Nokea
Which of the following statements on NAFLD is false?
- A. Weight loss is the prime way of management
- B. Long-term management is needed
- C. Patients should be referred to specialists for further evaluation
- D. Metformin should be used as first-line treatment in patients with NAFLD and diabetes mellitus
Correct Answer: D
Rationale: Weight loss (5-10%) is prime for NAFLD, long-term care is essential, and specialist referral aids complex cases all true. Statins manage dyslipidemia safely in NAFLD. Metformin, though first-line for diabetes, isn't for NAFLD itself lacking evidence for steatosis reversal making this false. Physicians must clarify this in chronic care planning.
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Cortical stimulation:
- A. Occurs before resection of a tumour.
- B. Localizes areas involved with hearing.
- C. Occurs by indirect application of electrodes.
- D. Allows identification of Wernicke's area, which is involved in the comprehension of language.
Correct Answer: D
Rationale: Cortical stimulation in awake craniotomy maps eloquent brain areas before tumor resection to avoid functional loss. It's performed pre-resection to define safe boundaries, localizing motor, sensory, and language areas, including hearing-related regions in the temporal lobe. Electrodes are applied directly to the cortex, not indirectly, for precision. Wernicke's area, in the dominant temporal lobe, is critical for language comprehension, and stimulation identifies it by eliciting speech errors (e.g., paraphasia). Seizures can occur, managed with cold saline irrigation, not warm. The ability to pinpoint Wernicke's area is pivotal, as its preservation ensures postoperative language function, balancing oncologic goals with quality of life in eloquent cortex surgeries.
People with obesity generally respond more strongly to food cues than non-obese people. Question: Which behavioural training is most indicated to reduce this mechanism?
- A. Cognitive modulation training
- B. Compulsivity training
- C. Extinction training
- D. None of the options above
Correct Answer: C
Rationale: Food cues overdrive extinction dims them, not cognitive tweaks or compulsion drills. Nurses train this, a chronic cue fade.
A 65-year-old female presented to the emergency room with complaint of progressively worsening fatigue, shortness of breath, and palpitations. Upon assessment, heart rate is 130 beats per minute and irregular, and there is positive jugular vein distention. Heart tones reveal a high-pitched holosystolic murmur. Which of the following disorders are consistent with these findings?
- A. Mitral regurgitation
- B. Mitral stenosis
- C. Mitral valve prolapse
- D. Aortic regurgitation
Correct Answer: A
Rationale: Mitral regurgitation leaks blood back holosystolic murmur, irregular tachycardia, JVD, and dyspnea fit, as left heart flops, backing up into veins. Stenosis murmurs diastolic; prolapse clicks midsystolic; aortic regurgitation's early diastolic. Nurses tie this to MR's volume overload, anticipating echo, a match for this failing valve tale.
A 10-year-old boy is being prepared for a bone marrow transplant. The nurse can determine that the child understands this treatment when he says:
- A. I'll be much better after this blood goes to my bones.
- B. I won't feel too good until my body makes healthy cells.
- C. This will help all of the medicine they give me to work better.
- D. You won't have to wear a mask and gown after my transplant.
Correct Answer: B
Rationale: A bone marrow transplant (BMT) replaces diseased marrow (e.g., in leukemia) with healthy stem cells, but recovery is slow new, functional blood cells take weeks to months to regenerate, during which the child may feel unwell due to immunosuppression and engraftment challenges. The statement I won't feel too good until my body makes healthy cells' shows the boy grasps this delay, reflecting realistic understanding critical for coping and consent in pediatric care. Feeling better immediately after infusion is inaccurate initial post-BMT phases often worsen symptoms. Enhancing medicine efficacy isn't the goal; BMT is the therapy. Masks and gowns persist post-transplant due to infection risk until immunity recovers. The nurse's validation of this insight ensures the child is prepared, aligning with oncology's focus on patient education and emotional support during complex treatments.
Mr Tan, a 50-year-old with hypertension, sees you for routine review. He reports three gout flares in the past two months relieved with three days of Arcoxia 120 mg OM for each episode. You perform some blood tests, which returns the following results: Creatinine 95 umol/L, eGFR >90 mL/min, Uric acid 460 mmol/L, HbA1c 5.4%, Random hypo-count 7.5 mmol/L. He is currently on Amlodipine 10 mg OM. He does not drink alcohol except one glass of wine once or twice a year on special occasions. His BMI is 20.5 kg/m². Which is the most appropriate next step?
- A. Prescribe NSAIDs standby for gout flare
- B. Offer dietary advice and advise regular exercise only
- C. Prescribe prednisolone standby for gout flare
- D. Discuss urate lowering therapy as he has had >2 gout flares in the past year, ideally with colchicine prophylaxis
Correct Answer: D
Rationale: Three gout flares in two months with uric acid 460 mmol/L (hyperuricemia) indicate frequent attacks warranting urate-lowering therapy (ULT) like allopurinol, per guidelines (e.g., ACR), especially with >2 flares yearly. Colchicine prophylaxis reduces flare risk during ULT initiation. NSAIDs or prednisolone treat acute flares but don't address recurrence. Diet/exercise alone won't suffice with this frequency and uric acid level. ULT discussion aligns with chronic gout management to prevent joint damage, critical for family physicians.