D446 Adult Health II - Set 3 - Part 1

Correct Answer: Reduces preload volume

Elevated positioning decreases venous return to the heart, reducing preload and subsequent pulmonary congestion, allowing easier breathing in heart failure patients.
Option a is incorrect because decreased lung compliance would worsen breathing; the position actually improves compliance by reducing pulmonary fluid congestion.
Option c is incorrect because position doesn't directly increase respiratory rate; it improves breathing efficiency by reducing pulmonary vascular congestion.
Option d is incorrect because while upright position may help diaphragm movement, the primary benefit is reducing pulmonary congestion through decreased preload.

Correct Answer: Air trapping increasing

Chronic air trapping from emphysematous changes causes lung hyperinflation, gradually expanding the chest cavity into the characteristic barrel shape seen in COPD.
Option a is incorrect because respiratory muscle hypertrophy may occur but doesn't cause the barrel chest shape; hyperinflation from trapped air does.
Option c is incorrect because calcium deposits don't accumulate in COPD to cause chest shape changes; the mechanism is air trapping.
Option d is incorrect because while lung tissue is damaged, scarring doesn't expand the chest; chronic hyperinflation from air trapping causes barrel chest.

Correct Answer: Direct arterial relaxation

Hydralazine directly relaxes arterial smooth muscle, causing immediate vasodilation and rapid blood pressure reduction without affecting venous tone or cardiac function significantly.
Option a is incorrect because hydralazine primarily affects arterioles, not veins; venodilators like nitroglycerin work differently on the venous system.
Option c is incorrect because hydralazine may actually increase cardiac output reflexively due to vasodilation, not reduce it directly.
Option d is incorrect because hydralazine doesn't inhibit renin; it may actually increase renin release compensating for lowered blood pressure.

Correct Answer: ACE inhibitor treatment

ACE inhibitors reduce intraglomerular pressure and have specific renoprotective effects, slowing diabetic nephropathy progression independent of blood pressure control benefits.
Option a is incorrect because beta blockers control heart rate and blood pressure but lack the specific renoprotective effects of ACE inhibitors.
Option c is incorrect because calcium channel blockers lower blood pressure but don't provide the same nephroprotection as ACE inhibitors in diabetes.
Option d is incorrect because thiazides treat hypertension and fluid retention but don't specifically protect kidneys from diabetic damage progression.

Correct Answer: Affects breathing earlier

Bulbar onset affects muscles controlling swallowing and breathing from disease start, leading to earlier respiratory complications and shorter survival than limb-onset ALS.
Option a is incorrect because spread rate varies individually; bulbar onset's worse prognosis relates to vital function involvement, not spread speed.
Option c is incorrect because ALS pain levels don't differ by onset type; prognosis relates to respiratory involvement timing, not pain.
Option d is incorrect because no ALS type responds well to current treatments; bulbar onset's prognosis relates to vital function compromise.

Correct Answer: Toxicity developing early

Tinnitus is an early sign of salicylate toxicity indicating aspirin levels approaching or exceeding safe therapeutic range, requiring dose adjustment immediately.
Option a is incorrect because tinnitus indicates excessive levels, not therapeutic range; therapeutic doses shouldn't cause ototoxic symptoms like ear ringing.
Option c is incorrect because allergic reactions cause rash, swelling, or breathing problems, not the specific ototoxic symptom of tinnitus.
Option d is incorrect because tinnitus from aspirin indicates direct toxicity, not drug interaction; it's a known dose-related adverse effect.

Correct Answer: Shows uric acid

Negatively birefringent needle-shaped crystals under polarized light specifically identify monosodium urate crystals, definitively confirming gout versus other arthritis types causing joint inflammation.
Option a is incorrect because bacterial infections show organisms and white cells on culture, not the characteristic crystals seen in gout.
Option c is incorrect because calcium pyrophosphate crystals are positively birefringent and indicate pseudogout, not true gout from urate.
Option d is incorrect because while inflammation is present, the specific crystal identification confirms gout rather than general inflammatory markers.

Correct Answer: Estrogen metabolism impaired

Liver failure impairs estrogen metabolism causing accumulation, leading to feminizing effects like breast enlargement and testicular atrophy in male patients.
Option a is incorrect because testosterone levels actually decrease in liver disease; excess testosterone wouldn't cause feminizing features seen.
Option c is incorrect because cortisol changes in liver disease cause different symptoms like weakness and hypotension, not feminization effects.
Option d is incorrect because growth hormone deficiency doesn't cause the specific feminizing changes; impaired estrogen clearance does in cirrhosis.

Correct Answer: Place items left

Placing important items on the neglected left side forces attention to that space, promoting awareness and preventing learned non-use of affected side.
Option a is incorrect because approaching from the right reinforces neglect; approaching from left encourages attention to the neglected side.
Option c is incorrect because constant verbal reminders create dependence; environmental setup promoting natural attention is more effective long-term.
Option d is incorrect because while mirror therapy helps motor recovery, strategic item placement better addresses spatial neglect and safety.

Correct Answer: Diaphragm irritation present

Dialysate fluid irritates the diaphragm's peritoneal surface, causing referred pain to shoulder via shared phrenic nerve innervation, a common benign occurrence.
Option a is incorrect because catheter malposition causes drainage problems or direct abdominal pain, not the specific referred shoulder pain pattern.
Option c is incorrect because infection causes abdominal pain, fever, and cloudy drainage, not isolated shoulder pain during infusion.
Option d is incorrect because fluid overload causes breathing difficulty and edema, not the specific shoulder pain from diaphragmatic irritation.

Correct Answer: Osmotic demyelination syndrome

Rapid sodium correction causes osmotic shifts damaging myelin sheaths, particularly in the pons, causing permanent neurological damage requiring careful correction rates.
Option a is incorrect because kidneys can handle hypertonic saline; the danger is neurological from rapid osmotic shifts, not renal failure.
Option c is incorrect because cardiac effects from SIADH relate to severe hyponatremia, not the correction rate causing demyelination syndrome.
Option d is incorrect because rapid correction actually reduces seizure risk from hyponatremia; the danger is demyelination, not increased seizures.

Correct Answer: Volar plate rupture

Inflammatory destruction of the volar plate at PIP joints causes hyperextension with compensatory DIP flexion, creating the characteristic swan neck appearance.
Option a is incorrect because cartilage erosion alone causes joint space narrowing and pain but not the specific swan neck deformity pattern.
Option c is incorrect because tendon shortening would cause flexion contractures, not the hyperextension pattern seen in swan neck deformity.
Option d is incorrect because bone fusion would create rigid immobile joints, not the hyperextension-flexion pattern of swan neck deformity.

Correct Answer: Symptom presence evaluation

Positive skin tests indicate TB exposure; distinguishing active disease requires evaluating symptoms like cough, fever, and weight loss plus chest imaging.
Option a is incorrect because erythema color isn't measured or significant; only induration size matters for skin test interpretation clinically.
Option c is incorrect because reactions are read at specific times; timing doesn't differentiate latent from active disease, symptoms do.
Option d is incorrect because BCG history affects interpretation threshold but doesn't distinguish latent from active infection requiring symptom assessment.

Correct Answer: Protein molecules present

Massive proteinuria in nephrotic syndrome causes urine to foam like beaten egg whites due to protein's surface tension properties creating bubbles.
Option a is incorrect because red blood cells cause dark or tea-colored urine in glomerulonephritis, not the frothy appearance of proteinuria.
Option c is incorrect because white blood cells cause cloudy urine suggesting infection, not the characteristic foamy appearance from protein.
Option d is incorrect because glucosuria in diabetes may cause sweet-smelling urine but doesn't create the frothy appearance protein causes.

Correct Answer: Lactic acidosis developing

Metformin accumulation in renal failure causes potentially fatal lactic acidosis, making kidney disease a contraindication requiring alternative diabetes management strategies.
Option a is incorrect because metformin rarely causes hypoglycemia alone; the concern in kidney disease is lactic acidosis, not low glucose.
Option c is incorrect because metformin doesn't significantly affect potassium; the renal failure concern is metabolic acidosis, not electrolyte imbalance.
Option d is incorrect because metformin isn't directly nephrotoxic; it's contraindicated because kidneys can't clear it, risking acidosis accumulation.

Correct Answer: Fluid shifts occurring

Massive capillary permeability increases cause fluid shifting to interstitial spaces despite IV fluids, temporarily reducing intravascular volume and kidney perfusion initially.
Option a is incorrect because acute kidney failure is less likely than expected fluid shifts in early burn management with adequate resuscitation.
Option c is incorrect because adequate resuscitation is being provided; the issue is fluid maldistribution from capillary leak, not dehydration.
Option d is incorrect because medications aren't the primary cause of oliguria in burn emergent phase; pathophysiological fluid shifts are.

Correct Answer: Orbital tissue inflammation

Autoimmune orbital inflammation and fibrosis behind the eyes occurs independently of thyroid hormone levels, causing persistent eye bulging despite normalized thyroid function.
Option a is incorrect because exophthalmos results from orbital autoimmune inflammation, not thyroid hormone levels, persisting despite successful hormone control.
Option c is incorrect because eye changes result from the disease's autoimmune process attacking orbital tissues, not from treatment medications.
Option d is incorrect because thyroid treatment may be complete with normal hormone levels while orbital inflammation continues independently causing exophthalmos.

Correct Answer: Glucagon also deficient

Pancreatic destruction affects both insulin-producing beta cells and glucagon-producing alpha cells, causing brittle diabetes with hypoglycemia risk from absent counter-regulation.
Option a is incorrect because pancreatic diabetes involves insulin deficiency from gland destruction, not the insulin resistance characterizing type two diabetes.
Option c is incorrect because ketoacidosis risk is similar; the unique feature is hypoglycemia risk from absent glucagon counter-regulatory response.
Option d is incorrect because pancreatic diabetes usually requires insulin since the gland is destroyed; oral agents targeting insulin resistance aren't effective.

Correct Answer: Kernig's sign positive

Positive Kernig's sign with resistance to knee extension when hip flexed specifically indicates meningeal inflammation, distinguishing meningitis from other infections.
Option a is incorrect because fever occurs with any infection; it doesn't specifically indicate the meningeal irritation characteristic of meningitis.
Option c is incorrect because tachycardia accompanies any febrile illness or infection, not specifically indicating meningeal involvement requiring assessment.
Option d is incorrect because elevated white cells indicate infection generally; Kernig's sign specifically identifies meningeal irritation distinguishing meningitis.

Correct Answer: Eye protection worn

UV light used in phototherapy can cause severe eye damage including cataracts, making protective eyewear essential during all treatment sessions.
Option a is incorrect because while skin care is important, eye protection from UV damage is the most critical safety measure required.
Option c is incorrect because diet doesn't specifically interact with phototherapy; eye protection from UV exposure is the priority precaution.
Option d is incorrect because exercise isn't contraindicated with phototherapy; protecting eyes from UV damage is the essential precaution needed.