FREE CPEN Basic Exam Question and Answers
A 20-day-old male child who has poor eating, bile vomiting, and signs of abdominal pain, but whose abdomen is not swollen, has recently passed small amounts of liquid stool. A small abdominal mass is palpable, the stool guaiac tests positive for blood, and the double bubble sign is shown on the radiograph. What diagnosis do these results imply?
Volvulus is caused by a genetic malrotation defect in which the intestines are attached to the back of the abdominal wall by a single attachment rather than a broad band across the abdomen. This defect suspends the bowels, allowing them to easily twist and cause a volvulus (i.e., twisted bowel), which cuts off the blood supply. Although it might untwist, it can cause intestinal infarction. Bilious vomiting and recurrent abdominal discomfort are typical symptoms, which usually start to manifest by two months. The double bubble sign indicates intestinal obstruction because it exhibits air in the stomach and nearby but none farther away. Males experience volvulus more frequently than females.
An ankle sprain occurs while a 16-year-old is playing basketball (grade II, inversion injury). Which type of therapy is the MOST likely?
Grade I to III sprains are typically treated with RICE therapy. Compression is important to prevent swelling and to support the joint and can be performed with an elastic bandage or an Aircast ankle brace. Elevation and ice (30 minutes on, 30 minutes off) both help to reduce swelling and improve circulation. Crutches should be used for many days, along with rest with little to no weight bearing, to aid in the healing process and stop future injury.
In cases of supratentorial herniation of the brain, in addition to consciousness level, the following three functions are evaluated to determine the progression of the syndrome:
The three functions that are evaluated to define the progress syndrome in patients with supratentorial herniation of the brain are ocular, motor, and respiratory in addition to awareness level. According to increasing intracranial pressure [ICP], the early diencephalon, late diencephalon, midbrain upper pons, lower pons/upper medulla, and medulla are the stages of progression. The signs and symptoms may be reversible if they persist in the early or late diencephalon stages (before the midbrain), but this is unlikely once they reach the midbrain stage.
A 2-cm forehead laceration on a 12-year-old is stitched up. When should the kid come back so the stitches can be taken out?
The 12-year-old with the 2 cm forehead laceration needs to come back in 5 days to have the stitches taken out. The nurse must take the affected area, the circulation, and the amount of tension or pushing on the wound into account when deciding whether to remove the stitches. Due to its high blood flow, the face heals more quickly than other parts of the body, where sutures may stay in place for up to 10 days. Stitches last significantly longer in places that experience more strain, like over joints.
An abdominal mass that can be felt in the right lower quadrant is present in a 17-year-old cystic fibrosis patient who frequently experiences constipation and complains of weight loss, abdominal cramps, pain, and distension. The patient is vulnerable to:
A cystic fibrosis patient is at risk for distal intestine obstruction syndrome if they frequently experience constipation, complain of weight loss, abdominal cramps, pain, and distension, and have an abdominal mass palpable in the right lower quadrant (aka meconium ileus equivalent). A thick, viscous stool that gathers in the distal segment of the small intestine and can cause intestinal blockage if left untreated, this illness affects 20% of adult cystic fibrosis patients. It is particularly related with pancreatic insufficiency.
A teen who was inebriated tried to pick up a rattlesnake and got bitten on the wrist. The first course of action ought to be to:
When a patient bites their wrist after trying to pick up a rattlesnake while intoxicated, the first course of action should be to immobilize the affected limb to stop any movement that could spread the venom and maintain it below the level of the heart. It is not recommended to use a tourniquet, suction the wound (a typical procedure in the past), or clean the wound with alcohol. Applying ice may harm the tissue. Many bites are dry (no venom is released), thus the site should be watched carefully; nevertheless, if swelling, discomfort, or other symptoms develop, the patient may require antivenin.
A 3-year-old child has several bruises on her arms, legs, and face that range in color from purple to yellow-green to brown, as well as a spiral fracture of the shaft of her right humerus. The toddler reportedly fell off a swing set the day before while playing, according to the mother. The best suitable course of action is:
It is important to alert the local child protective services agency so that authorities can look into the possibilities of child abuse. The most frequent fractures caused by abuse in children involve spiral fractures of the long bones. New bruises should also be reddish-purple in color. Yellow-green and brown bruises all over the body indicate prior injuries. A child under the age of three is not a reliable reporter, and if the mother is questioned about abuse or given advice, the abusive mother may remove the child from care to avoid being caught.