Mrs. Maroldo is an 81-year-old female who presents for evaluation of pain in her left lower quadrant. She has had this pain before and says she usually takes antibiotics and it goes away. However, this time it seems worse, and she has had it for 4 days even though she says she started taking her leftover antibiotics from the last episode. She denies any nausea or vomiting but says she simply isnt hungry. She had a little diarrhea yesterday but no bowel movements today. She has a temperature of 100.9F and a pulse of 104 bpm, respirations of 20 breaths per minute, and a blood pressure of 9460 mm Hg. She has some discomfort to deep palpation in the left lower quadrant. The AGACNP suspects

Correct Answer: A

Rationale: The correct answer is A: Irritable bowel syndrome. Mrs. Maroldo's history of recurrent left lower quadrant pain that usually resolves with antibiotics suggests a chronic condition rather than an acute one like diverticulitis, appendicitis, or inflammatory bowel disease. Her lack of nausea, vomiting, and severe symptoms, along with the presence of diarrhea and no bowel movements, align more with irritable bowel syndrome. Additionally, her vital signs are not significantly elevated, ruling out acute conditions like appendicitis. Discomfort to deep palpation in the left lower quadrant is common in irritable bowel syndrome due to visceral hypersensitivity. Therefore, based on her chronic symptoms, lack of severe signs, and typical presentation, the most likely diagnosis is irritable bowel syndrome.

Correct Answer: B

Rationale: The correct answer is B: Inadequate surfactant levels. Surfactant is a substance that reduces surface tension in the alveoli, preventing their collapse. In respiratory distress syndrome, premature infants have insufficient surfactant production, leading to collapsed alveoli and difficulty breathing. Choice A is incorrect because it focuses on quality rather than quantity of surfactant. Choice C is incorrect as rib cage underdevelopment is associated with congenital conditions like thoracic dystrophy, not RDS. Choice D is incorrect as gradual alveolar rupture is not a known cause of RDS.

Correct Answer: A

Rationale: The correct answer is A: Temperature > 102°F. A high fever in the context of right lower quadrant colicky pain raises concern for ureteral colic, which is often caused by kidney stones. Fever may indicate infection or obstruction, requiring urgent medical attention. Choices B, C, and D are incorrect because they are common findings in cases of ureteral colic but are not as specific to raise the index of suspicion. White blood cell count elevation and hematuria are common with kidney stones, while vomiting is a common symptom due to severe pain. However, fever is a more concerning sign that necessitates prompt evaluation.

Correct Answer: B

Rationale: Uterine apoplexy is the sudden rupture of blood vessels in the uterus, leading to severe hemorrhage. Placental abruption is the most likely cause due to the separation of the placenta from the uterine wall, resulting in bleeding. Incidental hemorrhage is not sudden or severe. Multiple pregnancy may increase the risk but doesn't directly cause uterine apoplexy. Placenta previa involves the placenta covering the cervix, leading to bleeding but not necessarily uterine rupture. Therefore, the correct answer is B.

Correct Answer: B

Rationale: The correct answer is B: Tonic. During the tonic stage of eclampsia, the muscles go into a prolonged contraction leading to an arched back and tightly clenched teeth. This is due to sustained muscle rigidity. In contrast, the clonic stage involves rhythmic muscle contractions and relaxations, not sustained rigidity. The premonitory stage is characterized by warning signs like headaches and visual disturbances, not specific physical postures. Coma is a severe stage of unconsciousness, not associated with specific physical postures or muscle rigidity seen in the tonic stage of eclampsia.

Correct Answer: A

Rationale: Placenta praevia is more common in women with a history of multiple pregnancies (Grandmultiparity), as repeated stretching of the uterine wall can lead to abnormal placental implantation. Preeclampsia is a separate condition associated with hypertension in pregnancy. Placenta fenestrate and placenta increta are specific placental abnormalities but do not directly cause placenta praevia.

Correct Answer: A

Rationale: Step-by-step rationale for why choice A is correct: 1. Pregnancy can lead to severe anaemia due to increased demand for iron and folate. 2. Pregnancy-induced physiological changes can exacerbate malaria-related anaemia. 3. Severe jaundice may occur in pregnant women with malaria due to liver dysfunction. 4. These effects are common during pregnancy and can worsen with malaria infection. Summary of why other choices are incorrect: - Choice B: Blood smear positivity is not always guaranteed in malaria, and severe anaemia is not the only effect. - Choice C: Therapy limitations can occur, but the presence of few parasites in severe cases is not a defining feature. - Choice D: Loss of pregnancy can happen, but it is not a universal effect of malaria during pregnancy, and severity is not based on parasite count alone.

Correct Answer: A

Rationale: The correct answer is A because in cases of anteriorly situated placenta praevia, where the placenta partially or completely covers the cervix, a classical caesarean section is indicated to prevent severe bleeding during delivery. For choice B, a posteriorly situated placenta praevia does not necessitate a classical caesarean section. Choice C, gestation of more than 32 weeks, does not specifically indicate the need for a classical caesarean section. Choice D, aesthetic purpose on maternal request, is not a valid medical indication for a classical caesarean section.

Correct Answer: A

Rationale: The correct answer is A: Caput succedaneum. This swelling is a result of pressure during birth and typically resolves on its own. Subgaleal hemorrhage involves bleeding into the potential space between the periosteum and skull, presenting as a boggy mass. Intracranial injury refers to damage within the skull, often due to trauma. Neonatal cephalhematoma is a subperiosteal collection of blood, causing a localized swelling. Caput succedaneum is the most likely diagnosis based on the description provided.