The commonest causative organism of pyelonephritis is

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: The correct answer is D: Assessment of nonprostate causes of nocturia. In this case, the patient's symptoms of nocturia, urinary urgency, and post-void dribbling are not indicative of prostate enlargement. Given that the digital rectal examination revealed a normal-sized prostate with no hypertrophy, it is essential to explore other potential causes of nocturia in this patient. By assessing non-prostate causes of nocturia, such as diabetes, urinary tract infection, medication side effects, or sleep disorders, a more accurate diagnosis and appropriate treatment plan can be developed. This approach will lead to better patient outcomes compared to focusing solely on prostate-related evaluations. Option A: Administration of the AUA Symptom Scale is not the best approach in this case because the patient's symptoms are not primarily related to prostate enlargement. Option B: Laboratory assessment to include a PSA is not necessary since the digital rectal examination already indicated a normal-sized prostate with no appreciable hypertrophy. Option C: Ordering a

Correct Answer: B

Rationale: The correct answer is B: Correct dehydration. Acute pyelonephritis can lead to dehydration due to fever, vomiting, and decreased fluid intake. High fluid intake helps correct dehydration by maintaining adequate fluid balance and preventing further complications. Increasing urine output (choice D) is a consequence of correcting dehydration. Promoting enough rest (choice A) is important but not the primary reason for advising high fluid intake. Relief of irritability (choice C) is not directly related to the management of acute pyelonephritis.

Correct Answer: D

Rationale: Correct Answer: D. Some form of vagotomy Rationale: 1. Vagotomy is a surgical procedure that involves cutting the vagus nerve to reduce acid production in the stomach, which can help in treating ulcers. 2. Vagotomy is often recommended when ulcers are refractory to medical therapy, making it an appropriate surgical option. 3. Lifelong vitamin D replacement (A) is not typically necessary for ulcer treatment. Excision of the ulcer (B) is not a common treatment and does not address the underlying cause. Eating smaller meals (C) may help manage symptoms but is not a surgical option for refractory ulcers.

Correct Answer: C

Rationale: The correct answer is C: Decompression of the colon with rectal tube. This is the most appropriate intervention for a patient with acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome. In this condition, there is colonic distention without an actual mechanical obstruction, leading to symptoms like abdominal pain, distention, and high-pitched bowel sounds. Decompression with a rectal tube can help relieve the distention and prevent complications like perforation. Choice A (stimulant laxative) is incorrect because ACPO is not due to simple constipation, so laxatives would not be effective. Choice B (carcinoma of the bowel) is unlikely given the acute onset and lack of risk factors. Choice D (angiography for mesenteric ischemia) is not indicated in this case as there are no signs of acute ischemia. In summary, the correct choice is C because it directly addresses the underlying issue of colonic distention in

Correct Answer: A

Rationale: The correct answer is A because an acute small for gestational age neonate will have all body parts proportionately reduced in size compared to a normal gestational age baby. This is due to intrauterine growth restriction. Choice B is incorrect because the head is not disproportionately larger. Choice C is incorrect as it states the body is larger than the head, which is not the case in SGA babies. Choice D is incorrect as SGA babies typically appear thin with a scaphoid abdomen, not plumpy.

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: C

Rationale: The correct answer is C: Consideration of prophylactic therapy. A 12-mm induration in a healthcare worker is considered positive for PPD. In the absence of active TB on chest radiograph, the next step is to consider prophylactic therapy to prevent the development of active TB. This is based on the guidelines for the management of latent TB infection. Choice A is incorrect as a positive PPD warrants further evaluation regardless of the chest radiograph result. Choice B, the Quantiferon assay, is not the next step after a positive PPD and negative chest radiograph. Choice D, beginning therapy for pulmonary TB pending sputum cultures, is not indicated in this scenario as there is no evidence of active TB.

Correct Answer: D

Rationale: Step-by-step rationale for why D is correct: 1. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy. 2. Prolonged vomiting can lead to electrolyte imbalances and nutritional deficiencies. 3. Vitamin B deficiency, specifically thiamine, can result in Wernicke’s encephalopathy. 4. Mallory-Weiss syndrome can occur due to repeated retching and vomiting. 5. Therefore, hyperemesis gravidarum can lead to both Wernicke’s encephalopathy and Mallory-Weiss syndrome. Summary: A: Placenta praevia is related to abnormal placental placement, not vomiting. B: Hypertensive disorders are associated with high blood pressure, not vomiting-related complications. C: Vitamin B deficiency can lead to Wernicke’s encephalopathy but is not directly caused by hyperemesis gravidarum.