Nokea
You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate slightly. Both are noted to constrict briskly when the light is placed on the right eye. What is the most likely problem?
- A. Optic nerve damage on the right
- B. Optic nerve damage on the left
- C. Efferent nerve damage on the right
- D. Efferent nerve damage on the left
Correct Answer: C
Rationale: The correct answer is C: Efferent nerve damage on the right. When both pupils dilate but only the right pupil constricts briskly in response to light, it indicates a problem with the efferent pathway controlling the right eye's pupillary constriction. This suggests damage to the parasympathetic fibers of the oculomotor nerve (CN III) that innervate the pupillary sphincter muscle. Choices A and B (optic nerve damage) do not involve pupil constriction. Choice D (efferent nerve damage on the left) would not explain the brisk constriction in the right eye.
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You are obtaining an arterial blood gas in the radial artery on a retired cab driver who has been hospitalized in the intensive care unit for a stroke. You are concerned about the possibility of arterial insufficiency. You perform the Allen test. This means that you:
- A. Checked for patency of the radial artery
- B. Checked for patency of the brachial artery
- C. Checked for patency of the ulnar artery
- D. Checked for patency of the femoral artery
Correct Answer: C
Rationale: The Allen test assesses collateral circulation by checking for patency of the ulnar artery. This is important before obtaining an arterial blood gas from the radial artery to ensure adequate blood flow and prevent ischemia. If the ulnar artery is not patent, using the radial artery could lead to arterial insufficiency. Checking the radial artery's patency (Choice A) is not the purpose of the Allen test. Checking the patency of the brachial artery (Choice B) or the femoral artery (Choice D) is not relevant in this context. The correct answer is C because ensuring ulnar artery patency is crucial for arterial blood gas sampling from the radial artery.
You are performing a cardiac examination on a patient with shortness of breath and palpitations. You listen to the heart with the patient sitting upright, then have him change to a supine position, and finally have him turn onto his left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position?
- A. Aortic
- B. Pulmonic
- C. Mitral
- D. Tricuspid
Correct Answer: C
Rationale: The correct answer is C: Mitral valve defect. This is because the mitral valve is best heard in the left lateral decubitus position. In this position, the heart rotates, bringing the mitral valve closer to the chest wall, making it easier to auscultate any abnormalities such as murmurs. Aortic (A), pulmonic (B), and tricuspid (D) valve defects are not typically better heard in the left lateral decubitus position, so they are incorrect choices.
When applying the SAMPLE mnemonic, which of the following statements from the patient would be classified under the letter 'M' for medications?
- A. I have been taking aspirin for my headaches.
- B. I am allergic to penicillin.
- C. I recently had surgery on my knee.
- D. I take Metformin for my diabetes.
Correct Answer: D
Rationale: Step 1: The 'M' in the SAMPLE mnemonic stands for Medications, which focuses on the current and past medications the patient is taking.
Step 2: Choice D, "I take Metformin for my diabetes," directly provides information about a medication the patient is currently taking.
Step 3: This statement is relevant to the patient's medical history and helps in understanding their current health condition.
Summary: Choice D is correct as it specifically addresses the patient's medication (Metformin for diabetes), while the other choices provide information related to headaches (A), allergies (B), and surgical history (C), which do not fall under the 'M' category for medications.
Which of the following drugs is not contraindicated for concurrent use with warfarin (Coumadin)?
- A. Amoxicillin (Amoxil)
- B. Trimethoprim/sulfamethoxazole (Bactrim)
- C. Ciprofloxacin (Cipro)
- D. Clarithromycin (Biaxin)
Correct Answer: A
Rationale: Rationale for correct answer (A): Amoxicillin does not significantly interact with warfarin. It is an antibiotic that works through a different mechanism than warfarin and is not known to affect its anticoagulant activity.
Summary of incorrect choices:
B (Trimethoprim/sulfamethoxazole): This drug combination can enhance the effects of warfarin, increasing the risk of bleeding.
C (Ciprofloxacin): Ciprofloxacin can increase warfarin's effects, leading to a higher risk of bleeding.
D (Clarithromycin): Clarithromycin can interact with warfarin, potentially increasing the risk of bleeding.
When palpating the prostate gland during the rectal exam, the prostate feels tender, swollen, boggy, and warm. This finding is consistent with:
- A. A normal prostate gland
- B. Acute bacterial prostatitis
- C. Benign prostatic hyperplasia
- D. Carcinoma of the prostate
Correct Answer: B
Rationale: The correct answer is B: Acute bacterial prostatitis. This is because the symptoms of tenderness, swelling, bogginess, and warmth are indicative of an acute inflammatory process, which is commonly seen in acute bacterial prostatitis. This condition typically presents with localized prostate tenderness and inflammation due to a bacterial infection. Other choices are incorrect because: A) A normal prostate gland should not exhibit these signs of inflammation. C) Benign prostatic hyperplasia is typically asymptomatic or may present with obstructive urinary symptoms, not acute inflammatory signs. D) Carcinoma of the prostate usually does not present with acute inflammatory findings on palpation.