Nokea
A patient with a severe viral infection exhibits reduced levels of circulating lymphocytes. Which of the following mechanisms is most likely responsible for this observation?
- A. Apoptosis of infected lymphocytes
- B. Clonal expansion of memory T cells
- C. T cell anergy
- D. Upregulation of adhesion molecules on lymphocytes
Correct Answer: A
Rationale: A patient with a severe viral infection exhibiting reduced levels of circulating lymphocytes is likely due to the apoptosis of infected lymphocytes. When a virus enters the body, it can infect and replicate within lymphocytes, subsequently triggering the immune system to induce apoptosis in infected cells to prevent further spread of the virus. This process is part of the body's defense mechanism to control the viral infection. As a result, the circulating lymphocyte levels may decrease as infected lymphocytes are targeted for apoptosis. This phenomenon helps to limit viral replication and spread within the body, thereby aiding in the immune response to eliminate the virus.
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A pregnant woman presents with a history of recurrent pregnancy losses in the second trimester. On examination, the cervix is dilated, and uterine contractions are absent. Which of the following conditions is the most likely cause of these symptoms?
- A. Ectopic pregnancy
- B. Threatened abortion
- C. Placenta previa
- D. Incompetent cervix
Correct Answer: D
Rationale: Incompetent cervix refers to a weakened cervix that is unable to support the weight of the growing fetus, leading to painless cervical dilation and second-trimester pregnancy loss. In this condition, the cervix may dilate prematurely without contractions, resulting in a painless cervical dilation. The history of recurrent second-trimester losses, along with cervical dilation and absence of uterine contractions in the presenting pregnant woman, are characteristic of incompetent cervix. Prompt recognition and management with cerclage placement can help prevent further pregnancy losses in women with incompetent cervix.
A patient presents with urinary frequency, urgency, dysuria, and suprapubic pain. Urinalysis reveals pyuria and bacteriuria. Which of the following conditions is most likely?
- A. Acute glomerulonephritis
- B. Chronic kidney disease
- C. Urinary tract infection (UTI)
- D. Renal calculi
Correct Answer: C
Rationale: The patient's presentation of urinary frequency, urgency, dysuria, and suprapubic pain along with the urinalysis findings of pyuria (pus in the urine) and bacteriuria (bacteria in the urine) are highly suggestive of a urinary tract infection (UTI). UTIs are one of the most common types of bacterial infections seen in clinical practice. The symptoms described are classic for a lower urinary tract infection. The presence of pyuria and bacteriuria on urinalysis further supports the diagnosis of a UTI. Acute glomerulonephritis typically presents with hematuria, proteinuria, hypertension, and edema. Chronic kidney disease is often asymptomatic in early stages and presents with symptoms like fatigue, edema, and changes in urination later on. Renal calculi are associated with severe colicky flank pain that can radiate to the groin, and they may present with
Which assessment findings is INDICATIVE of the diagnosis of hypertension?
- A. Family members with high blood pressure
- B. Elevation of blood cholesterol level
- C. Stressful work environment
- D. Consistent evaluation of blood pressure
Correct Answer: D
Rationale: The assessment finding that is indicative of the diagnosis of hypertension is consistent evaluation of blood pressure. Hypertension is diagnosed based on repeated measurements of elevated blood pressure. Consistently high blood pressure readings, usually defined as systolic blood pressure consistently at or above 140 mmHg and diastolic blood pressure consistently at or above 90 mmHg, are a key factor in diagnosing hypertension. Family history of high blood pressure (Choice A), elevation of blood cholesterol level (Choice B), and a stressful work environment (Choice C) may be risk factors for hypertension but are not diagnostic criteria. In order to diagnose hypertension, healthcare providers rely on consistent measurement and evaluation of blood pressure over time.
A patient with acute respiratory distress syndrome (ARDS) develops refractory hypoxemia despite maximal ventilatory support and prone positioning. Which of the following adjunctive therapies is most likely to improve oxygenation and reduce mortality in this patient?
- A. High-frequency oscillatory ventilation (HFOV)
- B. Continuous renal replacement therapy (CRRT)
- C. Extracorporeal membrane oxygenation (ECMO)
- D. Inhaled nitric oxide (iNO)
Correct Answer: C
Rationale: In a patient with ARDS who is experiencing refractory hypoxemia despite maximal ventilatory support and prone positioning, the use of extracorporeal membrane oxygenation (ECMO) is a potentially life-saving adjunctive therapy. ECMO works by providing temporary support for gas exchange outside the body, allowing the lungs to rest and heal while providing adequate oxygenation and carbon dioxide removal. The use of ECMO has been associated with improved oxygenation and reduced mortality in severe cases of ARDS, especially in patients who fail conventional therapies. High-frequency oscillatory ventilation (HFOV) has not consistently shown mortality benefit in ARDS, continuous renal replacement therapy (CRRT) is not directly indicated for hypoxemia in ARDS, and inhaled nitric oxide (iNO) has shown limited benefit in improving oxygenation in ARDS without a clear impact on mortality.
Which of the following signs is indicative of shock in a trauma patient?
- A. Increased heart rate
- B. Hypertension
- C. Rapid capillary refill
- D. Hyperthermia
Correct Answer: C
Rationale: Rapid capillary refill is a sign indicative of shock in a trauma patient. Shock is a life-threatening condition where the body's organs and tissues do not receive adequate blood flow and oxygen, leading to cellular damage and eventual organ failure. In a trauma patient, rapid capillary refill suggests poor perfusion, which is a common feature of shock. The capillary refill time is an important clinical assessment that measures the time it takes for color to return to the nail bed after pressure is applied. In cases of shock, the refill time is faster than normal, indicating a systemic circulatory disturbance. Other signs of shock may include tachycardia (increased heart rate), hypotension (not hypertension), and hypothermia (not hyperthermia).