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Which is FALSE regarding PCP pneumonia in AIDS?
- A. it is usually only seen when the CD4 count <200
- B. prophylaxis should be given in all pts with CD4 count <200
- C. CXR characteristically shows bilateral diffuse infiltrates
- D. Once a patient has had it they are unlikely to get it again
Correct Answer: D
Rationale: PCP relapse haunts AIDS CD4 <200 stays vulnerable, not a one-off. Prophylaxis holds below 200, CXR's diffuse or blank 20%, all true. Nurses know this chronic lung leech bites again sans lifelong guard.
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People with poorly controlled type 2 diabetes often show increased fasting blood glucose levels. Question: What causes these increased fasting blood glucose levels?
- A. Disturbed glucose uptake in adipose tissue due to insulin resistance
- B. Disturbed hepatic glucose uptake due to insulin resistance
- C. Disturbed suppression of hepatic glucose production by insulin
- D. Disturbed hepatic glucose uptake due to reduced insulin levels in portal blood
Correct Answer: C
Rationale: Type 2's fasting high liver pumps glucose, insulin can't hush it, resistance rules. Fat uptake's small, liver uptake's not key production's the leak nurses target this, a chronic dawn gush.
It is the start of your second successive night shift on the labour ward. You have only managed to sleep for 4 h in the previous day. Your usual sleep requirement is 8 h per night. Appropriate statements regarding this situation include:
- A. Your total cumulative sleep deficit is 8 h.
- B. Your alertness will increase between 3 a.m. and 7 a.m. due to natural fluctuation in your circadian rhythm.
- C. Unintentional dural puncture during epidural insertion is more likely to occur during a night shift than during normal working hours.
- D. Sleeping for an extra 4 h will eliminate the sleep deficit.
Correct Answer: C
Rationale: Night shifts disrupt sleep and performance. After one night with 4 hours sleep (8-hour need), the deficit is 4 hours; a second night compounds it variably, but total' implies current state 8 hours overstates it without further context. Alertness dips 3-7 a.m. (circadian nadir), not increases, heightening fatigue. Night-shift studies (e.g., anaesthesia journals) show increased errors like dural puncture due to fatigue, reduced dexterity, and decision-making capacity, especially with sleep deprivation. Four extra hours reduce, not eliminate, a deficit if it's 4-12 hours cumulatively. Modafinil promotes wakefulness, not daytime sleep. The night-shift risk of dural puncture reflects fatigue's real-world impact on technical skills.
In Europe and the USA, drugs licensed for use in intrathecal drug delivery systems include:
- A. Diamorphine.
- B. Methadone.
- C. Morphine.
- D. Ziconotide.
Correct Answer: C
Rationale: Intrathecal drug delivery systems (IDDS) use specific licensed drugs in Europe and the USA. Morphine is widely approved for its efficacy in cancer and chronic pain, binding spinal opioid receptors with a strong evidence base. Ziconotide, a non-opioid, is also licensed, targeting calcium channels for refractory cases. Diamorphine (heroin) isn't licensed intrathecally; it's used epidurally or systemically in some regions (e.g., UK palliative care) but lacks IDDS approval. Methadone's long half-life and oral efficacy preclude intrathecal use; it's not licensed. Ketamine has experimental use but no formal approval. Morphine's prominence stems from its pharmacokinetic suitability high potency and spinal receptor affinity making it a cornerstone of IDDS therapy alongside ziconotide.
You are seeing Mr Yee two months later. At your last visit, he did not want colchicine prophylaxis as he did not want to take 'too many tablets'. He has started and is adherent to his urate lowering agent. Last month, his uric acid had decreased to 390 mmol/L. He had a gout flare last week. Hence, he came to your clinic today to ask about colchicine prophylaxis. Which is INCORRECT advice regarding colchicine prophylaxis?
- A. Offer to start colchicine at 500 mcg once daily or alternate days as gout prophylaxis as his renal function is normal
- B. Colchicine can help to reduce the frequency of flares, especially during the first six months of Urate lowering therapy
- C. Tell him that if he is started on NEW medications, he should inform his doctor or pharmacist that he is on colchicine regularly as colchicine can have drug interactions. If unsure and he needs to take NEW medications, such as a short course of antibiotics, he is to omit colchicine until the new medication is completed
- D. Regular colchicine prophylaxis in someone with normal renal function and regular monitoring can lead to renal failure
Correct Answer: D
Rationale: Colchicine curbs flares 500 mcg fits normal kidneys, cuts attacks in urate-lowering's rocky start, and needs drug interaction flags or skips with gut upset. But renal failure from regular use with monitoring? False colchicine's safe there, not a kidney killer. Clinicians nix this myth, grounding chronic gout aid in truth.
Which percentage of the burden of sickness in the Netherlands can approximately be avoided?
- A. 30%
- B. 40%
- C. 50%
- D. 60%
Correct Answer: B
Rationale: Dutch sickness 40% dodgeable, lifestyle tweaks cut chronic loads, not half or more. Nurses bank this, a prevention slice.