Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
1. A 54-year-old African American woman has been in the intensive care unit (ICU) for the past 10 hours because she has failed to regain consciousness after passing out at a restaurant 11 hours ago. Upon initial arrival at the emergency department the patient's friend stated that the patient had remarked about the sudden onset of a terrible headache and neck stiffness while they were having lunch. A few minutes after the onset of the headache, she became confused, vomited, and lost consciousness. She regained consciousness briefly en route to the hospital, but she has been unconscious since admission. On arrival she was intubated and mechanically ventilated and transferred to the ICU, where intravenous fluids were started. Vital signs are: pulse 110/min and blood pressure 174/96 mm Hg. She exhibits no spontaneous movement and is unresponsive to verbal or painful stimuli. Lung fields are clear to auscultation. CT angiogram confirms subarachnoid hemorrhage from a ruptured cerebral aneurysm and impaired intracranial circulation. The family should be counseled regarding which of the following?
A) The futility of continued life support
B) The need for screening of first-degree relatives for aneurysms
C) The need for them to sustain hope
D) The need to have a guardian ad litem appointed to make informed decisions about the patient's care
E) The probability that the patient will not regain consciousness
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
2. A 21-year-old Asian-American man who sustained a closed head injury in a motorcycle accident is admitted to the hospital. He is intubated and is receiving mechanical ventilation in the intensive care unit. On repeat physical examinations during the next 2 days, he shows no clinical signs of cerebral activity and has no spontaneous respiration. His pupils are fixed in mid-position and he has no vestibulo-ocular reflexes. Electroencephalograms obtained 24 hours apart have nearly flat tracings. His driver's license indicates his desire to be an organ donor. When you inform his parents that he is brain dead, you remind them of his donor statement and request permission to harvest usable organs. The parents are shocked; they say they are unaware of his desire to be an organ donor and refuse to grant permission. Because the patient meets the clinical criteria for brain death, which of the following is most appropriate?
A) Explain how their son's death can contribute to another person's life
B) Have a potential organ recipient talk with the family
C) Obtain a court order authorizing removal of usable organs
D) Order cerebral angiography to convince the parents that their son is brain dead
E) Proceed with organ removal because the patient is an adult
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
E) Maintain the patient on a respirator but transfer him out of the NICU
14. A 42-year-old African-American man with hepatitis C is admitted to the hospital for evaluation of a 3-day history of fever and right upper quadrant abdominal pain. The pain is steady and does not change with position. He has had associated nausea but has not vomited. He has a history of alcohol dependence but has not had an alcoholic beverage since being diagnosed with hepatitis C 4 years ago. He does not take any medications. On admission, vital signs are: temperature 38.5°C (101.3°F), pulse 115/min, respirations 24/min and blood pressure 100/60 mm Hg. Physical examination shows scleral icterus. Abdominal examination discloses mild distention and right upper quadrant tenderness to palpation; the liver spans 25 cm. There is no rebound tenderness and bowel sounds are normal. Ultrasonography of the right upper quadrant shows three small gallstones, dilated right and left intrahepatic ducts and normal common bile duct. Laboratory studies show:
Serum
Blood
ALT 650 U/L,
Hematocrit 35%,
AST 442 U/L
WBC 22,000/mm3
Alkaline phosphatase 342 U/L
PT 14 sec
Bilirubin 7.0 mg/dL
PTT 28 sec
Na+ 140 mEq/L
INR 1.2
K+ 4.2 mEq/L
Cl- 104 mEq/L
HCO3- 23 mEq/L
Fluid resuscitation is begun. Which of the following is the most appropriate next step?
A) Biopsy of the liver
B) Cholecystectomy
C) CT scan of the abdomen
D) Endoscopic retrograde cholangiopancreatography with stent
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
yes a is right.
Another one ...
4. A 28-year-old man who lives in a small rural township is admitted to the hospital because of gastrointestinal bleeding. On admission the patient is pale and has orthostatic hypotension. Hemoglobin concentration is 8 g/dL. His condition is stabilized. Emergent upper endoscopy shows a visible gastric vessel, which is treated appropriately.
1 .Specific additional history should be obtained regarding which of the following?
A) Consumption of alcoholic beverages
B) Family history of cancer
C) Source of drinking water
D) Travel history
E) Use of tobacco products
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
4. A 28-year-old man who lives in a small rural township is admitted to the hospital because of gastrointestinal bleeding. On admission the patient is pale and has orthostatic hypotension. Hemoglobin concentration is 8 g/dL. His condition is stabilized. Emergent upper endoscopy shows a visible gastric vessel, which is treated appropriately.
C) Source of drinking water
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
The answer for Q2 is A)Explain how their son's death can contribute to another person's life.
The answer for Q14 is D)Endoscopic retrograde cholangiopancreatography with stent.
The answer for Q4 is A) Consumption of alcoholic beverages
Please reply
