A patient with suspected Cushings syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate

Correct Answer: A

Rationale: The correct answer is A: Low ACTH and low cortisol. In a patient with an adrenal tumor causing Cushing's syndrome, the tumor itself produces excess cortisol independently of ACTH regulation. Therefore, ACTH levels are low due to negative feedback from high cortisol levels. As a result, cortisol levels are high, while ACTH levels are low. Explanation for other choices: B: Low ACTH and high cortisol - This suggests primary adrenal insufficiency (Addison's disease), not Cushing's syndrome. C: High ACTH and low cortisol - This suggests secondary adrenal insufficiency, not Cushing's syndrome. D: High ACTH and high cortisol - This is contradictory and not physiologically possible in the context of an adrenal tumor causing Cushing's syndrome.

Correct Answer: C

Rationale: Step-by-step rationale for choice C: 1. Progressive cervical dilatation indicates effective labor progress. 2. Stopping the syntocinon drops prematurely allows natural labor progression. 3. Prematurely stopping drops before reaching full dilation may hinder labor. 4. Achieving cervical dilatation is a crucial indicator for successful labor. Summary: A: Contractions should be strong, not just moderate. B: Maternal observations alone do not determine labor progress. D: Fetal-related observations are important but not the primary indicator for stopping drops.

Correct Answer: A

Rationale: In face presentation, the face is an ill-fitting presenting part, leading to obstructed labor. The face has larger diameters, making it difficult to pass through the birth canal. This differs from vertex delivery where the head can mold to fit. Caput succedaneum is swelling of the soft tissues on the baby's head and does not directly cause obstructed labor.

Correct Answer: B

Rationale: The correct answer is B: Rotational injury. Flexion-distraction injuries of the thoracolumbar spine are often caused by rotational forces that occur during accidents such as motor vehicle collisions or falls. These forces lead to the spine being twisted, causing separation of the vertebrae. Blunt trauma (A) can cause various spinal injuries but is not specific to flexion-distraction injuries. Seat belts (C) are designed to prevent spinal injuries by restraining the body during a collision. Gunshot wounds (D) can cause spinal cord injuries but are not commonly associated with flexion-distraction injuries of the thoracolumbar spine.

Correct Answer: A

Rationale: The correct answer is A: Fever ≥ 38°C for three consecutive occasions. Puerperal pyrexia is defined as fever occurring after childbirth. The key diagnostic feature is the presence of fever (≥ 38°C) on three consecutive occasions, indicating a persistent infection. Choice B is incorrect because it doesn't specify the need for consecutive occasions. Choice C is incorrect as it extends the duration of fever to three weeks, which is too long for typical puerperal pyrexia. Choice D is incorrect as it mentions "occasionally" instead of "consecutively," which is not indicative of a consistent fever pattern seen in puerperal pyrexia.

Correct Answer: A

Rationale: The correct answer is A because the Brain Trauma Foundation recommends intracranial pressure monitoring for patients with traumatic brain injury and a GCS of 3 to 8, regardless of the head CT findings. Intracranial pressure monitoring helps in the management of elevated intracranial pressure, which can be life-threatening. Abnormal head CT findings may indicate the need for immediate intervention, but intracranial pressure monitoring is still recommended for all patients in this GCS range to guide treatment decisions. Choices B, C, and D are incorrect because hypotension, age > 40 years old, and bradycardia are not factors that would exclude a patient from needing intracranial pressure monitoring in the presence of a GCS of 3 to 8.

Correct Answer: D

Rationale: The correct answer is D because a client is declared fit for a vaginal birth after cesarean section if their previous delivery was via spontaneous vertex delivery. This indicates that the client has successfully given birth vaginally before, reducing the risk associated with a vaginal birth after cesarean section. A, B, and C are incorrect: A: Cephalopelvic disproportion was the reason for the previous C/S, indicating potential difficulty in vaginal delivery. B: Confirmation of a multiple pregnancy does not impact the client's eligibility for a vaginal birth after cesarean section. C: Previous cesarean section does not necessarily mean the client is fit for a vaginal birth after cesarean section.

Correct Answer: A

Rationale: The correct answer is A: 60 compressions coordinated with 30 breaths per minute. In neonatal resuscitation, the recommended compression-to-ventilation ratio is 3:1. This means 3 compressions are given followed by 1 breath. With a target compression rate of 120 per minute, this translates to 60 compressions coordinated with 30 breaths per minute. Each compression should be at a depth of about one-third the anterior-posterior diameter of the chest. This ratio and rate are crucial for maintaining adequate circulation and oxygenation during neonatal resuscitation. Choice B: 3 compressions coordinated with 1 breath per minute is too slow and would not provide enough support for the neonate's circulation. Choice C: 1 compression coordinated with 3 breaths per minute would not provide sufficient compressions to maintain circulation. Choice D: 90 compressions coordinated with 30 breaths per minute would result in an incorrect compression-to-vent

Correct Answer: B

Rationale: Step 1: Family history of colon cancer is a significant risk factor for developing colon cancer. Step 2: By discussing with his parents, Mr. Costigan can determine if there is a family history of colon cancer. Step 3: Knowing this information can help assess his own risk and guide appropriate screening and preventive measures. Step 4: The primary danger for Mr. Costigan lies in potential genetic predisposition rather than the presence of inflammatory polyps. Step 5: Therefore, discussing with family members about any history of colon cancer is crucial for his overall risk assessment and management. Summary: - Choice A is incorrect as the frequency of colonoscopy should be individualized based on the patient's risk factors. - Choice C is incorrect as all polyps have the potential to become cancerous, especially inflammatory polyps. - Choice D is incorrect as consulting an oncologist at this stage is premature without first assessing family history.