In the majority of cases, the first clinical manifestation of physiologic stress ulcer is

Correct Answer: C

Rationale: The correct answer is C: Fever. Physiologic stress ulcers are often associated with systemic stress response, leading to an increase in body temperature. Fever is an early sign of stress-related ulcers before other symptoms like epigastric pain or hemorrhage manifest. Change in mental status is more indicative of neurological issues rather than stress ulcers. Epigastric pain typically occurs after the ulcer has progressed, and hemorrhage is a severe complication of untreated stress ulcers.

Correct Answer: C

Rationale: The correct answer is C: Rebound tenderness. Tenderness to percussion is similar to rebound tenderness because both involve assessing pain upon release of pressure. Rebound tenderness specifically evaluates pain when the examiner quickly removes pressure, indicating peritoneal inflammation. Tympany (A) refers to a drum-like sound upon percussion, not pain. Guarding (B) is involuntary muscle contractions in response to palpation, not percussion. Somatic pain (D) is localized pain arising from skin, muscles, or bones, not related to percussion tenderness.

Correct Answer: C

Rationale: The correct answer is C: Seat belts. Flexion-distraction injuries of the thoracolumbar spine are commonly caused by seat belts due to the mechanism of injury during a motor vehicle accident. When a sudden deceleration occurs, the body is restrained by the seat belt while the spine continues to move forward, leading to hyperflexion of the spine. This results in distraction forces at the thoracolumbar junction, causing injury. Blunt trauma (choice A) can cause various types of spinal injuries but is not specifically associated with flexion-distraction injuries. Rotational injury (choice B) typically leads to injuries such as fractures or dislocations, not flexion-distraction injuries. Gunshot wounds (choice D) can cause direct spinal damage, but they do not typically result in flexion-distraction injuries.

Correct Answer: B

Rationale: The correct answer is B: Cyclosporine. Cyclosporine is an immunosuppressant medication commonly used post-bone marrow transplant to prevent graft-versus-host disease. It works by inhibiting T-cell activation and proliferation, reducing the risk of the donor's immune cells attacking the recipient's tissues. Immune globulin (A) is used for passive immunization, not prevention of graft-versus-host reaction. Prophylactic antibiotics (C) are used to prevent infections post-transplant, not graft-versus-host disease. Systemic corticosteroids (D) may be used to treat graft-versus-host disease but are not the first-line prophylactic medication.

Correct Answer: A

Rationale: The correct answer is A because in Cushing's syndrome, there is excess cortisol production leading to hyperglycemia (high glucose) and hypokalemia (low potassium). The high white blood cell count is due to the immunosuppressive effects of cortisol. Option B is incorrect as polycythemia is not typically seen in Cushing's syndrome. Option C is incorrect as low sodium and low potassium are not common findings in Cushing's syndrome. Option D is incorrect as high sodium, high chloride, and high RBCs are not typical features of Cushing's syndrome.