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NU 580
Health Promotion
EXAM Q & A
2024
1. A 65-year-old man with a history of hypertension, diabetes and chronic
kidney disease is admitted to the hospital with acute kidney injury (AKI).
His blood pressure is 180/100 mmHg, his serum creatinine is 3.5 mg/dL
(normal range 0.6-1.2 mg/dL) and his urine output is 200 mL in the last 24
hours. What is the most likely cause of his AKI?
A) Prerenal AKI due to hypovolemia
B) Intrinsic AKI due to acute tubular necrosis
C) Postrenal AKI due to urinary obstruction
D) Intrinsic AKI due to glomerulonephritis
, 2
**Answer: B**
Rationale: Prerenal AKI is caused by decreased blood flow to the kidneys,
which can result from hypovolemia, heart failure, sepsis or renal artery
stenosis. Intrinsic AKI is caused by damage to the renal parenchyma,
which can result from acute tubular necrosis (ATN), glomerulonephritis,
interstitial nephritis or vascular disorders. Postrenal AKI is caused by
obstruction of urine flow, which can result from kidney stones, benign
prostatic hyperplasia, tumors or strictures. This patient has risk factors for
ATN, such as hypertension, diabetes and nephrotoxic drugs (e.g., contrast
agents, antibiotics, NSAIDs). ATN is characterized by a sudden rise in
serum creatinine, oliguria and muddy brown casts in the urine.
2. A 55-year-old woman with a history of breast cancer is receiving
chemotherapy through a peripherally inserted central catheter (PICC). She
develops fever, chills and malaise. Her blood cultures are positive for
Staphylococcus aureus. What is the most appropriate management of her
condition?
A) Remove the PICC and start intravenous antibiotics
B) Leave the PICC in place and start intravenous antibiotics
, 3
C) Remove the PICC and start oral antibiotics
D) Leave the PICC in place and start oral antibiotics
**Answer: A**
Rationale: This patient has a catheter-related bloodstream infection
(CRBSI), which is a serious complication of central venous catheters
(CVCs). The mainstay of treatment for CRBSI is removal of the infected
CVC and administration of intravenous antibiotics for at least 14 days.
Oral antibiotics are not sufficient to eradicate the infection and may lead to
resistance. Leaving the infected CVC in place increases the risk of
complications such as septic shock, endocarditis and metastatic infections.
3. A 25-year-old woman presents to the emergency department with
severe abdominal pain, vaginal bleeding and shoulder tip pain. She has a
positive urine pregnancy test and her beta-hCG level is 3000 mIU/mL. An
ultrasound shows no intrauterine pregnancy. What is the most likely
diagnosis?
A) Ectopic pregnancy
, 4
B) Spontaneous abortion
C) Molar pregnancy
D) Pelvic inflammatory disease
**Answer: A**
Rationale: Ectopic pregnancy is a life-threatening condition where the
fertilized ovum implants outside the uterine cavity, most commonly in the
fallopian tube. It can cause rupture of the tube and lead to hemorrhagic
shock. The classic triad of symptoms is abdominal pain, vaginal bleeding
and amenorrhea. Shoulder tip pain is a sign of diaphragmatic irritation due
to blood in the peritoneal cavity. The diagnosis is confirmed by a positive
pregnancy test, an elevated beta-hCG level (>1500 mIU/mL) and an empty
uterus on ultrasound.
4. A 35-year-old man with a history of gout presents to the clinic with
acute onset of severe pain, swelling and redness in his right big toe. He
says he had a large meal of red meat and alcohol last night. His serum uric
acid level is 9 mg/dL (normal range 3.5-7 mg/dL). What is the most
effective pharmacological treatment for his condition?
NU 580
Health Promotion
EXAM Q & A
2024
1. A 65-year-old man with a history of hypertension, diabetes and chronic
kidney disease is admitted to the hospital with acute kidney injury (AKI).
His blood pressure is 180/100 mmHg, his serum creatinine is 3.5 mg/dL
(normal range 0.6-1.2 mg/dL) and his urine output is 200 mL in the last 24
hours. What is the most likely cause of his AKI?
A) Prerenal AKI due to hypovolemia
B) Intrinsic AKI due to acute tubular necrosis
C) Postrenal AKI due to urinary obstruction
D) Intrinsic AKI due to glomerulonephritis
, 2
**Answer: B**
Rationale: Prerenal AKI is caused by decreased blood flow to the kidneys,
which can result from hypovolemia, heart failure, sepsis or renal artery
stenosis. Intrinsic AKI is caused by damage to the renal parenchyma,
which can result from acute tubular necrosis (ATN), glomerulonephritis,
interstitial nephritis or vascular disorders. Postrenal AKI is caused by
obstruction of urine flow, which can result from kidney stones, benign
prostatic hyperplasia, tumors or strictures. This patient has risk factors for
ATN, such as hypertension, diabetes and nephrotoxic drugs (e.g., contrast
agents, antibiotics, NSAIDs). ATN is characterized by a sudden rise in
serum creatinine, oliguria and muddy brown casts in the urine.
2. A 55-year-old woman with a history of breast cancer is receiving
chemotherapy through a peripherally inserted central catheter (PICC). She
develops fever, chills and malaise. Her blood cultures are positive for
Staphylococcus aureus. What is the most appropriate management of her
condition?
A) Remove the PICC and start intravenous antibiotics
B) Leave the PICC in place and start intravenous antibiotics
, 3
C) Remove the PICC and start oral antibiotics
D) Leave the PICC in place and start oral antibiotics
**Answer: A**
Rationale: This patient has a catheter-related bloodstream infection
(CRBSI), which is a serious complication of central venous catheters
(CVCs). The mainstay of treatment for CRBSI is removal of the infected
CVC and administration of intravenous antibiotics for at least 14 days.
Oral antibiotics are not sufficient to eradicate the infection and may lead to
resistance. Leaving the infected CVC in place increases the risk of
complications such as septic shock, endocarditis and metastatic infections.
3. A 25-year-old woman presents to the emergency department with
severe abdominal pain, vaginal bleeding and shoulder tip pain. She has a
positive urine pregnancy test and her beta-hCG level is 3000 mIU/mL. An
ultrasound shows no intrauterine pregnancy. What is the most likely
diagnosis?
A) Ectopic pregnancy
, 4
B) Spontaneous abortion
C) Molar pregnancy
D) Pelvic inflammatory disease
**Answer: A**
Rationale: Ectopic pregnancy is a life-threatening condition where the
fertilized ovum implants outside the uterine cavity, most commonly in the
fallopian tube. It can cause rupture of the tube and lead to hemorrhagic
shock. The classic triad of symptoms is abdominal pain, vaginal bleeding
and amenorrhea. Shoulder tip pain is a sign of diaphragmatic irritation due
to blood in the peritoneal cavity. The diagnosis is confirmed by a positive
pregnancy test, an elevated beta-hCG level (>1500 mIU/mL) and an empty
uterus on ultrasound.
4. A 35-year-old man with a history of gout presents to the clinic with
acute onset of severe pain, swelling and redness in his right big toe. He
says he had a large meal of red meat and alcohol last night. His serum uric
acid level is 9 mg/dL (normal range 3.5-7 mg/dL). What is the most
effective pharmacological treatment for his condition?
