Nokea
Three (3) types of breech presentation:
- A. Frank breech, complete breech, footling breech
- B. Head-down, bottom-down, transverse
- C. Breech, vertex, and compound
- D. Frank, compound, and transverse
Correct Answer: A
Rationale: The correct answer is A: Frank breech, complete breech, footling breech. In a frank breech presentation, the baby's buttocks are aimed at the birth canal with legs flexed at the hips and extended at the knees. In a complete breech presentation, the baby's buttocks are aimed at the birth canal with legs flexed at the hips and knees. In a footling breech presentation, one or both of the baby's feet are positioned to come out first. These are the three main types of breech presentations. Choices B, C, and D do not accurately describe the different types of breech presentations, making them incorrect.
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Causes of Down syndrome are
- A. Trisomy, deletion and non-disjunction
- B. Mosaicism, duplication and translocation
- C. Translocation, mosaicism and deletion
- D. Mosaicism, trisomy and translocation
Correct Answer: D
Rationale: The correct answer is D because Down syndrome is primarily caused by trisomy of chromosome 21. This means there is an extra copy of chromosome 21, leading to the characteristic features of the syndrome. Mosaicism and translocation of chromosome 21 can also result in Down syndrome, albeit less frequently. Option A includes deletion, which is not a common cause of Down syndrome. Option B lists duplication, which is not a typical mechanism for Down syndrome. Option C includes deletion and mosaicism, but trisomy is the main cause of Down syndrome, making option D the most accurate choice.
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.
Ms. OReilly is a 69-year-old patient who is having a bowel resection for a malignant tumor of the right colon. She has several chronic medical conditions and takes numerous daily medications, including metoprolol 100 mg daily, warfarin 5 mg daily, vitamin E 200 units daily, and metformin 1000 mg bid. Which of the following regimens is the most appropriate approach to managing her medications preoperatively?
- A. All medications should be taken up to and including the morning of surgery
- B. The beta blocker may be taken up until the day of surgery, metformin should be held the day of surgery, and the remaining medications should be d/c’d 5–7 days before surgery
- C. Warfarin should be held 5 days before surgery; all other medications may be taken through the morning of surgery
- D. Metformin should be held if the morning blood sugar is < 200 mg/dL; all other medications except warfarin may be given the day of surgery
Correct Answer: B
Rationale: The correct answer is B. It is important to manage medications appropriately preoperatively to minimize complications. Metoprolol, a beta blocker, should be continued up until the day of surgery to prevent rebound hypertension or tachycardia. Metformin should be held on the day of surgery to avoid potential lactic acidosis due to its effects on kidney function. Warfarin should be discontinued 5-7 days before surgery to reduce the risk of bleeding. Vitamin E can increase bleeding risk and should be discontinued. Choice A is incorrect as not all medications should be taken until the morning of surgery. Choice C is incorrect as warfarin should be held earlier than 5 days before surgery. Choice D is incorrect as metformin should be held on the day of surgery, regardless of blood sugar levels, to prevent lactic acidosis.
Cardiac disease grade 1 is also known as
- A. Organic disease
- B. Mitral stenosis
- C. Ventricular failure
- D. Vascular disease
Correct Answer: A
Rationale: Grade 1 cardiac disease refers to early-stage or mild heart conditions that are not yet severe. Choice A, "Organic disease," is the correct answer as it encompasses a broad category of structural heart abnormalities. Mitral stenosis (B) and ventricular failure (C) are specific conditions that can be present in cardiac disease but do not represent the general term for grade 1. Vascular disease (D) primarily refers to conditions affecting blood vessels, not the heart itself. In summary, choice A is correct because it is a comprehensive term that includes various structural heart abnormalities typically found in grade 1 cardiac disease, while the other choices are either too specific or unrelated to the concept of grade 1 cardiac disease.
S. R. is a 51-year-old male patient who is being evaluated for fatigue. Over the last few months he has noticed a marked decrease in activity tolerance. Physical examination reveals a variety of ecchymoses of unknown origin. The CBC is significant for a Hgb of 10.1 gdL, an MCV of 72 fL and a platelet count of 65,000L the remainder of the CBC is normal. Coagulation studies are normal, but bleeding time is prolonged. The AGACNP recognizes that initial management of this patient will include
- A. Avoidance of elective surgery and nonessential medications
- B. Prednisone 60 mg daily until platelets normal
- C. Monoclonal antibody therapy such as rituximab
- D. Splenectomy
Correct Answer: D
Rationale: The correct answer is D: Splenectomy. In this case, the patient presents with signs of immune thrombocytopenic purpura (ITP) with low platelet count and bleeding time prolongation. Splenectomy is the definitive treatment for ITP as the spleen is the site of platelet destruction. Avoiding elective surgery and medications (choice A) may be necessary to prevent bleeding complications but do not address the underlying issue. Prednisone (choice B) is used for acute treatment but not for long-term management. Monoclonal antibody therapy (choice C) is an option for refractory cases but not first-line therapy.