A patient has low cardiac output due to poor cardiac function. He is * edematous. Which one of the following should be avoided because it can aggravate cardiac dysfunctions?

Correct Answer: C

Rationale: The correct answer is C: Mannitol. Mannitol is an osmotic diuretic that can worsen cardiac function by increasing plasma volume and potentially exacerbating edema. Furosemide (A) and Hydrochlorothiazide (D) are loop and thiazide diuretics, respectively, commonly used to reduce fluid overload in heart failure patients. Spironolactone (B) is a potassium-sparing diuretic that is often added to the treatment regimen in heart failure to help counteract potassium loss from other diuretics.

Correct Answer: D

Rationale: The correct answer is D: interlobular vessel. Blood leaves the glomerulus through the efferent arteriole, which then branches into the peritubular capillaries. These capillaries merge to form the interlobular veins, which ultimately carry the blood away from the nephron and back into the general circulation. The other choices are incorrect because: A: Bone marrow is not directly involved in blood leaving the glomerulus. B: The afferent arteriole brings blood into the glomerulus, it does not carry blood out. C: Kidneys are the site where blood is filtered, not where it leaves the glomerulus.

Correct Answer: B

Rationale: The correct answer is B: Pulmonary edema. Pulmonary edema is not an absolute indication for dialysis in acute renal failure (ARF) as it is primarily managed with oxygen therapy and diuretics. Refractory hyperkalemia >6.5 mmol/l is a life-threatening condition that requires immediate dialysis to remove excess potassium. Encephalopathy indicates severe uremia and is another absolute indication for dialysis. Other options were not provided in the question.

Correct Answer: B

Rationale: The correct answer is B: Acute tubular necrosis (ATN). ATN is the most likely diagnosis due to its common occurrence in critically ill patients with factors like hypotension, sepsis, or nephrotoxic medications. The key characteristic is the damage to the renal tubules leading to acute kidney injury. Prerenal failure (A) is usually due to decreased blood flow to the kidneys, glomerulonephritis (C) involves inflammation of the glomeruli, and postrenal failure (D) is caused by obstruction of urine flow. These conditions are less likely in a critically ill patient compared to ATN.

Correct Answer: D

Rationale: The correct option, D, is appropriate as it acknowledges the common concerns of adolescents regarding sexual activity, setting a non-judgmental and open tone for the interview. It helps establish rapport and encourages the adolescent to feel comfortable discussing their questions or concerns. Option A is too direct and may make the adolescent uncomfortable. Option B is intrusive and assumes the adolescent's behavior. Option C is specific and may not be relevant to the adolescent's current situation. Overall, option D is the most appropriate as it focuses on the adolescent's perspective and facilitates open communication.