Nokea
Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?
- A. High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplant
- B. There is a strong interest in developing corticosteroid-free posttransplant protocols
- C. Better results are demonstrated in corticosteroid-free protocols for second-transplant recipients
- D. Evidence supports corticosteroid-free rejection protocols
Correct Answer: A
Rationale: The correct answer is A. High-dose initial steroids are tapered off over a period of 4 to 6 weeks posttransplant. This is because corticosteroids are used initially to prevent rejection and then gradually tapered to minimize side effects. Choice B is incorrect as it states a general interest but does not address the specific protocol for corticosteroid use. Choice C is incorrect as there is no evidence suggesting better results in corticosteroid-free protocols for second-transplant recipients. Choice D is incorrect as there is no strong evidence supporting corticosteroid-free rejection protocols in posttransplant patients.
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Mr. Nelson is a 65-year-old male who has been advised that he is a candidate for coronary artery bypass grafting. He has been doing some internet research and is asking about whether or not he should have a beating heart bypass. Regarding off-pump coronary bypass grafting, the AGACNP advises Mr. Nelson that
- A. There is a slightly higher risk of neurologic complications
- B. Long-term results suggest that the grafts do not stay open as long as those in traditional bypass grafting
- C. The incidence of off-pump bypass grafting has increased significantly in the last 10 years
- D. The off-pump procedure is considerably more expensive but is correlated with better long-term outcomes
Correct Answer: A
Rationale: The correct answer is A: There is a slightly higher risk of neurologic complications.
Rationale:
1. Off-pump bypass grafting involves performing surgery on a beating heart without the use of a heart-lung machine.
2. The lack of cardiopulmonary bypass during off-pump surgery can lead to reduced blood flow to the brain, increasing the risk of neurologic complications.
3. This is why the AGACNP advises Mr. Nelson about the slightly higher risk of neurologic complications associated with off-pump bypass.
4. Choice B is incorrect as long-term results actually suggest similar or better patency rates for grafts in off-pump surgery.
5. Choice C is incorrect as the statement about the incidence increasing significantly in the last 10 years is not relevant to the risks of off-pump surgery.
6. Choice D is incorrect as off-pump surgery is not considerably more expensive and the correlation with better long-term outcomes is debatable.
Which one of the following is an endogenous cause of puerperal sepsis?
- A. Chlamydia trachomatis
- B. Escherichia coli
- C. Clostridium tetani
- D. Pseudomonas aeruginosa
Correct Answer: B
Rationale: The correct answer is B: Escherichia coli. Puerperal sepsis is often caused by endogenous bacteria from the mother's own flora. E. coli is a common endogenous bacteria found in the gastrointestinal tract and can cause infection during childbirth. Chlamydia trachomatis is a sexually transmitted infection, not typically associated with puerperal sepsis. Clostridium tetani causes tetanus, not puerperal sepsis. Pseudomonas aeruginosa is an environmental pathogen, not typically an endogenous cause of puerperal sepsis.
The congenital abnormality of the respiratory tract, associated with abnormal apical position, is
- A. Laryngeal stridor
- B. Diaphragmatic hernia
- C. Choanal atresia
- D. Tracheo-bronchi fistula
Correct Answer: C
Rationale: The correct answer is C: Choanal atresia. The congenital abnormality of the respiratory tract with abnormal apical position is typically associated with choanal atresia, which is a blockage or narrowing of the back of the nasal passage. This condition can lead to respiratory distress in newborns due to difficulty breathing through the nose.
Explanation:
1. Laryngeal stridor (Choice A) is a high-pitched noise during breathing and is not typically associated with abnormal apical position.
2. Diaphragmatic hernia (Choice B) is a defect in the diaphragm that allows abdominal organs to move into the chest cavity, but it is not related to abnormal apical position.
3. Tracheo-bronchi fistula (Choice D) is an abnormal connection between the trachea and bronchi, which is not associated with abnormal apical position.
In summary, choanal atresia is the correct answer because it fits the description of
Presence of severe epigastric pain in preeclampsia is associated with hyperacidity.
- A. TRUE
- B. FALSE
- C. -
- D. -
Correct Answer: B
Rationale: The correct answer is B: FALSE. In preeclampsia, epigastric pain is typically associated with liver and/or HELLP syndrome, not hyperacidity. Hyperacidity is more commonly seen in conditions like gastritis or peptic ulcers. Therefore, severe epigastric pain in preeclampsia is not related to hyperacidity. Other choices are not applicable as they do not provide relevant information to the question.
Excessive bleeding from the genital tract after the first 24 hours, but within the puerperium period, is referred to as
- A. Primary postpartum haemorrhage
- B. Tertiary postpartum haemorrhage
- C. Secondary postpartum haemorrhage
- D. Incidental postpartum haemorrhage
Correct Answer: C
Rationale: The correct answer is C: Secondary postpartum haemorrhage. This term refers to excessive bleeding from the genital tract after the first 24 hours but within the puerperium period (6 weeks postpartum).
A: Primary postpartum haemorrhage occurs within the first 24 hours after delivery.
B: Tertiary postpartum haemorrhage occurs more than 6 weeks postpartum.
D: Incidental postpartum haemorrhage is not a recognized medical term for postpartum bleeding.