Nokea
A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?
- A. Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.
- B. Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.
- C. Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.
- D. Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.
Correct Answer: C
Rationale: The correct answer is C because tenderness in the right upper quadrant with inspiration points towards Murphy's sign, indicative of cholecystitis. This sign is elicited by palpating the right upper quadrant while the patient takes a deep breath. This maneuver causes the gallbladder to descend and come into contact with the inflamed peritoneum, reproducing pain and halting inspiration. Choices A, B, and D do not describe physical examination findings specific to cholecystitis such as Murphy's sign or tenderness in the right upper quadrant with inspiration. Therefore, they are incorrect.
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Which of the following medications is commonly prescribed for patients with hypertension and chronic kidney disease?
- A. Lisinopril
- B. Furosemide
- C. Metoprolol
- D. Spironolactone
Correct Answer: A
Rationale: The correct answer is A: Lisinopril. Lisinopril is an ACE inhibitor commonly prescribed for patients with hypertension and chronic kidney disease. It helps to reduce blood pressure and protect the kidneys by dilating blood vessels and improving blood flow. Furosemide (B) is a diuretic used to treat fluid retention but not specifically indicated for chronic kidney disease. Metoprolol (C) is a beta-blocker primarily used for heart conditions. Spironolactone (D) is a potassium-sparing diuretic and is not the first-line treatment for hypertension in patients with chronic kidney disease.
Dr. Smith is obtaining informed consent from Mr. Jones to perform a colonoscopy. Which element of decision-making capacity is impaired in this case?
- A. Understanding
- B. Appreciation
- C. Ability to express a choice
- D. None of the above
Correct Answer: B
Rationale: The correct answer is B: Appreciation. In this scenario, Mr. Jones may understand the information presented about the colonoscopy, but he may not fully appreciate the implications and consequences of undergoing the procedure. Appreciation involves the ability to understand the personal relevance of the information provided. This is crucial in ensuring that the individual can make a truly informed decision.
A: Understanding is not impaired as Mr. Jones may comprehend the information presented.
C: Ability to express a choice is not necessarily impaired in this case, as Mr. Jones may still be able to verbalize his decision.
D: None of the above is incorrect because Appreciation is indeed impaired in this situation.
A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis?
- A. Dacryocystitis
- B. Chalazion
- C. Hordeolum
- D. Xanthelasma
Correct Answer: C
Rationale: The correct answer is C: Hordeolum. A hordeolum, also known as a stye, presents as a red raised tender area at the margin of the eyelid. In this case, the absence of tearing upon palpation of the lesion suggests it is localized to the eyelid itself. Dacryocystitis (choice A) involves the lacrimal sac and would present with tearing. A chalazion (choice B) is a painless nodule on the eyelid, unlike the tender lesion described here. Xanthelasma (choice D) is characterized by yellowish plaques on the eyelids, not a red raised tender area.
Where should the uterine fundus be palpable at 12 weeks?
- A. At the level of the umbilicus
- B. At the level of the symphysis pubis
- C. Midway between the symphysis and umbilicus
- D. Below the symphysis pubis
Correct Answer: B
Rationale: At 12 weeks of gestation, the uterine fundus should be palpable at the level of the symphysis pubis. This is because the uterus rises approximately 1 cm above the symphysis pubis each week during the first trimester. By 12 weeks, it should be palpable at this level.
Choice A (At the level of the umbilicus) is incorrect because the fundus is not expected to reach the level of the umbilicus until around 20 weeks.
Choice C (Midway between the symphysis and umbilicus) is incorrect as this would typically occur around 16-18 weeks.
Choice D (Below the symphysis pubis) is also incorrect because by 12 weeks, the fundus should have risen above the symphysis pubis.
Which is a true statement about varicose veins?
- A. They are due to congenital valve deformities
- B. They are usually diagnosed on clinical presentation
- C. They are not affected by pregnancy
- D. They are more symptomatic during ovulation
Correct Answer: B
Rationale: The correct answer is B because varicose veins are usually diagnosed based on clinical presentation, such as visible, bulging veins and symptoms like pain or swelling. This is because varicose veins are often easily visible and cause noticeable symptoms.
A: Varicose veins are not typically due to congenital valve deformities but rather develop over time due to weakened vein walls and valves.
C: Varicose veins can be affected by pregnancy due to hormonal changes and increased pressure on the veins.
D: Varicose veins may not necessarily be more symptomatic during ovulation; symptoms can vary based on individual factors.