D444 Adult Health I - Set 5 - Part 1

Correct Answer: Retinal detachment

Option b is correct because curtain-like shadow with vision loss indicates retinal detachment, an emergency requiring immediate surgical repair to preserve sight.
Option a is incorrect because lens displacement causes blurred vision or double vision rather than the curtain-like shadow pattern described specifically here.
Option c is incorrect because infection presents with pain, redness, and discharge rather than the specific curtain shadow of retinal detachment.
Option d is incorrect because increased pressure causes pain and halos around lights, not the curtain-like visual field defect described characteristically.

Correct Answer: Tension pneumothorax

Option a is correct because subcutaneous emphysema results from air escaping collapsed lung into tissues, indicating pneumothorax requiring immediate decompression urgently.
Option b is incorrect because cardiac tamponade causes muffled heart sounds and hypotension, not air tracking into subcutaneous tissues creating crepitus present.
Option c is incorrect because pulmonary embolism causes chest pain and hypoxemia but doesn't create subcutaneous air from lung rupture occurring typically.
Option d is incorrect because pleural effusion involves fluid accumulation not air escape into tissues creating the subcutaneous emphysema finding described.

Correct Answer: Small airway collapse

Option b is correct because pursed-lip breathing maintains positive pressure preventing premature small airway collapse and air trapping during exhalation.
Option a is incorrect because pursed-lip breathing doesn't mobilize mucus; coughing and hydration are needed for secretion clearance in COPD.
Option c is incorrect because while improving ventilation helps oxygenation, the specific mechanism prevents airway collapse not oxygen desaturation directly addressed.
Option d is incorrect because pursed-lip breathing actually helps eliminate CO2 by preventing air trapping, not preventing CO2 retention specifically.

Correct Answer: Scaling between toes

Option b is correct because tinea pedis characteristically causes scaling and maceration between toes unlike the spreading erythema of cellulitis typically.
Option a is incorrect because fever suggests bacterial cellulitis with systemic response rather than the localized fungal infection of tinea pedis.
Option c is incorrect because lymphadenopathy indicates bacterial spread in cellulitis rather than superficial fungal infection of athlete's foot typically present.
Option d is incorrect because rapid progression suggests bacterial cellulitis spreading through tissues rather than slow-growing fungal infection of tinea pedis.

Correct Answer: Color vision changes

Option b is correct because ethambutol causes optic neuritis affecting color vision, requiring immediate discontinuation to prevent permanent blindness potentially occurring.
Option a is incorrect because orange body fluids occur with rifampin not ethambutol, and represent harmless discoloration not requiring intervention typically.
Option c is incorrect because peripheral neuropathy occurs with isoniazid requiring B6 supplementation, not the ocular toxicity of ethambutol specifically monitored.
Option d is incorrect because while TB drugs cause hepatotoxicity, ethambutol's specific concern is optic neuritis requiring vision monitoring primarily conducted regularly.

Correct Answer: Ammonia

Option b is correct because elevated ammonia from liver failure causes hepatic encephalopathy with asterixis, requiring lactulose therapy to reduce levels.
Option a is incorrect because bilirubin elevation causes jaundice and pruritus but not the neurological sign of asterixis seen in encephalopathy.
Option c is incorrect because urea elevation indicates kidney dysfunction rather than the hepatic encephalopathy causing asterixis tremor in liver failure.
Option d is incorrect because creatinine reflects kidney function not the ammonia accumulation causing neurological symptoms in hepatic encephalopathy specifically present.

Correct Answer: Toxic megacolon

Option b is correct because severe distention with systemic toxicity indicates toxic megacolon, requiring immediate intervention to prevent perforation and death.
Option a is incorrect because perforation causes rigid abdomen with rebound tenderness rather than the massive distention of toxic megacolon initially presenting.
Option c is incorrect because simple obstruction doesn't cause the high fever and toxicity accompanying toxic megacolon's severe inflammation and dilation present.
Option d is incorrect because abscess causes localized pain and mass rather than the diffuse massive distention of toxic megacolon emergency.

Correct Answer: Muscle fatigue accumulation

Option b is correct because repetitive muscle use throughout the day depletes acetylcholine receptors causing progressive weakness by evening typically experienced.
Option a is incorrect because medication timing can be adjusted; the fundamental issue is cumulative fatigue from neuromuscular junction depletion occurring progressively.
Option c is incorrect because while heat worsens symptoms, evening weakness specifically results from accumulated fatigue rather than temperature variation alone typically.
Option d is incorrect because stress may trigger crisis but doesn't explain the predictable diurnal pattern of progressive weakness throughout the day.

Correct Answer: Hemorrhagic pancreatitis

Option b is correct because Cullen's sign indicates retroperitoneal bleeding from hemorrhagic pancreatitis tracking to periumbilical area causing discoloration visible externally.
Option a is incorrect because infection causes fever and elevated white cells rather than the specific periumbilical ecchymosis of Cullen's sign present.
Option c is incorrect because pseudocysts cause palpable mass and persistent pain, not the periumbilical discoloration indicating internal bleeding has occurred.
Option d is incorrect because biliary obstruction causes jaundice and clay stools rather than the hemorrhagic sign of periumbilical ecchymosis described.

Correct Answer: Low-residue diet

Option b is correct because low-residue diet reduces bowel stimulation and irritation helping maintain remission in inflammatory bowel disease patients.
Option a is incorrect because high fiber can irritate inflamed intestinal mucosa and increase symptoms even during remission periods in IBD.
Option c is incorrect because liquid diets are for acute flares; solid low-residue foods are appropriate during remission for adequate nutrition.
Option d is incorrect because gluten restriction helps celiac disease not inflammatory bowel disease unless concurrent celiac disease is present additionally.

Correct Answer: Oral candidiasis

Option b is correct because removable white patches with red base underneath characterize oral thrush from candida overgrowth in immunosuppression typically.
Option a is incorrect because hairy leukoplakia creates non-removable white patches on tongue sides that cannot be scraped off like thrush.
Option c is incorrect because aphthous ulcers are painful round lesions with yellow centers, not white patches that can be removed physically.
Option d is incorrect because oral Kaposi's sarcoma appears as purple lesions on palate, not white removable patches on tongue surface.

Correct Answer: Air trapping

Option b is correct because chronic air trapping from lost elastic recoil causes lung hyperinflation producing the barrel chest appearance characteristically seen.
Option a is incorrect because respiratory muscle hypertrophy doesn't change chest shape; air trapping and hyperinflation create barrel chest configuration typically observed.
Option c is incorrect because fluid accumulation causes dullness and decreased breath sounds, not the hyperresonant barrel chest of emphysema present.
Option d is incorrect because ribcage calcification occurs with aging but doesn't produce the hyperinflated barrel chest from air trapping specifically.

Correct Answer: Practice hand hygiene

Option c is correct because H. pylori spreads through fecal-oral route making hand hygiene essential for preventing reinfection after treatment completion.
Option a is incorrect because spicy foods don't cause H. pylori infection though they may irritate healing mucosa temporarily after treatment given.
Option b is incorrect because while probiotics support gut health, they don't specifically prevent H. pylori transmission requiring hygiene measures instead primarily.
Option d is incorrect because in developed countries with treated water, hand hygiene is more important than boiling water for prevention typically.

Correct Answer: Autonomic nerves

Option c is correct because bladder function requires autonomic nervous system control which becomes impaired from demyelination in multiple sclerosis progression.
Option a is incorrect because sensory neurons alone don't control bladder emptying; autonomic dysfunction causes the retention problems in MS patients.
Option b is incorrect because while motor neurons are affected, bladder dysfunction specifically involves autonomic nerve demyelination causing retention issues present typically.
Option d is incorrect because MS affects central nervous system including autonomic pathways, not peripheral nerves which remain intact generally preserved.

Correct Answer: Moisture and warmth

Option b is correct because warm moist environments like skin folds provide ideal conditions for candida proliferation especially with diabetes present.
Option a is incorrect because candida prefers slightly acidic environments; alkaline conditions actually inhibit rather than promote fungal growth typically occurring.
Option c is incorrect because sunlight has antifungal properties through UV radiation; dark moist areas promote candida growth more effectively instead.
Option d is incorrect because dry conditions inhibit fungal growth; moisture is essential for candida proliferation in skin fold areas specifically.

Correct Answer: Hepatomegaly

Option b is correct because liver enlargement results from venous congestion in right heart failure, distinguishing it from left-sided failure signs.
Option a is incorrect because pulmonary crackles indicate left heart failure with pulmonary congestion, not right-sided failure from COPD complications typically.
Option c is incorrect because orthopnea suggests pulmonary congestion from left heart failure rather than the systemic congestion of right failure.
Option d is incorrect because paroxysmal nocturnal dyspnea indicates left heart failure with pulmonary edema, not right-sided failure manifestations present clinically.

Correct Answer: Skin injury

Option b is correct because the Koebner phenomenon causes psoriasis lesions at injury sites making trauma avoidance important for preventing flares.
Option a is incorrect because controlled sun exposure actually helps many psoriasis patients through UV light's anti-inflammatory effects when used appropriately.
Option c is incorrect because exercise doesn't trigger psoriasis and may help through stress reduction and overall health benefits for patients.
Option d is incorrect because while cold weather may dry skin, direct trauma is more significant trigger than temperature changes alone typically.

Correct Answer: Notify provider immediately

Option b is correct because neuropsychiatric effects from oseltamivir require immediate provider notification for evaluation and management decisions regarding continuation.
Option a is incorrect because continuing medication with severe behavioral changes risks worsening neuropsychiatric effects requiring immediate medical evaluation first always.
Option c is incorrect because nurses cannot independently adjust oseltamivir dosing; provider consultation is required for any medication changes needed urgently.
Option d is incorrect because sedatives mask symptoms without addressing the underlying medication reaction requiring provider evaluation and decision-making immediately necessary.

Correct Answer: Trough level elevated

Option a is correct because elevated trough levels indicate drug accumulation from decreased renal clearance requiring dose reduction to prevent nephrotoxicity.
Option b is incorrect because normal peak levels don't indicate nephrotoxicity; elevated trough levels specifically suggest impaired renal drug clearance occurring progressively.
Option c is incorrect because Red Man Syndrome is histamine-mediated reaction not indicating nephrotoxicity, though requiring infusion rate adjustment for comfort.
Option d is incorrect because ototoxicity is separate toxicity concern; elevated trough levels specifically indicate nephrotoxicity requiring dose modification immediately needed.

Correct Answer: Neutralizing acid directly

Option b is correct because calcium carbonate is alkaline substance that directly neutralizes stomach acid providing rapid symptomatic relief in GERD.
Option a is incorrect because sucralfate coats ulcers; calcium carbonate works through acid neutralization not protective coating formation in stomach typically.
Option c is incorrect because proton pump inhibitors and H2 blockers reduce acid production; antacids neutralize existing acid already present immediately.
Option d is incorrect because antacids don't affect lower esophageal sphincter tone; they provide relief through direct acid neutralization occurring rapidly.