Nokea
While participating in sports, it is not uncommon for people to be subjected to sudden rotational injuries that result in the abrupt rotation of the cerebral cortex around the more fixed midbrain structures. This can interrupt input and outflow from the reticular activating system and result in what clinical phenomenon?
- A. Epidural hematoma
- B. Uncal herniation
- C. Concussion
- D. Contrecoup injury
Correct Answer: A
Rationale: The correct answer is A: Epidural hematoma.
1. Sudden rotational injuries can cause tearing of the middle meningeal artery, leading to an epidural hematoma.
2. The hematoma can compress the brain, disrupting the reticular activating system, causing altered consciousness.
3. Uncal herniation (B) involves herniation of the uncus, not rotation-related.
4. Concussion (C) is a mild traumatic brain injury, not directly related to rotational injuries.
5. Contrecoup injury (D) is when the brain impacts the opposite side of the skull due to sudden deceleration, not rotation-induced.
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Signs of obstructed labor per vaginally include
- A. Dry vagina, Oedema of the cervix, Caput succedaneum
- B. Plenty amniotic fluid, Hot/dry vagina, meconium stained liquor
- C. Meconium stained liquor, Hot/dry vagina, Diluted urine
- D. Caput succedaneum, Oedema of the cervix, plenty amniotic fluid
Correct Answer: A
Rationale: The correct answer is A because signs of obstructed labor include a dry vagina due to prolonged pressure, oedema of the cervix due to prolonged contractions, and caput succedaneum which is swelling of the baby's scalp from prolonged pressure.
Choice B is incorrect because plenty of amniotic fluid is not a sign of obstructed labor. A hot/dry vagina is not a typical sign of obstructed labor. Meconium-stained liquor can be a sign of fetal distress, but not specifically obstructed labor.
Choice C is incorrect because meconium-stained liquor is a sign of fetal distress, not necessarily obstructed labor. A hot/dry vagina is not a typical sign of obstructed labor. Diluted urine is not a typical sign of obstructed labor.
Choice D is incorrect because while caput succedaneum is a sign of obstructed labor, oedema of the cervix is more indicative of obstructed labor than plenty of amni
The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal
- A. Increased MCV
- B. Increased Hgb
- C. Increased platelets
- D. Increased albumin
Correct Answer: A
Rationale: The correct answer is A: Increased MCV. Following splenectomy, there is a compensatory increase in red blood cell production, leading to an increase in Mean Corpuscular Volume (MCV) due to the release of larger, younger red blood cells into circulation. This is known as stress erythropoiesis.
Summary:
B: Increased Hgb - Hgb levels may not necessarily increase post-splenectomy as it depends on factors such as bleeding or hydration status.
C: Increased platelets - Platelet count is not expected to increase immediately post-splenectomy.
D: Increased albumin - Albumin levels are not directly influenced by splenectomy for idiopathic thrombocytopenia purpura.
Which one of the following features is indicative of an abnormal labour pattern?
- A. Presence of the retraction ring
- B. Presence of the Bandl’s ring
- C. Cervical canal short and thin
- D. Vagina is warm and moist
Correct Answer: B
Rationale: The correct answer is B: Presence of the Bandl's ring. This is indicative of an abnormal labor pattern as it may suggest a uterine rupture, which is a serious complication. Bandl's ring is a constriction ring formed between the upper and lower uterine segments due to excessive uterine contractions. It can lead to fetal distress and necessitate immediate medical intervention.
A: Presence of the retraction ring is a normal phenomenon during labor, marking the boundary between the lower and upper uterine segments.
C: Cervical canal short and thin can be a normal variation in labor and does not necessarily indicate an abnormal pattern.
D: Vagina being warm and moist is a common physiological response during labor and does not provide information on the progress or abnormality of labor.
S. R. is a 51-year-old male patient who is being evaluated for fatigue. Over the last few months he has noticed a marked decrease in activity tolerance. Physical examination reveals a variety of ecchymoses of unknown origin. The CBC is significant for a Hgb of 10.1 gdL, an MCV of 72 fL and a platelet count of 65,000L the remainder of the CBC is normal. Coagulation studies are normal, but bleeding time is prolonged. The AGACNP recognizes that initial management of this patient will include
- A. Avoidance of elective surgery and nonessential medications
- B. Prednisone 60 mg daily until platelets normal
- C. Monoclonal antibody therapy such as rituximab
- D. Splenectomy
Correct Answer: D
Rationale: The correct answer is D: Splenectomy. In this case, the patient presents with signs of immune thrombocytopenic purpura (ITP) with low platelet count and bleeding time prolongation. Splenectomy is the definitive treatment for ITP as the spleen is the site of platelet destruction. Avoiding elective surgery and medications (choice A) may be necessary to prevent bleeding complications but do not address the underlying issue. Prednisone (choice B) is used for acute treatment but not for long-term management. Monoclonal antibody therapy (choice C) is an option for refractory cases but not first-line therapy.
A non-pharmacological measure of pain relief in labour includes
- A. Entonox
- B. Cyclothane
- C. Diamorphine
- D. Homeopathy
Correct Answer: C
Rationale: The correct answer is C: Diamorphine. Diamorphine is a non-pharmacological measure of pain relief in labor. It is a type of opioid analgesic that helps to reduce pain during labor. It works by binding to opioid receptors in the brain and spinal cord, altering the perception of pain.
Rationale:
1. Diamorphine is a medication that directly targets pain relief.
2. It is a commonly used non-pharmacological measure in labor settings.
3. Diamorphine does not involve the use of any gases or inhalants like Entonox (A) or Cyclothane (B).
4. Homeopathy (D) is based on the principle of treating "like with like" using highly diluted substances and is not typically used for pain relief in labor.
Summary:
A: Entonox and B: Cyclothane are incorrect because they are pharmacological measures involving the use of gases or inhalants. D: Homeopathy is