R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as cramping but has become more constant over the last day. She reports constipation over the last few days but admits that for as long as she can remember she has had variable bowel habits. Her vital signs are normal, but physical examination reveals some tenderness in the left lower quadrant. Which diagnostic test is most likely to support the leading differential diagnosis?

Correct Answer: B

Rationale: The correct answer is B: CBC with WBC differential. This test can help rule out infectious causes of left lower quadrant pain, such as diverticulitis or colitis, by assessing for elevated white blood cell count and left shift. A CT scan (A) with contrast may be indicated if the patient's condition worsens or if initial tests are inconclusive. Colonoscopy (C) is more appropriate for evaluating chronic or intermittent abdominal pain, not acute symptoms. Barium enema (D) is an outdated test and not commonly used for diagnosing acute abdominal pain.

Correct Answer: D

Rationale: Mallory-Weiss syndrome is caused by severe vomiting leading to tears in the esophagus. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy, which can result in Mallory-Weiss syndrome. Placenta praevia, cardiac disease, and postpartum hemorrhage are not directly associated with Mallory-Weiss syndrome.

Correct Answer: B

Rationale: Classical vitamin K deficiency bleeding occurs within the neonatal stage because newborns have low levels of vitamin K, which is essential for blood clotting. This deficiency typically manifests between 1-7 days after birth. Bleeding within the first 24 hours (choice A) is unlikely as it is too early for vitamin K deficiency to cause symptoms. Bleeding within infancy (choice C) is incorrect as it specifically refers to the neonatal stage. Bleeding within the first week of birth (choice D) is a close distractor, but the critical period for classical vitamin K deficiency bleeding is within the neonatal stage, which is slightly more specific than the first week of birth.

Correct Answer: D

Rationale: The correct answer is D: Compound. In compound presentation, a hand or foot is alongside the presenting part, usually the head. This can complicate the delivery process. A: Footling presentation means the foot presents first. B: Transverse presentation is when the baby is lying sideways. C: Cephalic presentation is normal, with the head presenting first. In this scenario, D is the correct answer as it specifically describes the situation where a hand or foot is alongside the presenting part.

Correct Answer: A

Rationale: The correct answer is A: Footling. When a hand/foot lies alongside the presenting part, it indicates a footling presentation where the foot is presenting first. This is a type of breech presentation, where the baby's buttocks or feet come out first. A transverse presentation would mean the baby is lying sideways, and an unstable lie refers to the baby's position not being fixed. Therefore, the presence of a hand/foot alongside the presenting part specifically indicates a footling presentation, making choice A the correct answer.

Correct Answer: A

Rationale: The correct answer is A: Entonox. Entonox, a mixture of nitrous oxide and oxygen, is commonly used for inhalational analgesia during labor due to its fast-acting and safe properties. Nitrous oxide provides pain relief without affecting the baby's heart rate or causing sedation. Trilene (B) is not commonly used during labor due to potential side effects on the baby. Oxygen (C) is not an analgesic but is often used in conjunction with Entonox. Nitrous oxide (D) is the active component in Entonox and is the primary analgesic agent in this mixture.

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.

Correct Answer: B

Rationale: The correct answer is B, Gestational diabetes mellitus. This condition is diagnosed when a pregnant woman exhibits symptoms of diabetes and has elevated fasting blood sugar and abnormal oral glucose tolerance test results. This specific combination of symptoms and test results during pregnancy points towards gestational diabetes mellitus. A: Potential diabetes mellitus - Incorrect. The symptoms combined with abnormal test results suggest an active condition, not potential. C: Clinical diabetes mellitus - Incorrect. While the symptoms and test results indicate diabetes, the context of pregnancy suggests gestational diabetes. D: Chemical diabetes mellitus - Incorrect. This term is not commonly used in medical practice and does not specifically address the condition in the given scenario.

Correct Answer: C

Rationale: The correct answer is C, major depression. Puerperal psychosis is a severe mental health condition that occurs in the postpartum period, characterized by symptoms such as hallucinations, delusions, and disorganized thinking. Major depression is a key clinical feature, often accompanied by mood disturbances and severe emotional distress. Rationale: - A: Episodic insomnia is a common symptom in various mental health disorders but not specific to puerperal psychosis. - B: Neglect of hygiene may occur in severe cases but is not the main clinical feature of puerperal psychosis. - D: Mild headache is not a characteristic symptom of puerperal psychosis, which is primarily marked by severe psychiatric symptoms.