Medical Final Exam Questions and Answers, Exams of Nursing

Download Medical Final Exam Questions and Answers and more Exams Nursing in PDF only on Docsity! United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ A 55-year-old woman falls in the shower and hurts her right shoulder. She shows up in the emergency department with her arm held close to her body, but the forearm rotated outward as if she were going to shake hands. She is in pain and will not move the arm from that position. Her shoulder looks "square" in comparison with the rounded unhurt opposite side, and there is numbness in a small area of her shoulder over the deltoid muscle. Which of the following is the most likely diagnosis? A. Acromioclavicular separation B. Anterior dislocation of the shoulder United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ C. Fracture of the upper end of the humeral shaft D. Posterior dislocation of the shoulder E. Scapular fracture Explanation: joi nt. The correct answer is B. Anterior dislocation of the shoulder is the most common dislocation of that The position is classic, as is the lack of the rounded contour of the humeral head. The area of numbness represents injury to the axillary nerve, a common complication of anterior dislocation of the shoulder. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ of 22 mg/dL, with a direct (conjugated) bilirubin of 16 mg/dL. His transaminases are minimally elevated, whereas his alkaline phosphatase is about six times the upper limit of normal. A sonogram shows dilated intrahepatic ducts, dilated extrahepatic ducts, and a very distended, thin-walled gallbladder without stones. Which of the following is the most appropriate next step in diagnosis? A. CT scan of the upper abdomen B. Endoscopic retrograde cholangiopancreatography (ERCP) C. Exploratory laparotomy United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ D. Percutaneous transhepatic cholangiogram (PTC) E. Serologies to define the type of hepatitis Explanation: The correct answer is A. Obstructive jaundice is evident by the high alkaline phosphatase and the dilated biliary ducts. Malignancy is suggested by the dilated, thin-walled gallbladder without stones. If there is a cancer of the head of the pancreas, CT has a good chance of showing it in a noninvasive manner. Endoscopic retrograde cholangiopancreatography United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ (ERCP) (choice B) or percutaneous transhepatic cholangiogram (PTC) (choice D) would be the next step if the CT scan were negative. A smaller tumor at the ampulla, the common duct itself, or even the head of the pancreas, could escape detection by the CT and necessitate a more invasive test to show up. Either of these could be used, although ERCP is favored by most. Exploratory laparotomy (choice C) would be premature at this point. Serologies (choice E) would have been called for if he had very high transaminases, normal or near normal alkaline phosphatase, and an unremarkable United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ cm H2O. On the basis of these findings, which of the following is the most appropriate next step in management? A. Diuretics should be given B. Fluid administration should continue at the present rate C. The rate of fluid administration should be decreased D. The rate of fluid administration should be increased E. Treatment is needed for renal failure United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ Explanation: O nc e The correct answer is D. The calculations made by standard formulas are only an educated guess. fluid administration begins, we judge its adequacy by the information provided by urinary output and central venous pressure, aiming for an output of 1-2 mL/kg/hr, while not exceeding a venous pressure of 10 or 15. In this case, our calculations fell short of the mark, and the patient needs more fluids at a faster rate. Diuretics (choice A) are not the answer when all indicators show fluid need: his venous pressure is low, his United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ blood pressure and pulse rate are marginal, and he has very concentrated urine. He needs fluids! The present rate (choice B) may follow the "formula," but it is clearly inadequate. Decreasing the rate (choice C) is the very opposite of what is needed. And as for renal failure (choice E), it is indeed part of the differential diagnosis whenever urinary output is not as high as it should be. However, the vignette told you that his urine is highly concentrated and has well less than 20 mEq/L of sodium: evidence of superb kidneys trying to conserve fluid to the best of their ability. Don't blame them. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ B. Close the abdomen with heavy retention sutures C. Give diuretics and close the abdomen in the usual way D. Leave the abdomen and its contents open to the air E. Provide temporary bowel coverage with an absorbable mesh Explanation: The correct answer is E. This is a new entity known as the abdominal compartment syndrome, unknown in United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ the days when severely traumatized patients died prior to, or during, surgery. The life-saving massive fl ui d an d infusions produce severe edema in the surgical field. Forced closure would compromise ventilation venous return. A temporary plastic coverage, or a mesh, allows the bowel to be protected without undue pressure. Closing the skin only (choice A) can be life-saving when hypothermia develops during surgery. In this setting, however, the skin will not come together without undue tension. Forced closure (choice B) would compromise ventilation and produce acute renal failure due to United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ pressure on the inferior vena cava. Diuretics (choice C) cannot selectively remove the fluid from the swollen tissues. Leaving the bowel exposed to the air (choice D) is not an option. In the short term, the patient would suffer severe heat loss; later, the bowel would dry out and perforate. Ten days after undergoing liver transplantation, a patient's levels of gamma-glutamyl transferase (GGT), alkaline phosphatase, and bilirubin begin to rise. Which of the following is the most appropriate United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ The correct answer is B. In all other solid organ transplants, deterioration of function 10 days out would suggest an acute rejection episode, and appropriate biopsies would be done to confirm the diagnosis. In the case of the liver, however, antigenic reactions are less common, whereas technical problems with the biliary and vascular anastomosis are the most common cause of early functional deterioration. They are, therefore, the first anomalies to be sought. Preformed antibodies (choice A) are responsible for hyperacute rejection, which would be evident within minutes of establishing blood flow to the graft. have United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ C ho ice s C, D, and E are centered on liver biopsy, which would be done only after technical problems been ruled out. A pediatrician's office gets a phone call from a frantic mother. Her 7-year-old daughter was playing under the sink and accidentally spilled Liquid Plumber (a strong, corrosive alkaline drain cleaner) all over her arms and legs. The nurse on the phone can hear the girl screaming in the background. Which of the following are the most appropriate instructions to give the mother? A. Cover the burned areas with triple antibiotic United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ ointment until the girl can be seen at the office B. Get the girl into the shower right away and keep the water running over her for 30 minutes before bringing her to the emergency department C. Get the girl to the emergency department as soon as possible D. Wash the burned areas with diluted vinegar and bring the girl to the office E. Wrap the burned areas in sterile dressings before bringing the girl to the emergency department United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ would take him a considerable time to get the urinary stream going, and the stream lacked force and often ended in a dribble. Because of a cold, 2 days ago he began taking an antihistamine, taking a decongestant, and drinking plenty of fluids. Physical examination shows a palpable, smooth, round mass arising from the pubis and reaching about half way toward the umbilicus. The mass is dull to percussion, and pushing on it accentuates the feeling of needing to void. Rectal examination reveals a large, boggy, non-tender prostate gland without nodules. This a classic presentation for which of the following acute conditions? United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ A. Bacterial prostatitis B. Cystitis in a patient with bladder cancer C. Renal failure D. Urinary retention in a patient with benign prostatic hypertrophy E. Urinary retention in a patient with prostatic cancer Explanation: United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ h av e The correct answer is D. The history and rectal examination findings are classic for benign prostatic hypertrophy. The use of a decongestant has led to stimulation of alpha adrenergic receptors, which further closed the bladder neck. A big, palpable bladder has resulted. Bacterial prostatitis (choice A) would produce pain, fever, and a very tender prostate on rectal examination. Cystitis and bladder cancer (choice B) could be expected to produce irritative symptoms and hematuria, but not painless retention. Renal failure (choice C) produces oliguria, not United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ biopsies of the breast are read as highly undifferentiated infiltrating ductal carcinoma, and assay for estrogen and progesterone receptors are negative. Which of the following is the most appropriate next step in management? A. Local wound care, but no specific antineoplastic therapy B. Tamoxifen therapy C. Radiation and chemotherapy D. Palliative mastectomy United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ E. Radical mastectomy with extended lymph node dissection Explanation: it ca n The correct answer is C. Although this is an impressive, very advanced cancer with a poor prognosis, be expected to shrink significantly with local radiation plus systemic chemotherapy. It may do so to the point at which a palliative mastectomy becomes technically feasible, something that cannot be done at this time. Taking care of the wound, and accepting defeat from United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ the cancer (choice A), was the only available choice before chemotherapeutic agents and radiation therapy were developed. It would be entirely inappropriate at the present time. Tamoxifen (choice B) would be the weakest systemic weapon in this case. She is premenopausal and receptor negative. Tamoxifen alone would not shrink this tumor to any appreciable extent. Mastectomy, either simple (choice D) or radical (choice E), is not possible at this time. The description clearly depicts an inoperable tumor. We first need to make it operable. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ E. There is a near-terminal increase in intracranial pressure Explanation: The correct answer is E. The clinical picture is that of a brain tumor with increased intracranial pressure. However, the development of hypertension and bradycardia (Cushing's reflex) signifies that the brain has run out of compensatory mechanisms to minimize the intracranial pressure elevation generated by increased intracranial volume. When that point is reached, brain perfusion suffers and death is imminent. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ Choices A and B correctly identify the disease as a brain tumor, but assign an incorrect meaning to the hemodynamic changes. Tentorial herniation would lead to respiratory arrest. Pressure on the hypothalamus is not the reason for the Cushing's reflex. Choice C makes a wrong diagnosis. Chronic subdural hematomas are seen in very old or alcoholic patients, where they press on the cortex—but do not "rupture" and create a sudden catastrophe in that fashion. Aortic dissection (choice D) happens to hypertensive patients, but what they get is chest and back pain, not a long-standing neurologic picture as depicted here. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ An 81-year-old man with Alzheimer disease who lives in a nursing home undergoes surgery for a fractured femoral neck. On the 5th postoperative day, it is noted that his abdomen is grossly distended and tense, but not tender. He has occasional bowel sounds. The rectal vault is empty on digital examination, and there is no evidence of occult blood. X-ray films show a few distended loops of small bowel and a very distended colon. The cecum measures 9 cm in diameter, and the gas pattern of distention extends throughout the entire large bowel, United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ The correct answer is C. Ogilvie syndrome is a type of colonic dysfunction often seen in elderly patients who are not too active to begin with and are then further immobilized by extra-abdominal surgery. Colonoscopy rules out obstructing cancer (always a consideration in this age group) and allows the gas to be sucked out as the instrument advances. A long tube is then left in place. Fecal A 44-year-old man complains of vague right upper abdominal discomfort that he has had for about 1 month. He describes no other symptoms, and, except for United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ enucleation of one eye at age 21 "for a tumor," he has been in excellent health all his life. He exercises regularly and neither smokes nor drinks. The only findings on physical examination include the artificial eye and a tender, enlarged, and nodular liver. CT scan of the upper abdomen demonstrates multiple masses within the liver. Which of the following will most likely be found on biopsy of these masses? A. Metastatic malignant melanoma B. Metastatic prostatic cancer United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ C. Metastatic retinoblastoma D. Metastatic sarcoma E. Primary hepatocellular carcinoma Explanation: do ne : The correct answer is A. There are two malignant tumors of the eye for which enucleation would be retinoblastoma and melanoma. Only melanoma would have this weird timetable, in which 20-some years may elapse between primary tumor and metastatic manifestations. In fact, the patient with a glass eye and a liver United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ metastatic tumors. When it happens it is usually in a cirrhotic patient, not in an otherwise healthy person. A 45-year-old woman, who wears high-heeled, pointed shoes, complains of pain in the forefoot after prolonged standing or walking. Occasionally, she also experiences numbness, a burning sensation, and tingling in the area. Physical examination shows no obvious deformities and a very tender spot in the third interspace, between the third and fourth toes. There is no redness, limitation of motion, or signs of inflammation. Which of the following is the most likely diagnosis? United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ A. Gout B. Hallux rigidus C. Metatarsophalangeal articulation pain D. Morton's neuroma E. Plantar fasciitis Explanation: The correct answer is D. The location and circumstances are classic for Morton's neuroma, a benign neuroma of the third plantar interdigital nerve. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ Gout (choice A) happens to obese, elderly males, and redness and signs of inflammation in the affected joint are evident. a n d Hallux rigidus (choice B) is osteoarthritis of the first metatarsophalangeal joint. There is deformity limitation of motion. The joint is tender on physical examination. Metatarsophalangeal articulation pain (choice C) is likewise associated with misalignment of joint surfaces. There is pain when examining the joint, and there is no history of numbness, burning, or tingling. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ E. E n b l o c k radical parotidectomy sacrificing the facial nerve Explanation: The correct answer is D. Clinically this has to be assumed to be a parotid tumor, and statistically it is likely to be a pleomorphic adenoma ("mixed tumor"). Only a formal parotidectomy can provide complete removal with permanent cure and sparing of the facial nerve. Whether a superficial or total parotidectomy is done depends on the location of the tumor, superficial or deep to the nerve. This formal operation serves as the biopsy. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ Core biopsies (choice A) or incisional biopsy (choice B) risk damaging the facial nerve, make preservation of the nerve at subsequent parotidectomy more difficult because of scarring, and also may produce salivary fistula. Surgical enucleation (choice D) will be followed by recurrence, at which time the proper surgery will be far more difficult to do. En block radical surgery (choice E) is only done for cancer. It would not be the first step before such a diagnosis had been established. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ A 45-year-old man with alcoholic cirrhosis is bleeding from a duodenal ulcer. He has required 6 units of blood United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ E x pl a n at io n: The correct answer is E. The studies show extremely marginal liver function, which would be tipped overt liver failure by an anesthetic and an operation. He is not a surgical candidate. Choice A obviously misses the gravity of his situation. Vitamin K (choice B) works only when there is a functioning liver that can use it. In the absence of adequate liver function, it will not correct the prothrombin time. Albumin (choice C) can be given, but it will have a short life span and will not correct the liver dysfunction. The low albumin is not the main problem per se, it is a symptom of how bad his liver is. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ w it h The same is true of bilirubin (choice D). It is a symptom, not the problem. We can operate on patients much higher bilirubin if it is not due to intrinsic liver disease. A 62-year-old man complains of perineal discomfort and reports that there are streaks of fecal soiling in his underwear. Four months ago, he had a perirectal abscess drained surgically. Physical examination shows a perineal opening in the skin lateral to the anus, and a cord-like tract can be palpated going from the opening toward the inside of the anal canal. Brownish purulent discharge can be expressed from the tract. Which of the United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ following is the most likely diagnosis? United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ drainage is pus, not feces; and there is no connection with recent perirectal abscess. Thrombosed hemorrhoids (choice E) would produce excruciating pain, and appear as a small. red, angry, mass protruding out of the anus. If they drain spontaneously, blood and clot, not feces, come out. During a campaign appearance, a political candidate is shot point blank in the right chest with a .22 caliber revolver. The entrance wound is well above the nipple line, just under the third rib, at the level of the United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ anterior axillary line. His motorcade brings him to the emergency department, but he makes it a point to walk in, holding his right chest with a bloody hand and waving for the news media. A chest x-ray shows a hemothorax on the right, and the bullet is seen to be embedded in the right paraspinous muscles. A chest tube is placed in the right pleural cavity, and 650 mL blood is recovered. Over the ensuing 4 hours, he continues to drain between 250 and 350 mL blood per hour. Which of the following is the most appropriate next step in management? A. Continued observation and appropriate blood replacement United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ B. A second chest tube in a better position to drain the blood United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ not pressing on some vital structure. If it happens to be lying there, just waiting to be plucked, we would of course take it. Pneumonectomy (choice E) targets the wrong organ. Bleeding from the lung is usually self-limiting. Bleeding that requires surgery is usually from systemic vessels, most commonly the intercostals. A man who weighs 65 kg sustains second and third degree burns over both of his lower extremities when his pants catch on fire. When examined shortly thereafter, it is ascertained that virtually all of the skin United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ from both groins to the tip of the toes, front and back, has been burned. According to the modified Parkland formula, which of the following is the approximate total amount of IV fluid that he can be expected to require during the first 24 hours post-burn? A. 3460 mL B. 4960 mL C. 6760 mL United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ D. 8160 mL E. 11,360 mL Explanation: The correct answer is E. The modified Parkland formula calls for 4 mL of Ringer's lactate per kilogram of body weight, times the percentage of the body surface that has been burned; plus an additional 2000 mL of dextrose 5% in water to cover maintenance fluid needs. In the "rule of nines," each lower extremity represents 18% of the body surface. Thus, this patient has sustained a 36% body burn: 4 × 65 × 36 = 9360, plus United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ The correct answer is B. The mechanism of injury (hyperextension) and the relative sparing of the lower extremities in the presence of upper extremity deficits are classic for central cord syndrome. In anterior cord syndrome (choice A), all functions are lost, except for positional and vibratory sense. Those injuries occur with blowout of the vertebral bodies. Posterior cord syndrome (choice C) is quite rare, and it would show loss of positional and vibratory sense. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ Reflex sympathetic dystrophy (choice D) produces agonizing burning pain (thus, it is a good distracter for this vignette), but it typically follows crushing injuries of the affected extremity and does not affect motion. Hemisection of the spinal cord (choice E) produces loss of one set of functions on one side, and a different set of functions on the other side. In addition, it follows a clear-cut penetrating injury, rather than hyperextension of the neck. A 72-year-old man is scheduled to have elective sigmoid resection for diverticular disease. He has a history of heart disease, and had a documented myocardial United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ infarction 2 years ago. He currently does not have angina, but he lives a sedentary life because "he gets out of breath" if he exerts himself. During the physical examination, it is noted that he has jugular venous distention. He has a hemoglobin of 12 g/dL. If surgery is indeed needed, which of the following should most likely be done prior to the operation? A. Evaluate the patient as a candidate for coronary revascularization B. Place the patient on intensive respiratory therapy C. Order a transfusion to increase the patient's hemoglobin to 14 g/dL United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ this case, the infarction happened 2 years ago; thus, the waiting period has already taken place. A 29-year-old man presents with a 2-day history of severe left-sided scrotal pain and swelling. He is sexually active and has had "many" sexual partners. His temperature is 38.2 C (100.8 F), blood pressure is 120/70 mm Hg, and pulse is 80/min. Examination shows unilateral intrascrotal tenderness and swelling. Testicular support makes the pain less intense. Which of the following is the most likely diagnosis? United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ A. Epididymitis B. Prostatitis C. Testicular torsion D. Urethritis E. Varicocele Explanation: The correct answer is A. This patient has epididymitis, most likely due to Chlamydia trachomatis. Epididymitis refers to inflammation of the epididymitis, which leads to unilateral intrascrotal pain, United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ swelling, and fever. Testicular support usually relieves the pain to some extent. Asymptomatic urethritis can be associated with epididymitis due to C. trachomatis or Neisseria gonorrhoeae. Urinalysis may reveal pyuria. Urethral culture, urine polymerase chain reaction (PCR) or ligase chain reaction (LCR) can confirm the diagnosis. Treatment is with azithromycin, doxycycline or tetracycline. The sexual partner should be treated to av oi d ba ck United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ Varicoceles (choice E) are a collection of veins that feel like a "bag of worms". Surgery is indicated if there is infertility or pain. They are more common on the left side. impaction (choice A) is always a good thing to look for in old immobilized people with abdominal distention. However, the rectal vault would have been full of feces, and the x-ray films might have shown the fecal column extending up into the sigmoid and descending colon. Neither mechanical intestinal obstruction (choice B) nor paralytic ileus (choice D) would develop from hip surgery. When these complications occur after abdominal surgery, they affect primarily the small United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ bowel, not the colon. Volvulus of the sigmoid (choice E) is another good thought in the distended old patient, but the radiologic picture would have been different, with a huge distended sigmoid way up into the right upper quadrant and tapering toward the left lower quadrant with the classic image of a "parrot's beak." A 59-year-old black man has a rock-hard, discrete, 1.5- cm nodule that is felt in his prostate during a routine physical examination. He is completely asymptomatic, and his prostatic specific antigen (PSA) done 3 months United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ ago was normal for his age. His last rectal examination was performed a year earlier and was unremarkable. Which of the following will best establish the diagnosis? A. Clinical follow-up during the ensuing year B. Repeat determination of PSA United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ Let us not resect the prostate (choice E) before we have a diagnosis. Depending on the results of the complete workup, one might elect a different surgical approach or a different treatment (radiation, for instance). A 22-year-old gang member arrives in the emergency department with multiple gunshot wounds to the chest and abdomen. He has labored breathing and is cyanotic, diaphoretic, cold, and shivering. He is wide awake, and in a normal tone of voice he tells everyone that he is going to die. An initial survey reveals a blood pressure of 60/40 United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ mm Hg. His pulse is 150/min and barely perceptible. He is in obvious respiratory distress and has big distended veins in his neck and forehead. His trachea is deviated to the left, and the right side of his chest is hyperresonant to percussion, with no breath sounds. Which of the following is the most appropriate initial step in management? A. Emergency blood gases B. Immediate chest x-ray films C.Awake endotracheal intubation D. A 16-gauge needle inserted in the second right United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ intercostal space United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ tension pneumothorax. In fact, as the most pressing problems are resolved, we might uncover other reasons for his state of shock, such as internal bleeding. Right now, however, what is crying out for help is his right pleural space. A front-seat passenger in a car involved in a head-on collision relates that he hit the dashboard with his knees, however, he is specifically complaining of severe pain in his right hip, rather than knee pain. He lies in the stretcher in the emergency department with the right lower extremity shortened, adducted, and internally rotated. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ Which of the following is the most likely injury? A. Femoral neck fracture B. Fracture of the shaft of the femur C. Intertrochanteric fracture D. Posterior dislocation of the hip E. Posterior dislocation of the knee Explanation: United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ The correct answer is D. The mechanism of injury is classic. As the knee hits the dashboard in the sitting position, the femoral head is driven backward and out of the socket. The position of the injured extremity is also typical, with the internal rotation produced by the posteriorly dislocated femoral head. This injury is an orthopedic emergency because of the tenuous blood supply of the femoral head. Femoral neck (choice A) and intertrochanteric (choice C) fractures are seen in elderly patients who fall and "hurt their hip." They present with a shortened extremity that is externally rotated. A fractured shaft of the femur (choice B) would produce pain right there (not in the hip) and would United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ there is spontaneous resolution. E. Obtain a fine-needle aspirate and go no further if no malignant cells are found Explanation: th at x- ra y The correct answer is C. A breast lump in a 43-year- old needs to be biopsied, but before we undertake aggressive step we must ascertain the full extent of her potential disease. Fingers can feel big lumps; films are needed to identify smaller ones. Discussing cancer therapy (choice A) is premature if we have not yet diagnosed cancer. We no longer live in the era of biopsy in the operating room, frozen section diagnosis, and surgery under the same United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ anesthetic. The diagnosis should be established first, and then the options discussed. We need the mammogram to know what else may need to be biopsied, but not to tell us whether a biopsy is needed (choice B). We already have the indications for biopsy of the existing lesion, regardless of its appearance in a mammogram. Waiting for resolution (choice D) is okay for a woman with fibrocystic disease who gets lumps every month, but not for this woman who has never had breast disease before. Fine-needle aspiration (FNA) before a more United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+ invasive biopsy (choice E) is an acceptable choice, provided we understand that we will respond to a positive diagnosis established by cytology, but will not be dissuaded from getting a more complete sample if the FNA is negative. This option is unacceptable as worded. United States Sports Academy FINAL EXAM 0001 Questions and Answers Best Rated A+ guaranteed success Latest update 2023 GRADED A+