Nokea
The earliest clinical manifestation of diabetic nephropathy is:
- A. An elevation in blood urea nitrogen (BUN)
- B. An elevation in blood urea nitrogen (BUN) and creatinine (CR)
- C. A decreased glomerular filtration rate
- D. Microalbuminuria
Correct Answer: D
Rationale: The correct answer is D: Microalbuminuria. In diabetic nephropathy, the earliest clinical manifestation is the presence of microalbuminuria, which indicates early kidney damage. This occurs before significant changes in BUN, creatinine, or glomerular filtration rate are observed. Microalbuminuria is a key indicator for monitoring and early intervention in diabetic nephropathy.
Incorrect Options:
A: An elevation in blood urea nitrogen (BUN) - BUN levels may rise in later stages of kidney damage.
B: An elevation in blood urea nitrogen (BUN) and creatinine (CR) - These markers typically increase as kidney function declines, not in the early stages.
C: A decreased glomerular filtration rate - GFR decreases as kidney function worsens, not typically an early sign in diabetic nephropathy.
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Racial disparities have been a part of US healthcare for many decades. How might this impact the expectations of older Black Americans?
- A. Reluctance to participate in medical research because of unethical studies in the past
- B. Underrepresentation of Black physicians in the geriatric workforce
- C. Cumulative effects of differences in access to healthcare providers
- D. All of these
Correct Answer: D
Rationale: The correct answer is D because each of the choices addresses a different aspect of how racial disparities in healthcare can impact the expectations of older Black Americans. A is correct because unethical studies in the past can lead to reluctance to participate in medical research. B is correct because the underrepresentation of Black physicians may affect the quality of care older Black Americans receive. C is correct because differences in access to healthcare providers can result in cumulative negative effects on health outcomes for older Black Americans. Therefore, the combination of these factors can significantly impact the expectations and experiences of older Black Americans in healthcare.
The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to?
- A. Chief complaint
- B. Present illness
- C. Personal and social history
- D. Review of systems
Correct Answer: D
Rationale: The correct answer is D: Review of systems. In this case, the information provided pertains to specific symptoms related to the cardiovascular system. The review of systems involves asking about symptoms in various body systems to identify any potential issues. This information helps in identifying any underlying health concerns that the patient may not have mentioned as their main complaint.
Summary of why other choices are incorrect:
A: Chief complaint - This is the main reason for the patient's visit or primary concern, not a list of symptoms.
B: Present illness - Focuses on the details of the current medical issue, not a general review of symptoms.
C: Personal and social history - Pertains to the patient's lifestyle, habits, and social support, not specific symptoms related to body systems.
Which of the following is a clinical identifier of metabolic syndrome?
- A. Waist circumference of 38 inches for a male
- B. Waist circumference of 34 inches for a female
- C. BP of 134/88 for a male
- D. BP of 128/84 for a female
Correct Answer: A
Rationale: The correct answer is A because a waist circumference of 38 inches for a male is a clinical identifier of metabolic syndrome. This measurement reflects abdominal obesity, a key component of metabolic syndrome. Excess abdominal fat is associated with insulin resistance, high blood pressure, and dyslipidemia, which are all features of metabolic syndrome.
Choice B is incorrect because a waist circumference of 34 inches for a female is not the correct measurement for identifying metabolic syndrome in females.
Choice C is incorrect because a blood pressure of 134/88 for a male, while elevated, is not a specific clinical identifier of metabolic syndrome.
Choice D is incorrect because a blood pressure of 128/84 for a female, although slightly elevated, is not a specific clinical identifier of metabolic syndrome.
Upon arriving at a scene where a patient has been involved in a minor car accident, she reports feeling faint and states that she has a history of diabetes. Given this information, what is the primary concern that the patient is expressing?
- A. Her blood sugar levels are likely unstable
- B. She is experiencing a headache
- C. She has a history of hypertension
- D. She is feeling nauseous
Correct Answer: A
Rationale: The correct answer is A: Her blood sugar levels are likely unstable. Given the patient's history of diabetes and feeling faint after a minor car accident, the primary concern is hypoglycemia, which can occur due to stress or delayed food intake. Symptoms may include feeling faint, weakness, and confusion. It is important to address this immediately as untreated hypoglycemia can lead to serious complications.
Choice B is incorrect as a headache is not typically a primary concern for a diabetic patient feeling faint. Choice C is incorrect as hypertension is not directly related to the symptoms described. Choice D is incorrect as nausea is not a typical symptom of hypoglycemia in this context. It is crucial to focus on the patient's diabetic history and potential hypoglycemia in this scenario.
Which is the most effective pattern of palpation for breast cancer?
- A. Beginning at the nipple, make an ever-enlarging spiral.
- B. Divide the breast into quadrants and inspect each systematically.
- C. Examine in lines resembling the back and forth pattern of mowing a lawn.
- D. Beginning at the nipple, palpate outward in a stripe pattern.
Correct Answer: B
Rationale: The correct answer is B. Dividing the breast into quadrants and inspecting each systematically is the most effective pattern of palpation for breast cancer because it ensures thorough coverage of the entire breast, making it easier to detect any abnormalities. This method allows for a structured approach, reducing the likelihood of missing any potential signs of cancer.
A: Beginning at the nipple and making an ever-enlarging spiral may not cover all areas of the breast equally, potentially leading to missed abnormalities.
C: Examining in lines resembling mowing a lawn may also result in uneven coverage and potentially missing crucial areas.
D: Beginning at the nipple and palpating outward in a stripe pattern may not provide comprehensive coverage of the entire breast, increasing the risk of overlooking abnormalities.