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A patient presents with a sensation of a foreign body stuck in the throat, difficulty swallowing, and odynophagia. Flexible laryngoscopy reveals a submucosal mass arising from the posterior pharyngeal wall. Which of the following conditions is most likely responsible for this presentation?
- A. Zenker's diverticulum
- B. Laryngopharyngeal reflux (LPR)
- C. Hypopharyngeal carcinoma
- D. Tonsillar hypertrophy
Correct Answer: A
Rationale: Zenker's diverticulum is a condition in which there is a pouch or sac that forms at the posterior pharyngeal wall above the upper esophageal sphincter. It can present with symptoms such as sensation of a foreign body stuck in the throat, difficulty swallowing (dysphagia), and odynophagia (painful swallowing). Flexible laryngoscopy can reveal a submucosal mass arising from the posterior pharyngeal wall, which is characteristic of Zenker's diverticulum.
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In terms of social support therapy, which of these is the MOST APRROPRIATE and therapeutic?
- A. With appropriate support, lives in the community, either independently or in supervised setting .
- B. Individualized relationship with a caregiver.
- C. High structured environment with constant aid and supervision.
- D. Vocational training with moderate supervision but not beyond second grade academic challenges.
Correct Answer: A
Rationale: In terms of social support therapy for a patient with Amyotrophic Lateral Sclerosis (ALS), the most appropriate and therapeutic option would be for the patient to live in the community with appropriate support, either independently or in a supervised setting. This approach allows the individual to maintain a sense of autonomy and independence while still having access to necessary support and care as needed. Living in the community promotes social interaction, engagement, and a sense of normalcy, which can contribute positively to the patient's mental well-being and overall quality of life. This approach also aligns with the principles of person-centered care, focusing on the individual's preferences, needs, and autonomy.
The BEST position for the patient to assume in case of shock is ______.
- A. modified Trendelenburg
- B. recumbent
- C. high Fowler's
- D. low Fowler's
Correct Answer: A
Rationale: The BEST position for a patient in shock is the modified Trendelenburg position. In this position, the patient's legs are elevated above the level of the heart to enhance blood flow back to the heart and vital organs. Placing the patient in the modified Trendelenburg position helps increase venous return, improves cardiac output, and promotes perfusion to vital organs, which can be crucial in managing shock. This position can help stabilize the patient's condition while awaiting further medical intervention.
A patient with a history of heart failure is prescribed a beta-blocker. Which assessment finding indicates a therapeutic effect of beta-blocker therapy?
- A. Decreased heart rate
- B. Increased blood pressure
- C. Elevated respiratory rate
- D. Worsening dyspnea Pharmacology
Correct Answer: A
Rationale: Beta-blockers are medications commonly used in the management of heart failure. One of the therapeutic effects of beta-blockers is to decrease the heart rate. By blocking the action of adrenaline on the heart, beta-blockers help to slow down the heart rate, reduce the workload on the heart, and improve overall heart function. In patients with heart failure, a decreased heart rate is a favorable outcome as it can help improve cardiac output and reduce symptoms of heart failure such as fatigue and shortness of breath. Monitoring the heart rate is an important assessment parameter to evaluate the effectiveness of beta-blocker therapy in patients with heart failure. Therefore, a decreased heart rate would indicate a therapeutic effect of beta-blocker therapy in this patient.
A patient presents with recurrent episodes of epistaxis, particularly after blowing the nose or during dry weather. Anterior rhinoscopy reveals a friable, vascular lesion in Little's area. Which of the following interventions is most appropriate for managing this condition?
- A. Nasal packing with anterior nasal tampons
- B. Application of silver nitrate cautery
- C. Endoscopic cauterization of the sphenopalatine artery
- D. Surgical excision of the nasal polyp
Correct Answer: B
Rationale: The clinical scenario described is consistent with a diagnosis of anterior epistaxis due to a prominent vascular lesion located in Little's area, which is an important site for nosebleeds. Silver nitrate cautery is the most appropriate intervention for managing this condition. Silver nitrate cautery is a commonly used method to chemically cauterize and eliminate the friable blood vessels responsible for recurrent epistaxis. It is a cost-effective and minimally invasive technique that can be easily performed in an outpatient setting. Nasal packing with anterior nasal tampons might be considered in cases of severe or refractory epistaxis, but in this scenario, where the source of bleeding is localized and identifiable, silver nitrate cautery is the treatment of choice. Endoscopic cauterization of the sphenopalatine artery and surgical excision of a nasal polyp are unnecessary and overly invasive for the described scenario.
A patient presents with sudden-onset, severe eye pain, headache, nausea, and vomiting. On examination, the affected eye appears red, with a steamy cornea and mid-dilated, non-reactive pupil. Which of the following conditions is most likely responsible for this presentation?
- A. Acute angle-closure glaucoma
- B. Central retinal artery occlusion
- C. Optic neuritis
- D. Corneal ulcer
Correct Answer: A
Rationale: The described presentation is classic for acute angle-closure glaucoma. This condition is characterized by sudden-onset severe eye pain, headache, nausea, and vomiting. The red eye, steamy cornea (corneal edema), and mid-dilated non-reactive pupil are consistent with acute angle-closure glaucoma. The sudden increase in intraocular pressure leads to impaired aqueous humor outflow, causing these symptoms. Immediate intervention is required to prevent permanent vision loss in such cases. Central retinal artery occlusion would present with sudden painless vision loss. Optic neuritis typically presents with vision loss and pain with eye movements. Corneal ulcer presents with eye discomfort, foreign body sensation, and may have a history of corneal trauma or contact lens wear.