D444 Adult Health I - Set 3 - Part 1

Correct Answer: Bacterial concentration varies

Option c is correct because tuberculosis bacteria shedding varies daily, requiring multiple samples to increase detection probability and diagnostic accuracy.
Option a is incorrect because specimen collection timing is based on diagnostic accuracy needs not laboratory scheduling convenience or workflow preferences.
Option b is incorrect because medical necessity drives the three-sample protocol, not insurance coverage requirements or reimbursement policies for testing.
Option d is incorrect because multiple samples aim to detect variable bacterial presence rather than reducing contamination which proper technique addresses.

Correct Answer: Reddened sclera

Option b is correct because reddened sclera with severe pain indicates acute angle closure requiring immediate pressure reduction interventions.
Option a is incorrect because mild photophobia occurs in many eye conditions and doesn't specifically indicate the emergency nature of angle closure.
Option c is incorrect because occasional tearing is less specific than the intense scleral injection seen in acute angle-closure crisis.
Option d is incorrect because slight blurriness understates the severe vision changes and halos characteristic of acute angle-closure glaucoma emergency.

Correct Answer: Hypoxemia developing

Option b is correct because restlessness is the earliest neurological sign of hypoxemia before cyanosis or respiratory distress becomes apparent.
Option a is incorrect because antibiotic reactions typically manifest with rash, fever, or gastrointestinal symptoms rather than isolated restlessness specifically.
Option c is incorrect because pain usually causes grimacing, guarding, or verbal complaints before manifesting as restlessness in pneumonia patients.
Option d is incorrect because new-onset restlessness during pneumonia treatment suggests physiological complications rather than primary anxiety disorder development suddenly.

Correct Answer: Pearly borders present

Option b is correct because basal cell carcinoma characteristically presents with waxy nodules having pearly borders unlike squamous cell lesions.
Option a is incorrect because both cancers can grow at variable rates, making growth speed unreliable for differentiation between types.
Option c is incorrect because both basal and squamous cell carcinomas may bleed when traumatized, not distinguishing between the two.
Option d is incorrect because neither type typically causes pain unless advanced, making this unreliable for early differentiation purposes clinically.

Correct Answer: Peripheral tingling

Option b is correct because peripheral neuropathy with tingling and numbness results from B6 deficiency caused by isoniazid interference.
Option a is incorrect because vision changes suggest ethambutol toxicity rather than the B6 deficiency associated with isoniazid therapy specifically.
Option c is incorrect because hearing loss relates to aminoglycoside antibiotics not the vitamin B6 deficiency from isoniazid treatment given.
Option d is incorrect because joint pain suggests pyrazinamide-induced hyperuricemia rather than B6 deficiency from isoniazid therapy complications developing.

Correct Answer: Respiratory muscle fatigue

Option c is correct because paradoxical breathing indicates diaphragm exhaustion causing chest wall to move opposite normal breathing patterns.
Option a is incorrect because paradoxical breathing represents decompensation and muscle failure, not normal compensatory mechanisms working effectively in COPD.
Option b is incorrect because paradoxical breathing indicates severe respiratory compromise beyond mild exacerbation, requiring immediate intervention to prevent failure.
Option d is incorrect because paradoxical movement results from mechanical muscle failure not psychological anxiety responses in respiratory distress situations.

Correct Answer: Thirty minutes before meals

Option b is correct because taking pyridostigmine before meals ensures peak effect during swallowing and chewing when muscle strength needed.
Option a is incorrect because rigid six-hour scheduling doesn't align medication peaks with activities requiring maximum muscle strength for function.
Option c is incorrect because bedtime-only dosing leaves patients weak during daytime activities when muscle strength is most needed functionally.
Option d is incorrect because single morning doses provide insufficient coverage throughout the day for this short-acting cholinergic medication's effects.

Correct Answer: Hypokalemia occurs

Option b is correct because insulin drives potassium intracellularly along with glucose, potentially causing dangerous hypokalemia requiring replacement therapy.
Option a is incorrect because sodium levels typically normalize or decrease with rehydration during DKA treatment, not increase to hypernatremic levels.
Option c is incorrect because calcium levels aren't significantly affected by insulin therapy in DKA treatment requiring specific monitoring typically.
Option d is incorrect because phosphate typically decreases not increases during insulin treatment as it shifts intracellularly with glucose molecules.

Correct Answer: Abdominal rigidity develops

Option c is correct because rigid boardlike abdomen indicates peritoneal inflammation from bacterial infection requiring immediate antibiotic therapy urgently.
Option a is incorrect because worsening edema reflects fluid retention common in cirrhosis, not specifically indicating peritonitis infection has developed.
Option b is incorrect because jaundice fluctuates with liver function generally and doesn't specifically indicate bacterial peritonitis complication occurring acutely.
Option d is incorrect because spider angiomas are chronic skin changes from hormone imbalances, not acute signs of peritonitis infection.

Correct Answer: PCP prophylaxis

Option b is correct because Pneumocystis pneumonia prophylaxis starts when CD4 falls below two hundred, critical at three hundred trending downward.
Option a is incorrect because MAC prophylaxis typically begins when CD4 drops below fifty, not at the three hundred level described.
Option c is incorrect because CMV prophylaxis is reserved for much lower CD4 counts or evidence of active CMV disease developing.
Option d is incorrect because toxoplasmosis prophylaxis starts below one hundred CD4 cells in patients with positive toxoplasma antibodies present.

Correct Answer: Barrett's esophagus

Option b is correct because Barrett's esophagus involves precancerous cellular changes from chronic acid exposure requiring regular endoscopic surveillance monitoring.
Option a is incorrect because hiatal hernia causes reflux but doesn't undergo malignant transformation requiring cancer surveillance like Barrett's esophagus.
Option c is incorrect because esophageal strictures cause dysphagia but don't have the same cancer risk as Barrett's metaplastic changes.
Option d is incorrect because peptic ulcers rarely undergo malignant transformation compared to the established cancer risk of Barrett's esophagus.

Correct Answer: Antihistamine administration

Option b is correct because antihistamines like diphenhydramine reduce the histamine-mediated flushing and pruritus of Red Man Syndrome effectively.
Option a is incorrect because epinephrine is reserved for anaphylaxis; Red Man Syndrome is a histamine reaction not true allergic response.
Option c is incorrect because corticosteroids take hours to work and aren't first-line treatment for acute Red Man Syndrome symptoms.
Option d is incorrect because bronchodilators don't address the histamine-mediated vascular effects causing Red Man Syndrome symptoms requiring treatment immediately.

Correct Answer: Temperature elevation

Option b is correct because heat sensitivity in MS causes temporary worsening of symptoms due to slowed nerve conduction with temperature.
Option a is incorrect because humidity alone doesn't trigger MS symptoms; the associated heat is the primary environmental trigger affecting conduction.
Option c is incorrect because allergens don't specifically trigger MS exacerbations though they may cause unrelated respiratory symptoms in patients.
Option d is incorrect because sunlight exposure benefits MS patients through vitamin D production rather than triggering symptom exacerbations typically.

Correct Answer: Maintain adequate hydration

Option b is correct because lactulose causes diarrhea leading to dehydration and electrolyte imbalances requiring careful fluid replacement monitoring.
Option a is incorrect because protein is often restricted not increased in hepatic encephalopathy to reduce ammonia production from metabolism.
Option c is incorrect because while sodium restriction helps ascites, hydration is more critical when starting lactulose causing fluid losses.
Option d is incorrect because carbohydrate restriction isn't necessary for hepatic encephalopathy; maintaining hydration during lactulose therapy takes priority instead.

Correct Answer: Red zone

Option c is correct because frequent rescue inhaler use indicates poor control and red zone status requiring immediate medical evaluation.
Option a is incorrect because green zone represents good control with minimal rescue inhaler use, not eight times daily as described.
Option b is incorrect because yellow zone involves increased symptoms but not the excessive rescue use indicating emergency red zone status.
Option d is incorrect because "clear zone" isn't part of asthma action plan zones; only green, yellow, and red zones exist.

Correct Answer: Biologic agents

Option b is correct because biologics like infliximab specifically promote fistula healing by targeting inflammatory pathways in Crohn's disease effectively.
Option a is incorrect because aminosalicylates help mild inflammation but lack efficacy for fistula healing requiring stronger anti-inflammatory effects typically.
Option c is incorrect because antidiarrheals manage symptoms but don't heal fistulas which require anti-inflammatory therapy to close properly.
Option d is incorrect because proton pump inhibitors treat acid-related conditions not the intestinal fistulas characteristic of Crohn's disease complications.

Correct Answer: Dull percussion sounds

Option b is correct because both effusion and consolidation produce dullness, but effusion has distinct decreased breath sounds versus consolidation.
Option a is incorrect because hyperresonance indicates air trapping or pneumothorax, not fluid accumulation or consolidation in lung tissue examined.
Option c is incorrect because tympanic sounds occur over air-filled structures like stomach, not over lung pathology being assessed here.
Option d is incorrect because normal resonance indicates healthy lung tissue without the pathology of effusion or consolidation present currently.

Correct Answer: Decreased INR levels

Option b is correct because spinach contains high vitamin K which antagonizes warfarin effect, reducing INR below therapeutic range potentially.
Option a is incorrect because vitamin K in spinach opposes warfarin's anticoagulant effect, decreasing not increasing bleeding risk in patients.
Option c is incorrect because dietary vitamin K doesn't affect platelet count; it influences clotting factors affected by warfarin therapy specifically.
Option d is incorrect because vitamin K intake decreases warfarin effectiveness and INR, not elevates it above therapeutic range levels.

Correct Answer: Airway collapse

Option b is correct because pursed-lip breathing creates back-pressure keeping airways open during exhalation, preventing premature collapse and air trapping.
Option a is incorrect because pursed-lip breathing primarily affects exhalation mechanics rather than directly preventing oxygen desaturation during breathing cycles.
Option c is incorrect because airway pressure from pursed-lip breathing doesn't specifically mobilize mucus which requires coughing and hydration instead.
Option d is incorrect because pursed-lip breathing may actually increase work of breathing slightly rather than preventing diaphragm fatigue directly.

Correct Answer: Monitor vital signs

Option b is correct because rapid fluid shifts during paracentesis can cause hypotension and shock requiring immediate detection through monitoring.
Option a is incorrect because ambulation should wait until vital signs stabilize after the procedure to prevent falls from hypotension.
Option c is incorrect because meals can wait until hemodynamic stability is confirmed through vital sign monitoring post-procedure initially first.
Option d is incorrect because diuretics may worsen hypotension after large-volume paracentesis; vital sign stability must be established first always.