K. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms the remainder of the GI review of systems is negative. His medical history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that

Correct Answer: C

Rationale: Rationale for Correct Answer (C): 1. The patient's symptoms of decreased capacity for intake and nausea after eating suggest gastroparesis, a common complication post-ulcer surgery. 2. Given the history of complicated peptic ulcer disease and prior surgery, medication may be ineffective, necessitating potential reoperation. 3. The AGACNP advises that another surgery may be needed, indicating that medication alone may not suffice to address the issue. Summary of Incorrect Choices: A: Endoscopy is not necessary at this point as the symptoms are likely indicative of a functional issue rather than a structural problem. B: While gastroparesis can occur post-ulcer surgery, the patient's symptoms are more suggestive of gastroparesis rather than chronic gastroparesis as a known complication. D: The frequency of occurrence of symptoms after ulcer surgery is not relevant to the current management of the patient's symptoms.

Correct Answer: B

Rationale: The correct answer is B: Klumpke's palsy. Neonatal injury to nerve roots C8 & T1 leads to Klumpke's palsy, characterized by paralysis of the lower arm and hand muscles. This occurs due to damage to the lower trunk of the brachial plexus. Erb's palsy (choice A) involves C5 & C6 nerve roots, causing weakness in the shoulder and upper arm. Phrenic injury (choice C) affects the diaphragm, leading to breathing difficulties. Radial palsy (choice D) results from damage to the radial nerve, causing wrist drop and weakness in forearm muscles. Klumpke's palsy specifically matches the description of injury to nerve roots C8 & T1.

Correct Answer: C

Rationale: The correct answer is C: Extraplacental haemorrhage. Incidental antepartum haemorrhage refers to bleeding occurring outside the placenta, such as from the cervix or vaginal walls, before the onset of labor. This is not associated with the placenta itself (intraplacental - choice A). Similarly, it does not occur during labor (intrapartum - choice B) or specifically before term (preterm - choice D). Extraplacental haemorrhage captures the essence of bleeding unrelated to the placenta during the antepartum period.

Correct Answer: C

Rationale: The correct answer is C. In Cushing's syndrome, there is excess cortisol production leading to sodium retention, potassium loss, and increased protein breakdown. Low sodium and potassium levels along with high BUN are commonly seen in patients with Cushing's syndrome. A: Low potassium and high glucose are possible findings, but high white blood cell count is not typically associated with Cushing's syndrome. B: High sodium and polycythemia are not typical findings in Cushing's syndrome, and low BUN is not consistent with the protein breakdown seen in this condition. D: High sodium and high chloride levels can be seen, but high RBCs are not typically associated with Cushing's syndrome.

Correct Answer: A

Rationale: The correct answer is A: Hypogastrinemia and acid hyposecretion. Gastrinoma is a tumor that secretes excessive gastrin, leading to hypergastrinemia and increased acid secretion. However, due to a negative feedback mechanism, chronic exposure to high gastrin levels can cause downregulation of gastrin receptors on parietal cells, leading to decreased acid secretion. Therefore, in gastrinoma, despite high gastrin levels, acid secretion may be reduced due to this negative feedback loop. Choices B, C, and D are incorrect because they do not align with the expected relationship between gastrin levels and acid secretion in gastrinoma.