Mrs. Carpenter is a 59-year-old female who presents with an acute myocardial infarction. She is acutely short of breath and has coarse rales on auscultation. Physical examination reveals a grade VVI systolic murmur, loudest at the point of maximal impulse with radiation to the midaxillary line. The AGACP recognizes

Correct Answer: A

Rationale: The correct answer is A: Acute mitral valve regurgitation. The presence of a grade VVI systolic murmur that radiates to the midaxillary line suggests mitral valve involvement. Mitral regurgitation leads to acute onset of symptoms such as dyspnea and pulmonary congestion, indicated by coarse rales on auscultation. The murmur is loudest at the point of maximal impulse due to eccentric regurgitation jet. Acute aortic valve regurgitation (B) typically presents with a diastolic murmur. Acute cardiac tamponade (C) would present with Beck's triad and pulsus paradoxus. Acute pulmonary embolus (D) would present with sudden onset dyspnea and pleuritic chest pain.

Correct Answer: A

Rationale: The correct answer is A: Acute mitral valve regurgitation. The presence of a grade VVI systolic murmur that radiates to the midaxillary line suggests mitral valve involvement. Mitral regurgitation leads to acute onset of symptoms such as dyspnea and pulmonary congestion, indicated by coarse rales on auscultation. The murmur is loudest at the point of maximal impulse due to eccentric regurgitation jet. Acute aortic valve regurgitation (B) typically presents with a diastolic murmur. Acute cardiac tamponade (C) would present with Beck's triad and pulsus paradoxus. Acute pulmonary embolus (D) would present with sudden onset dyspnea and pleuritic chest pain.

Correct Answer: D

Rationale: Non-infective mastitis is associated with adenitis because it refers to inflammation of breast tissue without an infection. Adenitis specifically involves inflammation of the lymph nodes, which can be a common cause of non-infective mastitis. Cellulitis (A) is an infection of the skin and tissues beneath the skin, not specific to mastitis. Flat (B) and bifid (C) nipples are anatomical variations that do not directly relate to the inflammation of breast tissue.

Correct Answer: D

Rationale: The correct answer is D: Escherichia coli. E. coli is the most common causative organism of pyelonephritis due to its prevalence in the gastrointestinal tract. It has specific virulence factors that enable it to ascend the urinary tract and cause infection. Streptococcus faecalis, Proteus vulgaris, and Staphylococcus pyogene are less commonly associated with pyelonephritis compared to E. coli.

Correct Answer: D

Rationale: 1. Emotional counseling helps women cope with grief. 2. Explaining causes provides closure and understanding. 3. Supporting future pregnancies ensures better outcomes. 4. All options address different aspects of support needed after stillbirth. 5. Therefore, providing emotional counseling, explaining causes, and supporting future pregnancies collectively offer comprehensive care.

Correct Answer: C

Rationale: Certainly! The correct answer is C: Hyperthermia neonatorum. Greatly reduced eliminations and a red rosy appearance of the face are indicative of hyperthermia, which is an elevated body temperature. This condition can lead to dehydration and other complications. A: Hypothermia neonatorum is characterized by low body temperature, not elevated. B: Hypoglycemia neonatorum refers to low blood sugar levels, not related to the symptoms mentioned. D: Hypocalcemia neonatorum is a deficiency of calcium in the blood, not associated with the given features. In summary, hyperthermia neonatorum is the correct answer due to the specific symptoms presented, while the other choices do not align with the described features.

Correct Answer: A

Rationale: The correct answer is A: Submentovertival, bitemporal. In a face presentation, the presenting diameters are submentovertival (chin to vertex) and bitemporal (temple to temple). This is because the fetus is in a face-first position with the chin presenting first. Option B is incorrect because submentobregmatic is not a recognized presenting diameter in face presentation. Option C is incorrect as biparietal refers to the widest transverse diameter of the fetal head, not relevant in face presentation. Option D is incorrect as mentovertical is not a valid presenting diameter in face presentation.

Correct Answer: A

Rationale: The correct answer is A: A temperature of 101.5°F. A fever indicates an inflammatory response, which could be due to a complication like cholecystitis or cholangitis. Elevated leukocyte count (choice B) supports infection but is not as specific as a fever. Palpable gallbladder (choice C) may suggest inflammation but not necessarily a complication. A positive Murphy's sign (choice D) is indicative of gallbladder inflammation but does not directly indicate a complication requiring surgical evaluation.

Correct Answer: D

Rationale: The correct answer is D: Short acting insulin. In gestational diabetes, short acting insulin is preferred as it provides immediate control over blood sugar levels after meals. This is crucial in managing the condition to prevent complications for both the mother and the baby. Therapeutic diet alone (choice A) may not be sufficient to control blood sugar levels, while long-acting insulin (choice B) may not provide the rapid response needed after meals. Oral hypoglycemics (choice C) are generally avoided in pregnancy due to potential risks to the fetus. Therefore, short acting insulin is the most appropriate therapy for managing gestational diabetes effectively.