Explanation:

• (a) Care of the patient's skin to prevent bed sores:Spinal cord compression can lead to immobility or decreased sensation, increasing the risk of pressure ulcers (bed sores). Skin care is a primary nursing responsibility to prevent this complication.
• (b) Help ambulate the patient with a walker:Ambulation depends on the severity of compression and neurological deficits. This may not be appropriate or safe for all patients and is not the most universal immediate instruction.
• (c) Give plenty of carbohydrate diet:Diet is important for overall health, but a carbohydrate-rich diet isn't a priority intervention specifically for spinal cord compression complications like skin breakdown.
• (d) Encourage the patient to take plenty of oral fluids:Fluid intake is important, but preventing dehydration is not the most immediate or specific nursing instruction related to the *compression* itself or its common severe complications like immobility-related pressure ulcers.

Explanation:

• (b) Use upright chairs:Patients with Parkinson's often have postural instability and a tendency to slump. Upright chairs help maintain good posture, improve breathing, and can aid in preventing falls when getting up.
• (a) Encourage tight clothing:Tight clothing can be difficult for a patient with Parkinson's due to rigidity and bradykinesia (slow movement). Loose, easy-to-manage clothing is preferred.
• (c) Use glass utensils while feeding:Glass utensils can be heavy and breakable, increasing the risk of accidents for patients with tremors. Lighter, non-breakable utensils are safer.
• (d) Wear tightly fitting shoes while moving:Tightly fitting shoes can restrict movement and be difficult to put on. Comfortable, well-fitting shoes with good support are recommended to prevent falls.

Explanation:

• (a) carry out passive movements of the paralysed limbs:Subarachnoid haemorrhage can lead to neurological deficits including paralysis. Passive range of motion exercises are crucial to prevent contractures, stiffness, and promote circulation in paralysed limbs. This is a priority to prevent long-term disability.
• (b) encourage a high fibre diet:A high fibre diet is important for preventing constipation, but it is not the *priority* intervention in the immediate management of a subarachnoid haemorrhage, which focuses on neurological stability and preventing complications like vasospasm.
• (c) encourage plenty of vitamin C:Vitamin C is important for general health but has no specific priority role in the immediate management of subarachnoid haemorrhage.
• (d) massage the whole body:Massage can be therapeutic, but it is not a priority in the acute phase of a subarachnoid haemorrhage. In some cases, vigorous massage might even be contraindicated depending on the patient's condition and risk of increasing intracranial pressure.

Explanation:

• (c) Use of acetylsalicylic acid and diuretics:Low-dose aspirin (acetylsalicylic acid) and many diuretics can interfere with the kidneys' ability to excrete uric acid, potentially worsening gout. These should generally be avoided or used cautiously under medical supervision in patients with gout.
• (a) Weight reduction:Obesity is a risk factor for gout. Weight loss can help lower uric acid levels and reduce the frequency of attacks. This is beneficial.
• (b) Controlling diet especially red meat:Red meat is high in purines, which are metabolized into uric acid. Limiting purine-rich foods is a key dietary recommendation for gout management. This is beneficial.
• (d) Resting the affected joint:Resting the inflamed joint during an acute gout attack helps reduce pain and inflammation. This is a recommended measure.

Explanation:

• (d) hypo thyroidism:Hypothyroidism is characterized by a slowed metabolism. Symptoms often include fatigue (leading to reduced physical activity), decreased appetite (though weight gain can occur due to fluid retention and slowed metabolism), dry/coarse skin, cold intolerance, and constipation.
• (a) hyper thyroidism:Hyperthyroidism is characterized by increased metabolism. Symptoms include increased appetite, weight loss, increased physical activity/restlessness, heat intolerance, and smooth, warm, moist skin.
• (b) hyper parathyroidism:Hyperparathyroidism affects calcium and phosphate levels, leading to symptoms like bone pain, kidney stones, fatigue, and depression, but not typically reduced appetite or coarse skin.
• (c) hypo parathyroidism:Hypoparathyroidism affects calcium levels, leading to symptoms like muscle cramps, tingling, and tetany, but not typically reduced appetite or coarse skin.

Explanation:

• (b) fluid volume excess:Kidney disease often impairs the kidneys' ability to excrete excess fluid and sodium, leading to fluid accumulation in the tissues, which manifests as oedema. Fluid volume excess is the most direct nursing diagnosis for this condition.
• (a) fluid volume deficit:This is the opposite of oedema and is incorrect.
• (c) altered nutrition:While kidney disease can impact nutrition, oedema itself is primarily a fluid balance issue, not a primary nutrition issue.
• (d) altered body image:Oedema can certainly cause altered body image, but the *most appropriate* nursing diagnosis directly addressing the physiological problem causing the oedema is fluid volume excess.

Explanation:

• (d) accumulation of fat:The classic "moon face" and "buffalo hump" (fat pad between shoulders) in Cushing's syndrome are caused by abnormal redistribution and accumulation of adipose tissue resulting from excess cortisol.
• (a) oedema:Oedema is fluid retention, which can contribute to facial puffiness, but the distinct roundness of the face in Cushing's is primarily due to fat deposition.
• (b) obesity:While patients with Cushing's often gain weight (central obesity), the specific moon face is not just general obesity but a characteristic fat redistribution.
• (c) skin hypertrophy:Skin changes in Cushing's include thinning, easy bruising, and striae, not hypertrophy (thickening).

Explanation:

• (b) Restrict fluid intake:Nephrotic syndrome often leads to significant oedema and fluid retention due to protein loss and impaired kidney function. Restricting fluid intake helps manage this fluid volume excess. Sodium restriction (not high salt) is also common to reduce fluid retention.
• (a) Give a high salt diet:A high salt diet would worsen fluid retention and oedema, and should be avoided.
• (c) Restrict a high carbohydrate diet:Dietary restrictions in nephrotic syndrome typically focus on protein (often adjusted depending on kidney function) and sodium, not generally carbohydrates.
• (d) Give plenty of fluids:Giving plenty of fluids would worsen fluid overload and oedema, and should be avoided when oedema is present.

Explanation:

• (d) renal failure:Severe dehydration reduces blood flow to the kidneys (prerenal azotemia), which, if prolonged, can lead to acute kidney injury (renal failure). Preventing dehydration is crucial for maintaining kidney perfusion and function.
• (a) pyelonephritis:Pyelonephritis is a kidney infection, typically caused by bacteria ascending from the urinary tract. Dehydration doesn't directly cause it, although poor fluid intake might contribute to urinary stasis in some cases.
• (b) glomerulonephritis:Glomerulonephritis is inflammation of the glomeruli, often immune-mediated. Dehydration is not a direct cause.
• (c) nephrotic syndrome:Nephrotic syndrome is a collection of symptoms including protein in the urine, low blood protein, high cholesterol, and oedema. Dehydration is not a cause; in fact, oedema represents fluid excess.

Explanation:

• (b) Maintain a patent airway:In any acute admission, especially with potential for severe complications like thyroid storm, maintaining a patent airway is a fundamental and immediate priority in the ABCs (Airway, Breathing, Circulation). Although less common than in other conditions, severe hyperthyroidism can impact respiratory function or lead to altered consciousness.
• (a) Provide warm bathing water:Patients with hyperthyroidism often have heat intolerance. Warm water would be uncomfortable; cool water is preferred. This is not a first priority.
• (c) Provide a high salt diet:A high salt diet is not indicated for hyperthyroidism.
• (d) Maintain an increased IV infusion:While IV fluids may be needed for hydration or medication administration, initiating an increased IV infusion is not the *first* action before ensuring airway patency.

Explanation:

• (a) Ensure bed rest:While prolonged bed rest is now discouraged for simple back pain, initial rest (usually short-term) is a common recommendation and nursing intervention to reduce stress on the spine and alleviate acute pain. Assessing the *cause* of the pain is the absolute first step, but among the *interventions* listed, bed rest is the most appropriate initial measure for acute pain relief.
• (b) Encourage lifting heavy objects:Lifting heavy objects would worsen lower back pain and should be strictly avoided.
• (c) Encourage consumption of a fatty diet:Diet has no direct impact on lower back pain, and a fatty diet is generally unhealthy.
• (d) Administer plenty of IV fluids:IV fluids are not indicated for lower back pain unless there's an underlying condition requiring hydration or IV medication.

Explanation:

• (b) Polydipsia:Diabetes insipidus is characterized by the excretion of large amounts of dilute urine (polyuria) due to a deficiency in or insensitivity to ADH. This excessive water loss leads to intense thirst and increased fluid intake (polydipsia) as the body tries to compensate.
• (a) Diarrhoea:Diarrhoea is loose stools, not a primary symptom of diabetes insipidus.
• (c) Polyphagia:Polyphagia is excessive hunger, a symptom of diabetes mellitus (sugar diabetes), not diabetes insipidus.
• (d) Weight gain:Diabetes insipidus typically leads to weight loss due to fluid excretion, not gain. Weight gain is associated with conditions like Cushing's syndrome or uncontrolled diabetes mellitus.

Explanation:

• (c) herpes zoster:Herpes zoster (shingles) is caused by reactivation of the varicella-zoster virus (the same virus that causes chickenpox). It typically presents with unilateral pain, tingling, or burning along a dermatome (area of skin supplied by a single nerve) before the characteristic rash appears. The pain can precede the rash by several days.
• (a) skin rash:"Skin rash" is too general. While herpes zoster causes a rash, the description specifically mentions neuropathic pain along dermatomes *before* or accompanying the rash.
• (b) chicken pox:Chickenpox is the primary infection with varicella-zoster virus, characterized by a widespread itchy rash, not typically unilateral dermatomal pain.
• (d) impetigo:Impetigo is a bacterial skin infection causing sores, not neuropathic pain along dermatomes.

Explanation:

• (a) Consume more milk and vitamin D:Milk is a good source of calcium, and vitamin D is essential for calcium absorption. Adequate intake of calcium and vitamin D is crucial for bone health and managing osteoporosis.
• (b) Avoid calcium and floride:Calcium is needed for bone strength. Fluoride can also be beneficial for bone health in some cases. Avoiding them would be harmful.
• (c) Avoid weight bearing exercises:Weight-bearing exercises (like walking, jogging, weightlifting) are recommended for patients with osteoporosis as they help strengthen bones. Avoiding them would be detrimental.
• (d) Take more progesterone than oestrogen supplements:Hormone replacement therapy often involves oestrogen (sometimes with progesterone) to help bone density, especially in post-menopausal women. The balance and need for specific hormones are medical decisions, and advising "more progesterone than oestrogen" as general advice is incorrect and potentially harmful.

Explanation:

• (a) late menopause:Menopause, especially early menopause, is a significant risk factor for osteoporosis because oestrogen levels decline, leading to bone loss. *Late* menopause (menopause occurring at an older age than average) is actually associated with a *reduced* risk of osteoporosis compared to early or average menopause. Therefore, late menopause is the risk factor that should be *excluded* from the list of *risk* factors.
• (b) cigarette smoking:Smoking is a known risk factor for osteoporosis.
• (c) sedentary life:Lack of weight-bearing exercise (sedentary life) contributes to bone loss and is a risk factor.
• (d) no pregnancies:Parity (number of pregnancies) has a complex relationship with osteoporosis risk, but having *no* pregnancies or a lower number of pregnancies is generally associated with a slightly increased risk compared to women who have had multiple pregnancies, possibly due to hormonal exposure or nutritional factors. So, this is often considered a *potential* risk factor. The clear exclusion here is late menopause.

Explanation:

• (c) polyuria:Patients with diabetes insipidus experience excessive urination (polyuria), which often occurs day and night (nocturia). Waking up frequently during the night to urinate directly causes sleep disturbance.
• (a) back pain:Back pain is not a typical symptom of diabetes insipidus.
• (b) irritability:While chronic sleep deprivation can lead to irritability, the *cause* of the sleep disturbance in diabetes insipidus is the polyuria, not irritability itself.
• (d) reduced osmolality:Reduced urine osmolality is a *sign* of diabetes insipidus (very dilute urine), not something that directly causes sleep disturbance. The high volume of urine (polyuria) causes the frequent waking.

Explanation:

• (d) Trigeminal neuralgia:Trigeminal neuralgia is a painful condition affecting the trigeminal nerve, which is the fifth cranial nerve (CN V). It causes severe, sharp facial pain, often triggered by touching the face, chewing, or talking.
• (a) Bell's palsy:Bell's palsy affects the facial nerve (seventh cranial nerve, CN VII), causing weakness or paralysis of the muscles on one side of the face.
• (b) Parkinson's disease:Parkinson's disease is a neurological disorder affecting the central nervous system (primarily the basal ganglia) and movement, not primarily a cranial nerve disorder.
• (c) Myasthenia Gravis:Myasthenia Gravis is an autoimmune neuromuscular disease causing weakness in voluntary muscles, often affecting muscles supplied by cranial nerves (like those controlling eye movement, speaking, swallowing) but it's a problem at the neuromuscular junction, not the nerve itself being primarily affected like in trigeminal neuralgia.

Explanation:

• (a) Elevate the head of the bed:Difficulty breathing (dyspnea) in a patient with renal failure is often due to fluid overload causing pulmonary oedema. Elevating the head of the bed is an immediate, non-pharmacological intervention that helps improve lung expansion and reduce the sensation of breathlessness by decreasing venous return to the heart and pooling fluid in the lower extremities.
• (b) Administer furosemide:Furosemide is a diuretic that helps remove excess fluid, addressing the cause of dyspnea. However, administering medication requires a prescription and is not the *first* immediate action the nurse takes independently.
• (c) Call doctor:Calling the doctor is important to report the symptom and receive orders (like for furosemide or oxygen), but it's not the *first* action. The nurse takes immediate steps while waiting for the doctor.
• (d) Administer oxygen:Oxygen may be needed to improve oxygenation, but elevating the head of the bed is often a more immediate and effective measure to improve mechanics of breathing in pulmonary congestion. Oxygen administration typically requires an order unless it's an emergency protocol situation. Elevating the head is a universally applicable first step for dyspnea.

Explanation:

• (d) make a fist and then oppose each finger to the thumb:Making a fist and performing thumb opposition (touching each fingertip to the thumb) assesses a wide range of fine motor movements and joint mobility in the hand and fingers, providing a good indication of overall hand function and range of motion relevant to activities of daily living.
• (a) wave the hand as though waving good bye:This assesses wrist and forearm movement (flexion/extension, pronation/supination) but doesn't fully assess finger and thumb range of motion.
• (b) grip the nurse's hand as hard as possible:This assesses grip strength, not full range of motion.
• (c) rapidly move the hand to have the palm face up:This assesses speed and coordination of pronation/supination, but not the full range of motion of all hand joints.

Explanation:

• (a) Limitation in movement and accompanying pain:Joint effusion (swelling due to excess fluid) causes the joint capsule to stretch, leading to pain, and the excess fluid mechanically restricts the joint's range of motion.
• (b) Obvious appearance of deformity:While severe effusion can make the joint look swollen and potentially *appear* deformed, "obvious deformity" usually suggests structural damage (like fracture or severe dislocation), which isn't a guaranteed finding with simple effusion.
• (c) Crepitus and difficulty bearing weight:Crepitus (a grating sound) is often associated with bone-on-bone friction or cartilage damage (like in osteoarthritis). Difficulty bearing weight is likely due to pain and swelling but crepitus is not directly caused by effusion itself.
• (d) Obvious redness and skin break down:Redness is a sign of inflammation or infection (septic arthritis), which can cause effusion, but effusion itself doesn't necessarily cause redness. Skin breakdown is not a typical finding with simple joint effusion unless there is concurrent trauma or infection causing skin changes.

Explanation:

• (c) streptococcus:Post-streptococcal glomerulonephritis is a common cause of acute glomerulonephritis, particularly in children, following an infection (like strep throat or impetigo) caused by certain strains of *Streptococcus pyogenes*.
• (a) toxoplasmosis:Toxoplasmosis is a parasitic infection, not a common cause of glomerulonephritis.
• (b) staphylococcus:While some staphylococcal infections can potentially lead to kidney issues, streptococcal infections are more commonly associated with post-infectious glomerulonephritis.
• (d) proteins:Protein in the urine (proteinuria) is a symptom of glomerular damage, not a cause of glomerulonephritis.

Explanation:

• (b) adequate calories, high carbohydrates, limited protein:A diet for renal failure often aims to provide enough calories (often from carbohydrates and fats) to prevent the body from breaking down its own protein for energy. Protein intake is typically *limited* because protein breakdown produces waste products (like urea) that the damaged kidneys cannot excrete effectively. Fat is also included to meet caloric needs.
• (a) high protection, high carbohydrates, low calories:"High protection" is unclear. High carbohydrates are often used, but low calories would not provide adequate energy, potentially leading to protein breakdown.
• (c) limited protein, low carbohydrates, adequate calories:Limited protein and adequate calories are correct goals. However, low carbohydrates would make it difficult to meet calorie needs without excessive fat intake, and carbohydrates are usually a primary source of non-protein calories.
• (d) low calories, limited protein, low carbohydrates:Low calories, limited protein, and low carbohydrates would be insufficient to meet nutritional needs and would promote malnutrition and protein breakdown.

Explanation:

• (b) diabetes insipidus:This condition is characterized by polyuria (large volume of urine) and polydipsia (excessive thirst) due to a problem with ADH. The key here is the urine being "very dilute".
• (a) urinary tract infection:UTIs typically cause increased frequency of urination (often small amounts), urgency, and painful urination, not usually large volumes of dilute urine.
• (c) hyperglycaemia:High blood sugar (hyperglycaemia), as seen in uncontrolled diabetes mellitus, can cause polyuria and polydipsia due to osmotic diuresis, but the urine contains glucose and is not typically described as "very dilute" in the same way as in diabetes insipidus.
• (d) hypoglycaemia:Low blood sugar does not cause excessive thirst or polyuria.

Explanation:

• (d) control blood glucose levels:The primary goal of diabetes mellitus treatment (both Type 1 and Type 2) is to maintain blood glucose levels within a target range to prevent both acute complications (hypo/hyperglycaemia) and long-term complications (damage to eyes, kidneys, nerves, blood vessels).
• (a) produce secretion of insulin / (b) increase the secretion of insulin:This is a goal only in Type 2 diabetes, where the pancreas may still produce some insulin, but it's not the primary goal in Type 1 (where insulin production is absent) or the overarching goal for all diabetes management, which is blood glucose control regardless of *how* that's achieved.
• (c) reduce the uptake of insulin by the cells:This would worsen insulin resistance (a feature of Type 2 diabetes) and make it harder for cells to utilize glucose, which is the opposite of the desired effect.

Explanation:

• (a) Early morning joint pain:Morning stiffness and pain lasting for more than 30 minutes (often several hours) is a classic symptom of inflammatory arthritis like rheumatoid arthritis.
• (b) Increased range of motion in the hands:Rheumatoid arthritis causes inflammation and damage to joints, leading to pain, stiffness, and *decreased* range of motion, often in the hands and feet.
• (c) Increased range of motion in the legs:Similar to the hands, joints in the legs (knees, ankles) are often affected, leading to *decreased* range of motion.
• (d) Absence of joint swelling:Joint swelling (synovitis) is a characteristic feature of active rheumatoid arthritis.

Explanation:

• (d) Urinary stones:Urinary stones are not a known association or complication of osteoarthritis.
• (a) Sedentary life style:While inactivity can worsen joint health, paradoxically, overuse and *active* lifestyle (especially involving repetitive stress or obesity) are more strongly associated with developing osteoarthritis. However, managing osteoarthritis involves balancing rest and activity.
• (b) Back-pain relieved by rest:Back pain is a common symptom of osteoarthritis of the spine. Pain in OA typically worsens with activity and improves with rest, although severe OA can cause pain at rest.
• (c) Fracture:While OA itself doesn't cause fractures, conditions that *co-occur* with OA (like older age, reduced physical activity) can increase fracture risk. Also, severe joint damage and instability from OA can contribute to falls which lead to fractures. So, fracture is a plausible associated issue, though not a direct symptom. Urinary stones are completely unrelated.

Explanation:

• (d) Sudden epigastric pain:Epigastric pain (pain in the upper abdomen) is not a typical symptom of stroke. Stroke symptoms are neurological and occur suddenly.
• (a) Sudden numbness:Sudden numbness or weakness, especially on one side of the body, is a common sign of stroke.
• (b) Sudden vision loss:Sudden vision changes, including loss of vision in one or both eyes, is a possible stroke symptom.
• (c) Sudden trouble speaking:Sudden difficulty speaking (dysarthria) or understanding speech (aphasia) is a key symptom of stroke.

Explanation:

• (b) embolus:An embolus is a mass (such as a blood clot, fat globule, air bubble, or piece of tissue) that travels through the bloodstream from one site to another.
• (a) thrombus:A thrombus is a blood clot that forms and stays in place within a blood vessel.
• (c) infarction:Infarction is tissue death (necrosis) caused by lack of oxygen due to obstruction of blood supply, often by an embolus or thrombus.
• (d) necrosis:Necrosis is the death of body tissue, often caused by insufficient blood flow or injury.

Explanation:

• (d) somatotropin:Somatotropin is another name for growth hormone (GH). Growth hormone deficiency leads to certain types of dwarfism.
• (a) aldosterone:Aldosterone is a hormone produced by the adrenal glands that regulates sodium and potassium balance, not growth.
• (b) cortisol:Cortisol is a stress hormone produced by the adrenal glands, affecting metabolism, immune function, etc., but not directly causing dwarfism from its absence.
• (c) renin:Renin is an enzyme produced by the kidneys that plays a role in blood pressure regulation, not growth.

Explanation:

• (a) Place the patient in isolation room:Meningococcal meningitis is a highly contagious bacterial infection spread by respiratory droplets. Placing the patient in respiratory isolation is a crucial and specific infection control measure.
• (b) Check to see if the patient is HIV positive:While immunocompromised individuals might be at higher risk for severe infections, checking for HIV status is not a specific immediate nursing action for managing meningococcal meningitis transmission.
• (c) Administer amphotericin B as ordered:Amphotericin B is an antifungal medication, used for fungal infections like cryptococcal meningitis, not bacterial meningococcal meningitis which is treated with antibiotics.
• (d) Observe patient for skin lesions:While meningococcal meningitis can cause a characteristic rash (petechiae or purpura), observing for skin lesions is a general assessment. Isolation is the specific *action* related to the *type* of infection and its transmission route.

Explanation:

• (c) urethritis:Urethritis is inflammation of the urethra. In women, it can cause symptoms like painful or frequent urination, vaginal discharge, and pelvic pain, sometimes worse during intercourse. It's often caused by sexually transmitted infections.
• (a) renal failure:Renal failure has widespread systemic effects but doesn't typically present with these specific genitourinary symptoms like vaginal discharge and painful intercourse.
• (b) glomerulonephritis:Glomerulonephritis is inflammation of the kidney glomeruli and causes symptoms like blood/protein in urine, oedema, hypertension, not vaginal discharge or painful intercourse.
• (d) pyelonephritis:Pyelonephritis is a kidney infection. Symptoms include flank pain, fever, chills, nausea, vomiting, and painful/frequent urination, but not typically vaginal discharge or pain during intercourse.

Explanation:

• (a) Haematuria:Blood in the urine (haematuria) is a common finding in glomerulonephritis because the damaged glomeruli allow red blood cells to leak into the urine.
• (b) Low blood urea nitrogen:Glomerulonephritis often impairs kidney function, leading to *increased* (high) blood urea nitrogen (BUN) and creatinine levels, not low levels.
• (c) Low specific gravity:Urine specific gravity reflects its concentration. While kidney disease can affect concentrating ability, glomerulonephritis is more directly associated with impaired filtration, leading to abnormal components in the urine (like blood and protein) rather than just dilute urine (low specific gravity). The specific gravity may be low if fluid overload is present, but haematuria is a more direct indicator of glomerular damage.
• (d) Hypotension:Glomerulonephritis is often associated with *hypertension* (high blood pressure) due to fluid retention and activation of the renin-angiotensin system, not hypotension (low blood pressure), unless in severe, complicated cases with shock.

Explanation:

• (c) their appetite is poor and protein is lost during dialysis:Patients with end-stage renal disease often have poor appetite due to the effects of kidney failure (uraemia). Dialysis itself can lead to nutrient losses, particularly protein and water-soluble vitamins. The special diet is designed to provide adequate protein and calories despite poor appetite and losses, manage fluid/electrolyte imbalances, and limit waste products.
• (a) they have accumulated a lot of waste products:While waste products accumulate, the special diet and drugs are not primarily given *because* they've accumulated waste (dialysis removes waste), but to manage the *consequences* of kidney failure and dialysis treatment.
• (b) their bodies cannot sustain the process of dialysis:This is generally not true; dialysis is a life-sustaining treatment that patients undergo regularly. The diet and drugs help them *tolerate* dialysis and manage kidney failure, not because their bodies cannot sustain it.
• (d) they need to gain body weight:While some patients may be malnourished and need to gain weight, this is not universally true for all dialysis patients. The diet is tailored to individual needs, which might include weight maintenance, gain, or loss.

Explanation:

• (b) Migraine headache:Migraine headaches are classically described as unilateral (one-sided), pulsating or throbbing pain of moderate to severe intensity, often accompanied by nausea, vomiting, and sensitivity to light and sound.
• (a) Brain tumour headache:Headaches from brain tumours are variable but are often dull, constant, and worsen with changes in position or coughing. They are less commonly described as strictly unilateral and throbbing like a migraine.
• (c) Tension headache:Tension headaches are typically described as a band-like tightness or pressure around the head, usually bilateral (on both sides), and are not usually throbbing or unilateral.
• (d) Cluster headache:Cluster headaches are also unilateral and severe, but they are typically described as excruciating, sharp, or piercing pain behind or around one eye, occurring in clusters, and often associated with symptoms like drooping eyelid, tearing, and nasal congestion on the affected side. While unilateral and intense, the quality of pain and associated symptoms differ from classic migraine.

Explanation:

• (d) Parkinson's disease:The core motor symptoms of Parkinson's disease are resting tremor, bradykinesia (sluggishness/slow movement), and rigidity (muscle stiffness).
• (a) Tourette's syndrome:Tourette's syndrome is characterized by tics (sudden, repetitive, involuntary movements or vocalizations), not primarily resting tremor, bradykinesia, or rigidity.
• (b) Huntington's disease:Huntington's disease is a genetic disorder causing progressive breakdown of nerve cells. It is characterized by uncontrolled movements (chorea), cognitive decline, and psychiatric problems, not typically resting tremor or significant rigidity in the early stages.
• (c) Glycogen storage disease:Glycogen storage diseases are metabolic disorders affecting glycogen metabolism, primarily causing issues like hypoglycaemia, muscle weakness, or liver enlargement, not the neurological symptoms described.

Explanation:

• (c) multiple sclerosis:Multiple sclerosis (MS) is a chronic disease affecting the central nervous system (brain, spinal cord, and optic nerves). It is characterized by demyelination, where the myelin sheath that insulates nerve fibers is damaged in patches, forming plaques or lesions.
• (a) polyneuropathy / (b) peripheral neuropathy:These terms refer to damage to the peripheral nerves (nerves outside the brain and spinal cord), not primarily the central nervous system structures like the brain, spinal cord, and optic nerves described.
• (d) transverse myelitis:Transverse myelitis is inflammation across a segment of the spinal cord, which can involve demyelination, but it is typically localized to the spinal cord and may be a symptom of MS or other conditions, rather than the overarching disorder affecting brain, spinal cord, and optic nerves.

Explanation:

• (a) spondylosis:Spondylosis refers to age-related wear and tear changes of the spine, including degeneration of the discs and facet joints. Cervical spondylosis affects the neck (cervical spine).
• (b) compression:Compression refers to pressure on nerves or the spinal cord, which can be a *consequence* of spondylosis (e.g., cervical spinal stenosis or nerve root compression) but is not the name of the degenerative disease itself.
• (c) atrophy:Atrophy means wasting away of tissue (like muscle), not a degenerative disease of the bone/disc structures.
• (d) neuropathy:Neuropathy is damage to nerves, which can be a *result* of spinal compression due to spondylosis, but not the name of the bone/disc degeneration.

Explanation:

• (a) acute transverse myelitis:As discussed in an earlier fill-in, transverse myelitis is inflammation *across* a segment of the spinal cord. Severe inflammation can lead to significant damage or swelling that interrupts nerve impulse transmission completely below the level of the lesion, causing paralysis, sensory loss, and autonomic dysfunction.
• (b) nerve disorder:Too general.
• (c) neuromuscular disorders:Affect the nerves *and* muscles or the junction between them, not specifically total blockage of impulses within the spinal cord itself.
• (d) spinal haematoma:A spinal haematoma (blood clot) can cause compression and block nerve transmission, but "transverse myelitis" specifically describes the inflammatory process across the cord, which fits the description of interrupting transmission up and down. Acute transverse myelitis implies a sudden onset and inflammation affecting the entire width of the cord segment.

Explanation:

• (b) spinal cord compression:Spinal cord compression can cause pain, weakness, sensory changes, and bowel/bladder dysfunction. Providing a safe environment is crucial due to mobility issues and weakness. Assisting with activity is needed to maintain function while avoiding injury. Monitoring neurological status and pain intensity are key assessments to detect worsening compression or complications.
• (a) transverse myelitis:While some measures (safe environment, neurological monitoring) apply, the emphasis on pain intensity monitoring and specific activity assistance due to compression fits spinal cord compression more directly.
• (c) general paralysis of the insane:An outdated term for neurosyphilis, which primarily causes cognitive and psychiatric issues in later stages, not the immediate concerns listed.
• (d) demyelinating disorders:A broad category including MS. While neurological monitoring and safe environment are relevant, the specific focus on pain intensity and activity assistance in the context of *compression* points strongly to spinal cord compression.

Explanation:

• (b) hypothyroidism:Hypothyroidism is a condition of underactive thyroid, leading to a slowed metabolism. This results in decreased heart rate (bradycardia), reduced cardiac output, slowed circulation (cool skin), and difficulty tolerating cold temperatures (cold intolerance).
• (a) hypopituitarism:Hypopituitarism is decreased hormone production by the pituitary gland. Symptoms vary depending on which hormones are deficient but typically don't include this specific set of cardiovascular and metabolic symptoms unless thyroid-stimulating hormone (TSH) deficiency is involved, leading to secondary hypothyroidism.
• (c) hyperpituitarism:Hyperpituitarism is excessive hormone production by the pituitary. Symptoms depend on the hormone but are generally related to *increased* metabolic function (e.g., gigantism, acromegaly), not slowed function.
• (d) hyperthyroidism:Hyperthyroidism is overactive thyroid, leading to increased metabolism. Symptoms include tachycardia (fast heart rate), increased cardiac output, warm/moist skin, and heat intolerance.

Explanation:

• (b) Hydronephrosis:Hydronephrosis is swelling of the kidney due to a blockage of urine flow. While the *cause* of the obstruction (like kidney stones) can cause hematuria, hydronephrosis itself (the swelling due to back pressure) typically does not cause blood in the urine unless there is an associated infection, stone, or trauma.
• (a) Kidney stones:Stones can cause bleeding as they move through the urinary tract, irritating and damaging the lining.
• (c) Glomerulonephritis:Inflammation of the glomeruli leads to leakage of blood cells into the urine (hematuria).
• (d) Obstruction of the ureters:Obstruction (e.g., by a stone or tumour) can cause bleeding from irritation or increased pressure, similar to kidney stones.

Explanation:

• (c) using a uristic:A "uristic" likely refers to a urine dipstick (urinalysis strip). Urine dipsticks are the standard, most accurate, and convenient method for qualitative or semi-quantitative detection of glucose in urine in a clinical setting.
• (a) using boiling method:Older methods like Benedict's test involving boiling were used but are less accurate and less convenient than dipsticks.
• (b) culture and sensitively:Urine culture and sensitivity tests are used to identify bacteria and determine antibiotic effectiveness, not to detect glucose.
• (d) microscopic examination of urine:Microscopic examination looks for cells, crystals, casts, etc., but does not directly detect dissolved substances like glucose in the urine.

Explanation:

• (a) Uncontrolled diabetes mellitus:When there is insufficient insulin (especially in Type 1), cells cannot use glucose for energy. The body then breaks down fats, producing ketones as a byproduct. These ketones accumulate in the blood and spill into the urine (ketonuria), which is a hallmark of diabetic ketoacidosis (DKA).
• (b) Obstruction of the urinary bladder:Obstruction affects urine flow, not the metabolic processes that produce ketones.
• (c) Prostate cancer:Prostate cancer affects the prostate gland, not the metabolic processes that produce ketones.
• (d) Kidney infections:Kidney infections (pyelonephritis) are bacterial infections and do not directly cause ketone body formation, although severe illness from infection in a diabetic patient could trigger DKA.

Explanation:

• (b) help the kidneys excrete excess salt and water:Acute nephrotic syndrome causes significant protein loss, leading to low blood albumin and fluid shifting into tissues, resulting in severe oedema. Diuretics (like loop diuretics) are given to help the body excrete the excess fluid and sodium accumulated due to impaired kidney function and protein loss.
• (a) reduce the high blood pressure:While diuretics can help reduce blood pressure by reducing fluid volume, their primary purpose in acute nephrotic syndrome with oedema is to remove excess fluid causing swelling. Hypertension is also treated, but fluid removal is the main goal for diuretics here.
• (c) help the kidneys to function normally:Diuretics manage symptoms (oedema) but do not correct the underlying glomerular damage or restore normal kidney function.
• (d) help the kidneys to excrete toxic substance:Diuretics promote water and electrolyte excretion, not primarily the excretion of general "toxic substances" which is a broad term.

Explanation:

• (a) urethral abscess:In acute gonococcal urethritis, infection can spread locally to the glands lining the urethra, leading to the formation of a painful collection of pus or abscess, which is a relatively immediate complication.
• (b) urethral stricture:A urethral stricture (narrowing) is a *long-term* complication caused by scarring from chronic or repeated inflammation/infection, not an immediate one.
• (c) urethral diverticula:A urethral diverticulum is an out-pouching of the urethra. While infection can contribute, it's not the *most common immediate* complication.
• (d) urethral fistula:A urethral fistula is an abnormal connection between the urethra and another organ (e.g., vagina, skin). This is a rare and usually later complication of severe, untreated infection or trauma, not an immediate one.

Explanation:

• (c) mood:Asking about how a person feels currently ("on this day") and generally ("usually other days") directly assesses their subjective emotional state or mood.
• (a) attention:Attention is assessed by testing concentration and focus (e.g., asking to repeat numbers).
• (b) insight:Insight is assessed by understanding the patient's awareness of their illness and its implications.
• (d) immediate recall:Immediate recall is assessed by asking the patient to remember something said a few moments ago.

Explanation:

• (d) neuropathic:Neuropathic pain is pain caused by damage or disease affecting the somatosensory nervous system (nerve pathways).
• (a) phantom:Phantom pain is pain felt in a part of the body that has been removed (e.g., a limb after amputation). It is a type of neuropathic pain but not the general term.
• (b) psychological:Psychological pain is pain influenced or caused by psychological factors, not directly by nerve pathway abnormalities.
• (c) chronic:Chronic pain is pain that persists for a long time (usually >3 months). Neuropathic pain can be chronic, but "chronic" describes duration, not the origin in the nerve pathway.

Explanation:

• (a) insomnia:Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or waking up too early and feeling unrefreshed (as if insufficient sleep was obtained).
• (b) hypersomnia:Hypersomnia is excessive daytime sleepiness or prolonged nighttime sleep.
• (c) parasomia:Parasomnias are disruptive sleep-related disorders that occur during sleep (e.g., sleepwalking, nightmares).
• (d) narcolopsy:Narcolepsy is a neurological disorder affecting the control of sleep and wakefulness, characterized by excessive daytime sleepiness and sudden episodes of sleep (sleep attacks).

Explanation:

• (a) tremor:A tremor is an involuntary, rhythmic, oscillatory movement produced by alternating contractions of agonist and antagonist muscles.
• (b) athetosis:Athetosis refers to slow, writhing, involuntary movements.
• (c) cramps:Cramps are sudden, involuntary, painful contractions of muscles.
• (d) chorea:Chorea refers to sudden, brief, irregular, involuntary movements that flow randomly from one body part to another.

Explanation:

• (a) Muscle weakness:Muscle weakness (motor deficit) is a common symptom of MS because demyelination can affect motor pathways, but it is a *motor* symptom, not a *sensory* symptom.
• (b) Numbness:Numbness (paresthesia/dysesthesia) is a very common sensory symptom in MS.
• (c) Lack of sensation in the vagina:Sensory changes, including decreased sensation in the genital area, can occur in MS due to damage to sensory pathways, affecting sexual function. This is a sensory symptom.
• (d) Difficult to reach organism:This seems to be a typo and likely refers to "difficult to reach orgasm". Sexual dysfunction, including difficulty reaching orgasm, is common in MS due to a combination of sensory, motor, and autonomic nerve damage, as well as psychological factors. While the *experience* is complex, altered sensation contributes, making it related to sensory pathway issues. Muscle weakness is clearly a motor symptom.

Explanation:

• (b) mono-neuropathy:Mononeuropathy refers to damage to a *single* nerve.
• (a) peripheral neuropathy:Peripheral neuropathy is a general term for damage to the peripheral nerves (nerves outside the brain and spinal cord). It can involve one nerve (mononeuropathy), multiple nerves (polyneuropathy), or multiple separate nerves (mononeuropathy multiplex).
• (c) multiple mono-neuropathy:Refers to damage to *several separate* nerves.
• (d) poly neuropathy:Refers to widespread damage affecting *many* nerves, often symmetrically.

Explanation:

• (b) anxiety and emotional stress:The resting tremor characteristic of Parkinson's disease is often worsened by stress, anxiety, and excitement.
• (a), (c), (d) Inadequate sleep and fatigue:While fatigue can sometimes influence movement symptoms, anxiety and emotional stress are particularly well-known triggers for exacerbating Parkinsonian tremor. The options combining these suggest fatigue *might* play a role, but anxiety/stress is the most direct and consistent factor for tremor increase. Option (b) specifically lists anxiety and emotional stress.

Explanation:

• (c) constipation:Constipation is a common symptom in MS due to autonomic dysfunction, affecting bowel motility and sphincter control. However, it is an *autonomic/bowel symptom*, not a direct *motor* symptom related to voluntary muscle control or movement.
• (a) dizziness / (b) unsteadiness:Dizziness and unsteadiness (ataxia, balance problems) are common in MS and are related to motor control issues involving coordination pathways in the cerebellum and brainstem. These are considered motor/coordination symptoms.
• (d) difficult in walking:Difficulty walking (gait problems) is a primary motor symptom in MS, caused by weakness, spasticity, fatigue, or balance issues.

Explanation:

• (a) Involvement of single joint:Acute gout attacks typically affect a single joint, most commonly the metatarsophalangeal joint of the great toe (podagra). While polyarticular gout can occur, monoarticular (single joint) involvement is characteristic, especially in the initial attacks.
• (b) Appearance of tophi on elbows and feet:Tophi (deposits of uric acid crystals) are a sign of *chronic* gout, not necessarily present during an *acute* attack or in early stages.
• (c) Appearance of rheumatic nodules on elbow:Rheumatic nodules are subcutaneous nodules associated with *rheumatoid arthritis*, not gout.
• (d) Appearance of Bouchard's nodules:Bouchard's nodules are hard, bony enlargements on the proximal interphalangeal joints (PIP joints) of the fingers, characteristic of *osteoarthritis*, not gout.

Explanation:

• (b) L4-L5 and L5 - S1:The lower lumbar spine (L4-L5 and L5-S1) bears the most weight and undergoes the most movement, making the discs in this region most susceptible to degeneration and herniation (prolapse). These levels are the most common sites for "slipped disc" causing sciatica.
• (a) L1-L2 and L2-L3:Less common than lower lumbar.
• (c) C5-C6 and C6-C7:These are common levels for cervical disc herniation, but lumbar disc herniation is overall more frequent than cervical.
• (d) C3-C4 and C4-C5:Less common levels for cervical disc herniation compared to C5-C6 and C6-C7.

Explanation:

• (c) A long distance bus driver:This occupation involves prolonged sitting, vibration, and often poor posture, all of which are significant risk factors for developing chronic lower back pain.
• (a) A 60-year-old clerk who walks regularly:While age is a factor, regular walking is a protective activity. A clerk position involves sitting but regular walking mitigates risk compared to prolonged, uninterrupted sitting.
• (b) A 25-year-old lady who weighs 45 kgs:Younger age and low body weight are generally associated with lower risk of mechanical back pain, compared to occupations involving strain.
• (d) A 30-year old nurse who works in critical care unit:Nursing, especially in critical care, involves lifting and manual handling, which poses a risk. However, a long-distance driver's risk from prolonged static posture and vibration is often considered higher for *chronic* mechanical low back pain in this context. It's a close call, but prolonged sitting with vibration is a very strong risk factor.

Explanation:

• (b) Kyphosis:Kyphosis is an excessive outward curve of the spine, causing a rounding of the back. Severe thoracic kyphosis is often referred to as a "humpback" or "dowager's hump," particularly common in older women due to osteoporosis leading to vertebral compression fractures.
• (a) Lordosis:Lordosis is an excessive inward curve of the spine, typically in the lumbar region (swayback).
• (c) Scoliosis:Scoliosis is a sideways curvature of the spine.
• (d) Ankylosis:Ankylosis is the fusion or stiffening of a joint, limiting movement. While spinal joints can fuse (e.g., in ankylosing spondylitis), "hump back" refers to a specific type of abnormal spinal curvature.

Explanation:

• (d) Vital signs:Vital signs (temperature, pulse, respiration, blood pressure) are objective data, measured by the nurse. The question asks for *subjective* data, which is what the patient *reports* or tells the nurse.
• (a) Life style data:Lifestyle (e.g., occupation, exercise habits, diet, smoking) is subjective information reported by the patient and is very important for assessing musculoskeletal risk factors and impact on daily life.
• (b) Past health history:Past illnesses, surgeries, injuries, and previous musculoskeletal problems are subjective information reported by the patient and are crucial for understanding the current condition.
• (c) Family history:Family history of conditions like arthritis or osteoporosis is subjective information reported by the patient and helps identify genetic predispositions.

Explanation:

• (c) Morning stiffness which resolves in 30 minutes:This is a characteristic symptom of osteoarthritis. Stiffness after inactivity is typical, but it is usually brief, lasting less than 30-60 minutes.
• (a) Fever and malaise:Fever and malaise are systemic symptoms indicative of infection or inflammatory conditions (like rheumatoid arthritis or septic arthritis), not typically seen in uncomplicated osteoarthritis.
• (b) Tender swollen joints:While joints in OA can be tender, significant *swelling* (effusion or inflammation) is less prominent and less generalized than in inflammatory arthritis like rheumatoid arthritis. Tenderness is common, but swelling is variable.
• (d) Morning stiffness lasting more than an hour:Prolonged morning stiffness (more than 30-60 minutes) is a hallmark symptom of inflammatory arthritis, such as rheumatoid arthritis, not osteoarthritis.

Explanation:

• (d) Atherosclerosis:Severe atherosclerosis in the renal arteries can reduce blood flow to the kidneys (renal artery stenosis), leading to prerenal acute kidney injury due to insufficient perfusion.
• (a) Glycosuria:Glucose in the urine is a symptom of high blood sugar (diabetes) and can cause osmotic diuresis, potentially leading to dehydration, which *can* cause prerenal AKI, but glycosuria itself is not the direct *cause* of reduced kidney perfusion.
• (b) Myoglobinuria:Myoglobin in the urine occurs after severe muscle breakdown (rhabdomyolysis). Myoglobin is toxic to the renal tubules, causing *intrarenal* AKI, not prerenal AKI (which is caused by problems *before* the kidney).
• (c) Enlarged prostate gland:An enlarged prostate causes obstruction of the urinary tract *after* the kidneys, leading to postrenal AKI, not prerenal AKI.