D446 Adult Health II - Set 4 - Part 1

Correct Answer: Stabilizes shoulder girdle

Tripod position fixes the shoulder girdle, allowing accessory respiratory muscles to more effectively assist diaphragm movement, improving ventilation in severe COPD.
Option a is incorrect because airway diameter in emphysema is determined by tissue destruction and inflammation, not body positioning affecting airway caliber.
Option c is incorrect because while comfort may reduce anxiety, the mechanical advantage of fixed shoulders for accessory muscle use is primary.
Option d is incorrect because the position doesn't reduce metabolic oxygen demand; it mechanically improves ventilation efficiency through shoulder stabilization.

Correct Answer: Retroperitoneal hemorrhage occurring

Grey Turner's sign indicates blood tracking along tissue planes from retroperitoneal bleeding in severe necrotizing pancreatitis, appearing as flank ecchymosis.
Option a is incorrect because enzyme activation causes inflammation and necrosis; the bruising specifically indicates hemorrhage tracking through retroperitoneal tissues.
Option c is incorrect because portal thrombosis causes different complications; Grey Turner's sign specifically indicates retroperitoneal bleeding, not vascular thrombosis.
Option d is incorrect because biliary obstruction causes jaundice and pain but not the flank bruising pattern indicating retroperitoneal hemorrhage.

Correct Answer: Calcitriol production failed

Kidneys cannot convert vitamin D to active calcitriol, impairing calcium absorption and causing secondary hyperparathyroidism, leading to characteristic bone disease.
Option a is incorrect because thyroid hormone isn't primarily involved; the kidney's failure to produce calcitriol drives renal bone disease development.
Option b is incorrect because growth hormone deficiency doesn't cause renal osteodystrophy; failed vitamin D activation is the primary mechanism.
Option d is incorrect because cortisol elevation isn't the mechanism; impaired calcitriol synthesis preventing calcium absorption causes the bone pathology.

Correct Answer: Bacterial translocation reduced

Lactulose acidifies intestinal contents and promotes bowel movements, reducing bacterial overgrowth and translocation across the damaged intestinal barrier in cirrhosis.
Option a is incorrect because lactulose isn't an antibiotic; it works by acidifying gut contents and promoting elimination, not killing bacteria.
Option b is incorrect because while motility increases, the key mechanism is reducing bacterial load and translocation, not just improving movement.
Option d is incorrect because lactulose doesn't enhance immunity; it reduces bacterial burden preventing translocation through the permeable gut barrier.

Correct Answer: Vitamin K antagonism

Spinach's high vitamin K content directly opposes warfarin's anticoagulant effect by promoting clotting factor synthesis, making INR control difficult.
Option a is incorrect because iron content doesn't affect warfarin; vitamin K in leafy greens directly counteracts warfarin's therapeutic mechanism.
Option c is incorrect because dietary factors don't significantly affect warfarin's protein binding; vitamin K directly opposes its anticoagulant action.
Option d is incorrect because absorption isn't the issue; vitamin K actively reverses warfarin's effect on clotting factor synthesis.

Correct Answer: Diaphragm fatigue present

Paradoxical breathing with inward abdominal movement during inspiration indicates diaphragmatic fatigue or weakness, suggesting weaning failure requiring continued support.
Option a is incorrect because anxiety causes rapid breathing but not the specific paradoxical chest-abdomen movement indicating diaphragm dysfunction.
Option c is incorrect because pneumothorax causes absent breath sounds and hypoxia, not the specific paradoxical breathing pattern of diaphragm fatigue.
Option d is incorrect because secretions cause rhonchi and ineffective cough, not the paradoxical movement pattern indicating respiratory muscle fatigue.

Correct Answer: Preload dependence critical

Right ventricular infarcts require high preload for adequate output; nitroglycerin's venodilation dramatically reduces preload, causing dangerous hypotension and shock.
Option a is incorrect because coronary steal isn't the mechanism; the problem is preload reduction in a ventricle requiring high filling pressure.
Option c is incorrect because while afterload reduction occurs, the critical issue in RV infarct is preload reduction causing output failure.
Option d is incorrect because nitroglycerin doesn't typically cause bradycardia; the hypotension results from preload reduction in preload-dependent RV.

Correct Answer: Diaphragm weakness quantified

Vital capacity directly measures respiratory muscle strength including diaphragm function, predicting need for mechanical ventilation before overt respiratory failure develops.
Option a is incorrect because vital capacity measures muscle strength, not infection; declining values indicate neuromuscular weakness requiring ventilatory support.
Option c is incorrect because oxygenation may remain normal initially; vital capacity detects muscle weakness before hypoxemia develops requiring intervention.
Option d is incorrect because vital capacity measures inspiratory force, not secretion management; it predicts ventilatory failure from ascending paralysis.

Correct Answer: Distal interphalangeal affected

Psoriatic arthritis characteristically affects distal interphalangeal joints often spared in rheumatoid arthritis, helping distinguish these inflammatory arthropathies clinically.
Option a is incorrect because symmetrical involvement characterizes rheumatoid arthritis; psoriatic arthritis often shows asymmetric patterns distinguishing it clinically.
Option c is incorrect because both conditions cause morning stiffness; DIP involvement and skin changes distinguish psoriatic from rheumatoid arthritis.
Option d is incorrect because psoriatic arthritis is seronegative; positive rheumatoid factor indicates RA, not psoriatic arthritis which lacks this marker.

Correct Answer: Osmotic diuresis prolonged

HHS develops insidiously over weeks with sustained severe hyperglycemia causing massive osmotic diuresis and dehydration before presentation, unlike DKA's rapid onset.
Option a is incorrect because absence of ketones doesn't explain fluid losses; the prolonged unrecognized hyperglycemia causes severe dehydration in HHS.
Option c is incorrect because less vomiting would reduce fluid loss; HHS has greater losses from extended osmotic diuresis, not vomiting differences.
Option d is incorrect because while older patients get HHS more often, the severe dehydration results from prolonged osmotic diuresis duration.

Correct Answer: Immune complex deposition

Osler nodes result from immune complex vasculitis in small vessels, causing painful inflammatory nodules, distinguishing them from septic embolic phenomena.
Option a is incorrect because Osler nodes aren't infected lesions; they result from immune-mediated vasculitis, not direct bacterial invasion of tissues.
Option b is incorrect because septic emboli cause Janeway lesions which are painless; Osler nodes are painful immune complex depositions.
Option d is incorrect because platelet aggregation forms vegetation on valves; Osler nodes specifically result from circulating immune complex deposition.

Correct Answer: Renal excretion increased

Alkalosis causes distal tubule hydrogen-potassium exchange, wasting potassium in urine to retain hydrogen attempting to correct pH imbalance.
Option a is incorrect because gastric fluid contains minimal potassium; the loss occurs through increased renal excretion, not direct vomiting losses.
Option c is incorrect because while some cellular shift occurs, the primary mechanism is renal potassium wasting attempting pH correction.
Option d is incorrect because absorption remains normal; hypokalemia results from excessive renal losses during metabolic alkalosis compensation attempts.

Correct Answer: Peripheral vasodilation dangerous

External heating causes peripheral vasodilation before thyroid replacement takes effect, potentially causing cardiovascular collapse from blood pooling peripherally without adequate cardiac response.
Option a is incorrect because while hypothermic skin is fragile, the danger is cardiovascular collapse from vasodilation, not skin injury risk.
Option c is incorrect because impaired shivering doesn't contraindicate external heating; the risk is hemodynamic instability from peripheral vasodilation.
Option d is incorrect because unchanged metabolism doesn't explain the danger; peripheral vasodilation without cardiac compensation causes collapse risk.

Correct Answer: Reduces blood viscosity

Hydration decreases blood viscosity reducing sickling and vaso-occlusion, addressing the crisis's underlying pathophysiology rather than just managing pain symptoms.
Option a is incorrect because pain mediator dilution isn't the mechanism; hydration reduces sickling by decreasing blood viscosity and improving flow.
Option c is incorrect because while kidneys benefit, the primary goal is reducing viscosity to prevent sickling and vaso-occlusive events.
Option d is incorrect because fluid replacement isn't the main goal; reducing viscosity to prevent sickling is hydration's therapeutic purpose.

Correct Answer: Antithrombin III loss

Nephrotic syndrome causes urinary loss of antithrombin III, a natural anticoagulant, creating hypercoagulability and increased spontaneous thrombosis risk significantly.
Option a is incorrect because albumin loss causes edema through oncotic pressure changes, not the hypercoagulability causing thrombosis in nephrotic syndrome.
Option c is incorrect because immunoglobulin loss increases infection risk; thrombosis results from anticoagulant protein losses, not antibody deficiency.
Option d is incorrect because transferrin carries iron; its loss causes anemia but doesn't explain the hypercoagulable state causing thrombosis.

Correct Answer: Alveolar recruitment increased

PEEP prevents alveolar collapse and recruits previously collapsed alveoli, improving ventilation-perfusion matching and gas exchange despite potential hemodynamic effects.
Option a is incorrect because PEEP doesn't stimulate surfactant production; it mechanically keeps alveoli open improving gas exchange surface area.
Option c is incorrect because PEEP may actually increase dead space; the benefit is alveolar recruitment improving oxygenation, not dead space reduction.
Option d is incorrect because shunting isn't completely eliminated; PEEP reduces shunt by recruiting alveoli but doesn't eliminate all ventilation-perfusion mismatch.

Correct Answer: Cardiomyopathy development occurring

Chronic growth hormone excess causes direct myocardial hypertrophy and fibrosis, leading to acromegalic cardiomyopathy with diastolic dysfunction progressing to failure.
Option a is incorrect because valve disease isn't the primary cardiac manifestation; growth hormone causes myocardial changes leading to cardiomyopathy.
Option c is incorrect because coronary spasm isn't characteristic; the problem is myocardial hypertrophy and dysfunction from growth hormone excess.
Option d is incorrect because while arrhythmias may occur, the primary issue is structural cardiomyopathy from chronic growth hormone exposure.

Correct Answer: Regional anticoagulation provided

Citrate provides anticoagulation only within the circuit by chelating calcium, avoiding systemic anticoagulation risks in bleeding-prone patients requiring CRRT.
Option a is incorrect because citrate systems are complex and expensive; the advantage is regional versus systemic anticoagulation, not cost.
Option c is incorrect because citrate requires careful ionized calcium monitoring; the benefit is avoiding systemic anticoagulation, not eliminating monitoring.
Option d is incorrect because citrate doesn't need reversal since it's metabolized; the advantage is regional anticoagulation avoiding systemic bleeding risk.

Correct Answer: Stress response inadequate

Severe hypothyroidism prevents appropriate stress response to surgery; inability to increase metabolism during stress precipitates myxedema crisis requiring emergency treatment.
Option a is incorrect because while drug metabolism is slowed, the crisis results from inadequate physiological stress response, not anesthesia duration.
Option c is incorrect because fluid issues are consequences not causes; the precipitant is inability to mount stress response to surgery.
Option d is incorrect because hypoglycemia may occur but isn't the precipitant; inadequate stress hormone response triggers myxedema crisis perioperatively.

Correct Answer: Carboxyhemoglobin misread falsely

Pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin, showing falsely normal saturation despite tissues receiving no oxygen from CO-bound hemoglobin.
Option a is incorrect because the sensor works normally; it simply cannot differentiate carboxyhemoglobin from normal oxyhemoglobin spectrophotometrically.
Option c is incorrect because circulation status doesn't explain false readings; the issue is carboxyhemoglobin being misinterpreted as oxygenated blood.
Option d is incorrect because respiratory rate doesn't affect oximetry accuracy; the problem is inability to detect carbon monoxide binding.