An automatic internal cardioverter-defibrillator delivers an electric shock to the heart to terminate episodes of ventricular tachycardia and ventricular fibrillation. This is necessary for a patient with significant ventricular symptoms, such as tachycardia resulting in syncope.

Option A: A patient with myocardial infarction that resolved with no permanent cardiac damage would not be a candidate.
Option B: A patient recovering well from coronary bypass would not need the device.
Option D: Atrial tachycardia is less serious and is treated conservatively with medication and cardioversion as a last resort.

The implanted pacemaker will interfere with the magnetic fields of the MRI scanner and may be deactivated by them. Patients with cardiac implantable electronic devices or CIED are at risk for inappropriate device therapy, device heating/movement, and arrhythmia during MRI. These patients must be scheduled in a CIED blocked slot or scheduled with electrophysiology nurse or technician support. But nowadays MRI conditional cardiac implantable electronic devices are widely available.

Option A: Shellfish/iodine allergy is not a contraindication because the contrast used in MRI scanning is not iodine-based. MRI contrast agents are gadolinium chelates with different stability, viscosity, and osmolality. Gadolinium is a relatively very safe contrast; however, it rarely might cause allergic reactions in patients.
Options C: Open MRI scanners and anti-anxiety medications are available for patients with claustrophobia. Claustrophobic patients might refuse to complete the MRI scan and need sedation. These patients need to be well informed about the MRI scan procedure. The recommendation is that a physician has a discussion with them about the details in advance. Using Larger and opener MRI systems might be helpful in claustrophobic patients.
Option D: Psychiatric medication is not a contraindication to MRI scanning. MRI helps in high-resolution investigations of soft tissues without the use of ionizing radiation. This safe modality currently becomes the imaging technique of choice for diagnosing musculoskeletal, neurologic, and cardiovascular disease. However, there are restrictions and contraindications caused by MRI magnetic fields, machine structure, and gadolinium contrast agents.

Typical symptoms of pulmonary embolism include chest pain, shortness of breath, and severe anxiety. The physician should be notified immediately. Clinical signs and symptoms for pulmonary embolism are nonspecific; therefore, patients suspected of having pulmonary embolism—because of unexplained dyspnea, tachypnea, or chest pain or the presence of risk factors for pulmonary embolism—must undergo diagnostic tests until the diagnosis is ascertained or eliminated or an alternative diagnosis is confirmed.

Option A: The patient may present atypical symptoms based on risk factors, such as delirium or a decreasing level of consciousness.
Option B: The diagnosis of pulmonary embolism should be sought actively in patients with respiratory symptoms UNEXPLAINED by an alternative diagnosis; symptoms may include productive cough and wheezing.
Option D: A patient with fever, chills, and loss of appetite may be developing pneumonia. Fever of less than 39°C (102.2ºF) may be present in 14% of patients; however, a temperature higher than 39.5°C (103.1º) F is not from a pulmonary embolism.

A rapidly enlarging abdominal aortic aneurysm is at significant risk of rupture and should be resected as soon as possible. No other appropriate treatment options currently exist.

Option A: Admitting the patient for observation will be a delay and may result in the rupture of the aneurysm. Immediate surgery is the only recommended management.
Option B: Sclerotherapy, in which a solution is injected into a vein, causing it to collapse, scar, and fade, remains the primary treatment for the small-vessel varicose disease of the lower extremities.
Option D: The patient should not be discharged because the abdominal aneurysm may rupture at any time and place the patient’s life at risk.

A platelet count of 25,000/microliter is severely thrombocytopenic and should prompt the initiation of bleeding precautions, including monitoring urine and stool for evidence of bleeding.

Option A: According to three retrospective case reviews of childhood leukemia (in which 75% to 100% of the cases were acute lymphoblastic leukemia), common presenting signs and symptoms include fever (17% to 77%), lethargy (12% to 39%), and bleeding (10% to 45%).
Option B: Requiring protective clothing is indicated to prevent infection if white blood cells are decreased. Protective garments consisting of gloves, chemotherapy gowns, eye protection e.g.; goggles, N95 respirator, and shoe covers will be worn according to the task being performed with a Chemotherapy/Biotherapy agent or excreta of a patient who has received a Chemotherapy/Biotherapy agent within the last 48 hours.
Option C: Transfusion of red cells is indicated for severe anemia. Blood transfusions represent one of the most important forms of supportive care for patients with leukemia. Cancer is the major cause of transfusion. One-third of transfused patients have a malignant disease, with acute leukemia being the malignancy in a large part of them.