After brain surgery, a male client is lethargic and is having difficulty talking. His blood pressure is 146/122 mm Hg and his urine specific gravity is 1.055. These findings are consistent with which pathophysiological response to intracranial surgery?

Reference Range:

Urine Specific Gravity [1.005 to 1.03]

Hyposecretion of Antidiuretic hormone (ADH).

Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

Hypopituitarism.

Septic shock.

Answer and Explanation

The Correct Answer is B

The clinical manifestations described in the scenario, including lethargy, difficulty talking, hypertension (blood pressure of 146/122 mm Hg), and elevated urine specific gravity (1.055), are indicative of Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Here's a breakdown of the rationale:

A) Hyposecretion of Antidiuretic Hormone (ADH):

Hyposecretion of ADH would result in decreased levels of ADH, leading to increased urine output (polyuria) and low urine specific gravity. This condition is known as diabetes insipidus, characterized by excessive thirst and dilute urine. The elevated urine specific gravity in the scenario is inconsistent with diabetes insipidus. Therefore, this option is incorrect.

B) Syndrome of Inappropriate Antidiuretic Hormone (SIADH):

Correct. SIADH is a condition characterized by excessive release of antidiuretic hormone (ADH) from the posterior pituitary gland, leading to water retention, dilutional hyponatremia, and concentrated urine. The elevated urine specific gravity (1.055) in the scenario indicates concentrated urine, consistent with SIADH. Additionally, lethargy and difficulty talking are common neurological manifestations of hyponatremia, which can occur as a result of water retention in SIADH. The client's hypertension is likely a compensatory response to hyponatremia-induced cerebral edema. Therefore, SIADH is the most likely diagnosis in this context.

C) Hypopituitarism:

Hypopituitarism refers to deficient production of one or more pituitary hormones, which can lead to a variety of endocrine abnormalities depending on which hormones are affected. While it is possible for hypopituitarism to cause hyponatremia, the other clinical manifestations described in the scenario are not typically associated with this condition. Additionally, the elevated urine specific gravity is not consistent with hypopituitarism-induced hyponatremia. Therefore, this option is less likely.

D) Septic shock:

Septic shock is a life-threatening condition characterized by severe hypotension and tissue hypoperfusion due to systemic infection. While septic shock can cause altered mental status, hypotension (not hypertension), and oliguria (not concentrated urine), it is not typically associated with elevated urine specific gravity. Therefore, septic shock is not the most likely diagnosis in this context.

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Correct Answer is C

Explanation

A) An increase in afterload results in decreased systolic pressure, which creates a decreased cardiac output:

This statement is not consistent with the Frank-Starling law. Afterload refers to the resistance against which the heart must pump blood during systole. An increase in afterload typically results in increased systolic pressure, not decreased, as the heart works harder to overcome the increased resistance. However, increased afterload can lead to decreased cardiac output due to the increased work of the heart.

B) A decrease in afterload causes the cardiac muscles to hypertrophy, resulting in increased diastolic volume:

This statement is not consistent with the Frank-Starling law. Afterload refers to the pressure or resistance against which the heart must pump blood during systole. A decrease in afterload typically reduces the workload on the heart, which may lead to reverse remodeling and a reduction in cardiac hypertrophy. Increased diastolic volume may occur due to reduced afterload, but it's not the direct result of hypertrophy.

C) An increase in preload results in greater shortening of myocardial fibers, thereby increasing contractility:

Correct. According to the Frank-Starling law, an increase in preload (end-diastolic volume or stretch of myocardial fibers) leads to greater overlap of actin and myosin filaments within myocardial fibers during systole. This increased overlap results in stronger myocardial contraction (increased contractility), leading to an increased stroke volume and cardiac output.

D) A decrease in preload results in increasing diastolic muscle fiber length, which impedes contractility:

This statement is not consistent with the Frank-Starling law. Preload refers to the degree of stretch of the myocardial fibers at the end of diastole. A decrease in preload would lead to decreased stretch of the myocardial fibers, not increasing diastolic muscle fiber length. Decreased preload typically results in decreased contractility rather than impediment to contractility due to reduced myocardial stretch.

A. Histamine-mediated vascular permeability leading to fluid transudation. B. Bradykinin cascade resulting in the accumulation of substance P. C. Thromboxane A activation of chemical mediators. D. Neutrophil migration secondary to chemotaxis.

Correct Answer is A

Explanation

A) Histamine-mediated vascular permeability leading to fluid transudation:

Correct. Ankle edema following an ankle sprain is often due to inflammation and increased vascular permeability. Histamine, released from mast cells and basophils during the inflammatory response, causes vasodilation and increases vascular permeability. This leads to the leakage of fluid from the blood vessels into the surrounding tissues, resulting in edema.

B) Bradykinin cascade resulting in the accumulation of substance P:

While bradykinin is involved in the inflammatory response and can contribute to pain and vasodilation, it does not directly cause fluid transudation leading to edema in the context of an ankle sprain.

C) Thromboxane A activation of chemical mediators:

Thromboxane A is involved in platelet aggregation and vasoconstriction rather than increasing vascular permeability and edema formation.

D) Neutrophil migration secondary to chemotaxis:

Neutrophil migration is part of the inflammatory response and can contribute to tissue damage and inflammation, but it is not the primary mechanism responsible for the development of edema following an ankle sprain.

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