Nokea
Which of the following diuretics is the most potent and cause hypotension * due to hypovolemia from excessive diuresis?
- A. Acetazolamide
- B. Furosemide
- C. Spironolactone
- D. Hydrocholorpthiazide
Correct Answer: B
Rationale: Step 1: Furosemide is a loop diuretic, known for its high potency in inhibiting the reabsorption of sodium and chloride in the loop of Henle.
Step 2: This leads to significant diuresis, causing hypovolemia and subsequent hypotension.
Step 3: Acetazolamide is a carbonic anhydrase inhibitor diuretic, not as potent as loop diuretics.
Step 4: Spironolactone is a potassium-sparing diuretic, less likely to cause hypotension due to its mechanism of action.
Step 5: Hydrochlorothiazide is a thiazide diuretic, less potent than loop diuretics like furosemide in causing hypovolemia and hypotension.
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Red man syndrome has been associated with rapid intravenous injection of which of the following antibiotic?
- A. Vancomycin
- B. Clindamycin
- C. Cefoperazone
- D. Piperacillin
Correct Answer: A
Rationale: The correct answer is A: Vancomycin. Red man syndrome is a type of hypersensitivity reaction associated with rapid intravenous infusion of vancomycin. This is due to the release of histamine from mast cells and basophils. Vancomycin is known to cause this syndrome, while the other antibiotics listed do not have a similar association. Clindamycin is more commonly associated with pseudomembranous colitis, Cefoperazone with liver toxicity, and Piperacillin with hypersensitivity reactions like rash or anaphylaxis. Therefore, based on the mechanism of action and clinical evidence, vancomycin is the correct choice for causing red man syndrome.
The first physical sign associated with puberty in boys is:
- A. Height spurt
- B. Penis lengthening
- C. Sperm production
- D. Pubic hair development
Correct Answer: E
Rationale: I'm sorry, but it seems there might be a mistake in the question as there is no option E provided. However, I can provide a rationale for each option based on the typical sequence of physical changes during puberty in boys. The first physical sign associated with puberty in boys is usually pubic hair development (D), followed by penis lengthening (B), height spurt (A), and lastly sperm production (C). Pubic hair development is often the initial visible sign of puberty due to hormonal changes. Height spurt and penis lengthening occur later in puberty, while sperm production typically begins towards the end of puberty.
The commonest type of ureteric calculus is
- A. calcium oxalate
- B. triple phosphate
- C. urate
- D. cysteine
Correct Answer: A
Rationale: The correct answer is A: calcium oxalate. This is because calcium oxalate stones are the most common type of ureteric calculus, accounting for around 75% of cases. They form due to an excess of calcium and oxalate in the urine. Triple phosphate stones (choice B) are more commonly found in the bladder and are associated with urinary tract infections. Urate stones (choice C) are less common and typically seen in patients with gout or acidic urine. Cysteine stones (choice D) are rare and usually seen in patients with a genetic disorder affecting cysteine metabolism.
Where are the glomeruli and Bowman’s capsules found?
- A. Renal pelvis
- B. Ureter
- C. Renal cortex
- D. Renal column
Correct Answer: C
Rationale: The glomeruli and Bowman's capsules are found in the renal cortex. The renal cortex is the outer layer of the kidney where the initial stages of urine formation occur. Glomeruli are clusters of capillaries responsible for filtering blood, while Bowman's capsules surround the glomeruli and collect the filtrate. The renal pelvis (A) is the innermost part of the kidney where urine collects before entering the ureter (B). Renal columns (D) are extensions of the renal cortex that project into the renal medulla. Therefore, the correct answer is C as it accurately locates the structures involved in urine filtration.
A patient with suprapubic pain and symptoms of urinary frequency and urgency has two negative urine cultures. What is one assessment finding that would indicate interstitial cystitis?
- A. Residual urine greater than 200 mL
- B. A large, atonic bladder on urodynamic testing
- C. A voiding pattern that indicates psychogenic urinary retention
- D. Pain with bladder filling that is transiently relieved by urination
Correct Answer: D
Rationale: The correct answer is D. Pain with bladder filling that is transiently relieved by urination is a classic symptom of interstitial cystitis. This pattern of pain is due to inflammation of the bladder lining, which worsens as the bladder fills with urine and improves temporarily after urination. This finding is specific to interstitial cystitis and not typically seen in other conditions.
Choices A, B, and C are incorrect:
A: Residual urine greater than 200 mL is more indicative of bladder outlet obstruction or neurogenic bladder dysfunction, not specifically interstitial cystitis.
B: A large, atonic bladder on urodynamic testing is suggestive of neurogenic bladder or bladder outlet obstruction, not interstitial cystitis.
C: A voiding pattern indicating psychogenic urinary retention is more likely related to psychological factors affecting bladder function, not interstitial cystitis.