Answer to Question 1
B
Compensated metabolic alkalosis should show alkalosis pH and HCO3 (metabolic) values, with a slightly acidic CO2 (compensatory respiratory acidosis). In this case, pH 7.52 is alkaline (normal = 7.35 to 7.45), PaCO2 is acidic (normal 35 to 45 mm Hg), and HCO3 is elevated (normal = 22 to 26 mEq/L). A result of pH 7.78, PaCO2 40 mm Hg, HCO3 30 mEq/L is uncompensated metabolic alkalosis. pH 7.35, PaCO2 35 mm Hg, HCO3 26 mEq/L is within normal limits. pH 7.25, PaCO2 47 mm Hg, HCO3 29 mEq/L is compensated respiratory acidosis.
Answer to Question 2
C
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A Although use of the Valsalva manoeuvre may contribute to hemorrhoids in pregnancy, this is not as serious as increasing the intraocular pressure of a patient with glaucoma.
B The Valsalva manoeuvre is not contraindicated in a patient with hypertrophied prostate disease.
C Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greatest risk of serious complications (such as cardiac irregularities and elevated blood pressure) with this manoeuvre, and need to avoid straining to pass the stool.
D The Valsalva manoeuvre is not contraindicated in a patient with stomach cancer.
Sperm in the fallopian tube.
Example of problem focused patient
A patient with exophthalmos.
An open chamber MRI may be more comfortable for the patient, but images may not be as distinct.
Sandwich or capture enzyme immunoassay for patient IgM (double capture: IgM capture, Ag capture).