Nokea
Which of the following fungicidal drug that acts by inhibiting fungal squalene epoxidase enzyme and is the drug of choice for onychomycosis of the toe nails in 56 year old woman with diabetes?
- A. Griseofulvin
- B. Terbinafine
- C. Itraconazole
- D. Amphotericin B
Correct Answer: B
Rationale: Step 1: Terbinafine is a fungicidal drug that inhibits fungal squalene epoxidase enzyme, disrupting fungal cell membrane synthesis.
Step 2: Onychomycosis of toenails is a common fungal infection that terbinafine is specifically effective against.
Step 3: The patient being a 56-year-old woman with diabetes may require a drug with good efficacy and safety profile, making terbinafine an appropriate choice.
Step 4: Griseofulvin (A) works by disrupting microtubule function, not inhibiting squalene epoxidase. Itraconazole (C) is an azole antifungal that inhibits ergosterol synthesis, not squalene epoxidase. Amphotericin B (D) is a polyene antifungal used for systemic mycoses, not onychomycosis.
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A patient calls the clinic for instructions before having a Papanicolaou (Pap) smear. The most appropriate instructions from the nurse are:
- A. If you are menstruating, please use pads to avoid placing anything into the vagina.
- B. Avoid intercourse, inserting anything into the vagina, or douching within 24 hours of your appointment.
- C. If you suspect that you have a vaginal infection, please gather a sample of the discharge to bring with you.
- D. We would like you to use a mild saline douche before your examination. You may pick this up in our office.
Correct Answer: B
Rationale: The correct answer is B because avoiding intercourse, inserting anything into the vagina, or douching within 24 hours of the appointment helps ensure an accurate Pap smear result. Intercourse, vaginal products, and douching can introduce foreign substances or disrupt the natural vaginal flora, potentially affecting the test results. Option A is incorrect because using pads during menstruation is a general recommendation and not specific to a Pap smear appointment. Option C is incorrect because bringing a sample of discharge is not necessary for a Pap smear. Option D is incorrect because douching is not recommended before a Pap smear as it can alter the vaginal environment.
The nurse is inspecting the scrotum and testes of a 43-year-old man. Which finding would require additional follow-up and evaluation?
- A. Skin on the scrotum is taut.
- B. Left testicle hangs lower than the right testicl
- D. Scrotal skin has yellowish 1-cm nodules that are firm and nontender.
Correct Answer: D
Rationale: The correct answer is D because the presence of yellowish 1-cm nodules that are firm and nontender on the scrotal skin could indicate a serious issue such as testicular cancer or a benign condition like sebaceous cysts. Further evaluation is necessary to rule out malignancy or infection.
A: Skin on the scrotum being taut is a normal finding.
B: Left testicle hanging lower than the right is a common anatomical variation, not a cause for concern.
C: The absence of information makes it impossible to determine if this finding requires follow-up.
The nurse is performing a genitourinary assessment on a 50-year-old obese male laborer. On examination, the nurse notices a painless round swelling close to the pubis in the area of the internal inguinal ring that is easily reduced when the individual is supine. These findings are most consistent with a(n) ______ hernia.
- A. Scrotal.
- B. Femoral.
- C. Direct inguinal.
- D. Indirect inguinal.
Correct Answer: C
Rationale: The correct answer is C: Direct inguinal hernia. In this scenario, the key clues are the painless round swelling close to the pubis, easily reduced when supine, and in the area of the internal inguinal ring. Direct inguinal hernias occur due to weakness in the abdominal wall muscles, often seen in older males with increased intra-abdominal pressure. The hernia protrudes directly through the abdominal wall, typically in the area of the internal inguinal ring. Scrotal hernias (Choice A) present in the scrotum, not close to the pubis. Femoral hernias (Choice B) occur below the inguinal ligament and are more common in females. Indirect inguinal hernias (Choice D) pass through the internal inguinal ring and are more common in young males.
Thiazide diuretics may produce an increase in blood levels of uric acid and:
- A. Potassium
- B. BUN
- C. Urea
- D. Glucose
Correct Answer: D
Rationale: Thiazide diuretics can lead to hyperglycemia by reducing insulin sensitivity. This can result in increased blood glucose levels. Thiazides also elevate uric acid levels by reducing its excretion. Therefore, the correct answer is D (Glucose).
Incorrect choices:
A (Potassium) - Thiazides typically cause hypokalemia, not hyperkalemia.
B (BUN) and C (Urea) - Thiazides may cause a slight increase in BUN and serum creatinine levels due to reduced kidney function, but not as significantly as glucose levels.
A 23 year old pregnant woman has UTI and presents to the ER with fever, frequency and urgency. Which of the following antibiotics can cause potential harm to her fetus?
- A. Nitrofurantoin
- B. Amoxicillin
- C. Gentamycin
- D. Cephalexin
Correct Answer: C
Rationale: The correct answer is C: Gentamycin. Gentamycin is known to have potential harmful effects on the fetus, such as causing hearing loss and kidney damage. This is due to its ability to cross the placental barrier. Amoxicillin (B) and Cephalexin (D) are both considered safe for use in pregnancy and are commonly prescribed for UTIs. Nitrofurantoin (A) is typically avoided in the third trimester due to the risk of hemolytic anemia in the newborn, but it is considered safe earlier in pregnancy. Therefore, Gentamycin is the correct choice as it poses a higher risk to the fetus compared to the other antibiotics.