Nokea
The signs of thyroid crisis resulting from Graves' disease include:
- A. constipation with gastric distension.
- B. bradycardia and bradypnea.
- C. hyperthermia and tachycardia.
- D. constipation and lethargy.
Correct Answer: C
Rationale: Thyroid crisis in Graves' disease typically presents with hyperthermia (high body temperature) and tachycardia (rapid heart rate). These symptoms are a result of excessive thyroid hormone production and can lead to life-threatening complications if not promptly addressed. Choices A, B, and D are incorrect because constipation with gastric distension, bradycardia and bradypnea, and constipation and lethargy are not typical signs of a thyroid crisis in Graves' disease.
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Abrupt withdrawal or discontinuation of prednisone can cause:
- A. adrenal crisis.
- B. hypercortisolism.
- C. ACTH stimulation.
- D. thyroid crisis.
Correct Answer: A
Rationale: The correct answer is A: adrenal crisis. Abrupt discontinuation of prednisone can lead to adrenal insufficiency, resulting in adrenal crisis. Prednisone is a corticosteroid that suppresses the adrenal glands' ability to produce cortisol. Abrupt withdrawal can cause a sudden drop in cortisol levels, leading to adrenal crisis with symptoms like fatigue, weakness, abdominal pain, and potentially life-threatening low blood pressure. Choices B, C, and D are incorrect because hypercortisolism refers to excess cortisol levels, ACTH stimulation would not result from prednisone withdrawal, and thyroid crisis is not directly related to corticosteroid discontinuation.
Which pathophysiologic process causes the decreased glomerular filtration rate in a patient with acute glomerulonephritis?
- A. Decreased renal-induced constriction of the renal arteries
- B. Immune complex deposition, increased capillary permeability, and cellular proliferation
- C. Necrosis of 70% or more of the nephrons secondary to increased kidney interstitial hydrostatic pressure
- D. Scar tissue formation throughout the proximal convoluted tubule secondary to toxin-induced collagen synthesis
Correct Answer: B
Rationale: The correct answer is B: Immune complex deposition, increased capillary permeability, and cellular proliferation. In acute glomerulonephritis, immune complexes deposit in the glomerulus, leading to inflammation, increased capillary permeability, and cellular proliferation. These processes collectively reduce the glomerular filtration rate. Choices A, C, and D do not accurately describe the pathophysiologic process in acute glomerulonephritis. Decreased renal-induced constriction of the renal arteries, necrosis of nephrons due to increased kidney interstitial hydrostatic pressure, and scar tissue formation in the proximal convoluted tubule are not the primary mechanisms responsible for the decreased filtration rate in this condition.
During admission, 82-year-old Mr. Robeson is brought to the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client's daughter best supports the diagnosis?
- A. "Maybe it's just caused by aging. This usually happens by age 82."
- B. "The changes in his behavior came on so quickly! I wasn't sure what was happening."
- C. "Dad just didn't seem to know what he was doing. He would forget what he had for breakfast."
- D. "Dad has always been so independent. He's lived alone for years since mom died."
Correct Answer: B
Rationale: The correct answer is B because sudden onset of behavioral changes is a typical symptom of delirium. Delirium is characterized by an acute and fluctuating disturbance in attention, awareness, and cognition. Choice A is incorrect because delirium is not a normal part of aging. Choice C describes memory issues, which can be seen in delirium but are less specific than sudden behavioral changes. Choice D, while it mentions the patient's independence, does not directly support the diagnosis of delirium.
In which patient would the manifestation of a headache be a sign of a serious underlying disorder?
- A. A 55-year-old man with new onset of headaches that are worse at night and reported mood swings according to his family
- B. A 30-year-old woman with a unilateral throbbing headache with photophobia and nausea
- C. A 60-year-old man with his head feeling full and throbbing and muscle aching around his neck and shoulders
- D. A 40-year-old woman who experiences food cravings, gets irritable, and then develops a pulsatile-like headache on the right side of her head
Correct Answer: A
Rationale: The correct answer is A. New onset headaches in older adults, especially if worse at night, may indicate a serious condition like a brain tumor. Choice B describes symptoms commonly seen in migraines. Choice C describes tension-type headaches. Choice D describes symptoms of a menstrual migraine which is not typically associated with a serious underlying disorder.
A 51-year-old woman has the following clinical findings: thin hair, exophthalmos, hyperreflexia, and pretibial edema. These findings are consistent with:
- A. Subacute thyroiditis.
- B. Autoimmune thyroiditis.
- C. Graves disease.
- D. Hashimoto's disease.
Correct Answer: C
Rationale: The clinical findings of thin hair, exophthalmos, hyperreflexia, and pretibial edema are classic features of Graves disease, an autoimmune disorder that results in hyperthyroidism. Exophthalmos (bulging eyes) and pretibial edema (swelling in the lower legs) are particularly associated with Graves disease due to the autoimmune stimulation of the thyroid gland, leading to increased thyroid hormone production. Subacute thyroiditis (Choice A) typically presents with neck pain and tenderness, while autoimmune thyroiditis (Choice B) is commonly known as Hashimoto's thyroiditis, which presents with hypothyroidism symptoms. Hashimoto's disease (Choice D) is characterized by goiter and hypothyroidism, which contrasts with the hyperthyroidism seen in this patient.