Question

It's raining, it's pouring.

The old man's snoring.

He got into bed

And bumped his head

And couldn't get up in the morning.

Head trauma is known to cause a specific acid/base imbalance, so an arterial blood gas is drawn.

Which acid/base imbalance is the reason this old man could not get up in the morning?

Answer 1

Correct Answers:

Respiratory acidosis

Rationale :

🔷 Head injury can depress the brainstem respiratory drive, causing hypoventilation and CO₂ retention.

🔷 Snoring/airway obstruction while sleeping points to hypoventilation → ↑PaCO₂ → ↓pH.

🔷 CO₂ (carbonic acid) narcosis produces lethargy/somnolence, explaining “couldn’t get up.”

🔷 ABG pattern: ↓pH, ↑PaCO₂, with renal HCO₃⁻ compensation if time allows.

🔷 Rapid recognition is key: treat underlying ventilatory failure (airway, ventilation support).

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Answer 2

Correct Answers:

Compensated metabolic acidosis

Rationale :

🔶 Pregnant, insulin-dependent diabetic with polyuria/polydipsia fits DKA, a metabolic acidosis state.

🔶 In DKA, lungs compensate with Kussmaul respirations (↓PaCO₂) to buffer low pH.

🔶 ABG shows ↓pH (acidic), ↓HCO₃⁻, and compensatory ↓PaCO₂ toward normal pH.

🔶 Ketone production from insulin deficiency drives the high-anion-gap acidosis.

🔶 Volume depletion from osmotic diuresis reinforces clinical thirst and frequent urination.

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Answer 3

Correct Answers:

Uncompensated respiratory alkalosis

Rationale :

💠 Tachypnea (RR 28) with mild respiratory distress drives excess CO₂ blow-off → ↑pH.

💠 Vomiting can cause metabolic alkalosis, but hyperventilation here points primarily to respiratory cause.

💠 Acute onset means renal compensation has not occurred → uncompensated.

💠 Typical ABG: ↑pH, ↓PaCO₂, with near-normal HCO₃⁻ early on.

💠 Clinical delirium can be worsened by cerebral vasoconstriction from low PaCO₂.

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Answer 4

Correct Answers:

Disseminated Intravascular Coagulation

Rationale :

💎 Diffuse bleeding, petechiae, and purpura with trauma/major injury strongly suggest DIC.

💎 Microthrombi form first, consuming platelets/clotting factors, then bleeding ensues (“consumptive coagulopathy”).

💎 Labs typically: ↓platelets, ↑PT/↑aPTT, ↑D-dimer, ↓fibrinogen.

💎 Widespread endothelial/tissue factor activation is common after major trauma.

💎 Management targets the trigger plus support (e.g., cryo, platelets) if bleeding severe.

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Answer 5

Correct Answers:

Aldosterone hypersecreting tumor

Rationale :

◈ Aldosterone promotes Na⁺ reabsorption (and K⁺ loss) in distal nephron → ↑serum Na⁺ tendency.

◈ Primary hyperaldosteronism (Conn’s) can present with hypernatremia, hypokalemia, and hypertension.

◈ Increased total body sodium and water retention shifts volume status toward expansion.

◈ Other listed choices either dilute Na⁺ (↑water intake) or lose Na⁺ (↑urinary loss), which don’t cause hypernatremia.

◈ Consider renin-aldosterone testing and adrenal imaging for confirmation.

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Answer 6

Correct Answers:

Hodgkin's Lymphoma

Rationale :

❖ Painless, firm lymphadenopathy (4 cm) with cyclic fevers/night sweats suggests Hodgkin (Pel-Ebstein).

❖ Prior EBV/mono increases risk for Hodgkin’s.

❖ Path hallmark: Reed–Sternberg cells on lymph node biopsy.

❖ “B symptoms” (fever, night sweats, weight loss) are classic systemic features.

❖ Often contiguous nodal spread; staging guides combined chemo ± radiation.

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Answer 7

Correct Answers:

High Cyanocobalamin (Vit Bl 2) levels

Rationale :

🔹 Neurologic signs (paresthesias, clumsiness, balance issues) point to B12 deficiency, not folate alone.

🔹 Exam: beefy red tongue and pallor align with megaloblastic anemia.

🔹 Labs typically show ↑MCV, possible ↓retic, and ↑methylmalonic acid in B12 deficiency.

🔹 Demyelination of dorsal columns/lateral corticospinal tracts explains neuro findings.

🔹 Causes include pernicious anemia, malabsorption, or strict dietary deficiency.

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Answer 8

Correct Answers:

NSTEMI

Rationale :

🔵 Prolonged ischemic chest pain (>20–30 min) unrelieved by nitro fits acute coronary syndrome.

🔵 Typical NSTEMI shows positive troponin without ST-segment elevation; pain may persist >4 h.

🔵 Risk profile (↑LDL, ↓HDL, smoking, stimulant use) raises probability of plaque rupture with partial occlusion.

🔵 Management parallels ACS: antiplatelets, anticoagulation, statin, beta-blocker, and risk-guided early PCI.

🔵 STEMI would require ST elevation; stable/unstable angina lack necrosis (troponin rise).

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Answer 9

Correct Answers

Blank 1 Correct Option: Cystic Fibrosis I Autosomal Recessive
Blank 2 Correct Option: Valley Fever I Autosomal Dominant

Rationale :

🟢 “Salty skin” is classic for CF (↑sweat chloride).

🟢 Autosomal recessive inheritance matches family hints of affected relatives/siblings with early severe disease.

🟢 CFTR mutation causes thick secretions, recurrent lung infections, and pancreatic insufficiency.

🟢 Early infant signs include failure to thrive, chronic cough, and steatorrhea.

🟢 Diagnosis: sweat chloride test and/or CFTR genetic testing.

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Answer 10

Correct Answers:

Hypovolemic shock

Rationale :

🟣 Diabetes insipidus → massive free-water loss → hypovolemia and potential shock.

🟣 Decompensated shock with unconsciousness after weeks of polyuria fits volume depletion.

🟣 Exam/vitals (often tachycardia, hypotension, poor perfusion) align with hypovolemic physiology.

🟣 Management priorities: rapid isotonic fluids, treat underlying DI (e.g., desmopressin if central DI).

🟣 Other shock types (septic, anaphylactic, cardiogenic) lack the pure water-loss trigger seen here.

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QLexNursing

9 :
An 18-year-oId male and 18-year-oId female bring their 6 month old daughter to the pediatrician for her 6 month vaccinations and check-up.

Correct Answers

QLexNursing

9 : An 18-year-oId male and 18-year-oId female bring their 6 month old daughter to the pediatrician for her 6 month vaccinations and check-up.

Correct Answers

9 :
An 18-year-oId male and 18-year-oId female bring their 6 month old daughter to the pediatrician for her 6 month vaccinations and check-up.