of the same sex
- B. They share a similar fingerprint pattern
- C. They have different blood groups
- D. Superfetation is a common finding
Correct Answer: A
Rationale: The correct answer is A: They are always of the same sex. This is because monozygotic twins, also known as identical twins, develop from a single fertilized egg that splits into two embryos. As a result, they share the same genetic material and are always of the same sex.
Choice B is incorrect because fingerprint patterns are not determined by genetics and can vary even between identical twins. Choice C is incorrect because monozygotic twins share the same blood type since they have the same genetic makeup. Choice D is incorrect as superfetation, the occurrence of multiple pregnancies in the same uterus but from different ovulations, is extremely rare and not a common finding in monozygotic twins.