clinical skills exam questions

Correct Answer: B

Rationale: The correct answer is B: fluid replacement with 0.45% saline. The patient's symptoms suggest dehydration and hypovolemia, indicated by low blood pressure, elevated heart rate, and lack of urine output. Fluid replacement with isotonic saline would help restore intravascular volume and improve blood pressure. Blood transfusion (A) is not indicated without evidence of significant blood loss. Inotropic agents (C) are used to improve cardiac function, which is not the primary issue in this case. Antiemetics (D) may help with nausea and vomiting but do not address the underlying cause of hypovolemia.

Correct Answer: B

Rationale: The correct answer is B: a decreased risk of peritonitis exists. Peritoneal dialysis involves using the peritoneum as a membrane for fluid exchange, reducing the risk of infections like peritonitis compared to hemodialysis. Option A is incorrect as peritoneal dialysis can be done at home and is less time-consuming than hemodialysis. Option C is incorrect as biochemical disturbances are corrected more gradually with peritoneal dialysis. Option D is incorrect as there is a risk of bleeding complications with peritoneal dialysis.

Correct Answer: D

Rationale: Step-by-step rationale: 1. CRRT removes solutes and water slowly to avoid hemodynamic instability. 2. Slow removal better tolerates fluid and electrolyte shifts in critically ill patients. 3. Unlike intermittent hemodialysis, CRRT provides continuous, gentle therapy. 4. Choice A is incorrect as both CRRT and intermittent hemodialysis use a hemofilter. 5. Choice B is incorrect as CRRT does not provide faster solute and water removal. 6. Choice C is incorrect as CRRT allows for diffusion to occur, albeit at a slower rate. Summary: Continuous renal replacement therapy (CRRT) removes solutes and water slowly to prevent hemodynamic instability, making it a gentler and more continuous process compared to intermittent hemodialysis. The other choices are incorrect as CRRT does use a hemofilter, does not provide faster removal, and still allows for diffusion to occur.

Correct Answer: C

Rationale: Rationale for Correct Answer (C): Elevated T and T3/T4 levels are indicative of primary hypothyroidism, such as myxedema. In this case, the patient presents with classic symptoms of hypothyroidism, including altered mental status, hypothermia, and heart failure. Elevated T3/T4 levels confirm the diagnosis. Summary of Incorrect Choices: A: Elevated adrenocorticotropic hormone is associated with adrenal disorders, not hypothyroidism. B: Elevated cortisol levels suggest Cushing's syndrome, a condition of excess cortisol production, not hypothyroidism. D: Elevated thyroid-stimulating hormone is seen in primary hypothyroidism, but in myxedema, the issue is not with TSH but with T3/T4 levels.

Correct Answer: B

Rationale: The correct answer is B: fluid replacement with 0.45% saline. The patient's symptoms suggest dehydration and hypovolemia, indicated by low blood pressure, elevated heart rate, and lack of urine output. Fluid replacement with isotonic saline would help restore intravascular volume and improve blood pressure. Blood transfusion (A) is not indicated without evidence of significant blood loss. Inotropic agents (C) are used to improve cardiac function, which is not the primary issue in this case. Antiemetics (D) may help with nausea and vomiting but do not address the underlying cause of hypovolemia.