Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?

Correct Answer: A

Rationale: The correct answer is A. High-dose initial steroids are tapered off over a period of 4 to 6 weeks posttransplant. This is because corticosteroids are used initially to prevent rejection and then gradually tapered to minimize side effects. Choice B is incorrect as it states a general interest but does not address the specific protocol for corticosteroid use. Choice C is incorrect as there is no evidence suggesting better results in corticosteroid-free protocols for second-transplant recipients. Choice D is incorrect as there is no strong evidence supporting corticosteroid-free rejection protocols in posttransplant patients.

Correct Answer: A

Rationale: The correct answer is A (Low ACTH and low cortisol) because in patients with an adrenal tumor causing Cushing's syndrome, the tumor autonomously produces cortisol, leading to suppression of ACTH secretion from the pituitary. This results in low ACTH levels and high cortisol levels. Choices B, C, and D are incorrect because they do not reflect the characteristic hormone levels seen in patients with an adrenal tumor causing Cushing's syndrome.

Correct Answer: A

Rationale: The correct answer is A: Cyclosporine. Cyclosporine is a first-line treatment for acute rejection following hepatic transplant due to its immunosuppressive properties. It inhibits T-cell activation and cytokine production, suppressing the immune response against the transplanted liver. This helps in preventing further damage caused by rejection. Azathioprine (B) and Sirolimus (D) are also immunosuppressants, but Cyclosporine is preferred as the initial treatment. Methylprednisolone (C) is a corticosteroid that can be used in combination with Cyclosporine for acute rejection to provide a more potent immunosuppressive effect.

Correct Answer: B

Rationale: The correct answer is B (500-1500 gm) because very low birth weight babies typically weigh less than 1500 grams at birth. This range encompasses the common weight range for these babies. Option A (1000-500 gm) is too narrow and excludes babies weighing below 500 grams. Option C (1001-1500 gm) is incorrect as it includes babies weighing over 1500 grams. Option D (1500-2000 gm) is incorrect as it includes babies above the typical weight range for very low birth weight babies.

Correct Answer: A

Rationale: The correct answer is A: TRUE. Uterine atony is the most common cause of immediate postpartum hemorrhage due to inadequate uterine contraction to control bleeding. This is supported by research and clinical evidence. Trauma to the genital tract is a less common cause and usually leads to delayed hemorrhage. Choice B is incorrect as uterine atony is a well-documented primary cause. Choice C is incorrect as uterine atony is consistently the leading cause. Choice D is incorrect as the cause of immediate postpartum hemorrhage is clear, with uterine atony being the most common culprit.

Correct Answer: C

Rationale: The correct answer is C: Secondary postpartum haemorrhage. This term refers to excessive bleeding from the genital tract after the first 24 hours but within the puerperium period (6 weeks postpartum). A: Primary postpartum haemorrhage occurs within the first 24 hours after delivery. B: Tertiary postpartum haemorrhage occurs more than 6 weeks postpartum. D: Incidental postpartum haemorrhage is not a recognized medical term for postpartum bleeding.

Correct Answer: B

Rationale: The correct answer is B: His procedure has put him at significant risk for B12 absorption problems. Rationale: 1. Jejunum is primarily responsible for nutrient absorption, including B12. 2. Resection of a large portion of the jejunum can lead to malabsorption of B12. 3. B12 is essential for neurological function and red blood cell production. 4. Patients with significant jejunum resection are at high risk for B12 deficiency. 5. Monitoring B12 levels and potentially requiring supplementation is crucial for patients like Jake. Summary of other choices: A: Incorrect. Lifetime issues with diarrhea are not necessarily expected following jejunum resection. C: Incorrect. The ileum may assume some functions of the jejunum but cannot fully compensate. D: Incorrect. Enteral nutrition should not be delayed for months as it is essential for Jake's recovery and nutritional needs.

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: FALSE. In preeclampsia, epigastric pain is typically associated with liver and/or HELLP syndrome, not hyperacidity. Hyperacidity is more commonly seen in conditions like gastritis or peptic ulcers. Therefore, severe epigastric pain in preeclampsia is not related to hyperacidity. Other choices are not applicable as they do not provide relevant information to the question.