Nokea
A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer?
- A. Stage 1
- B. Stage 2
- C. Stage 3
- D. Stage 4
Correct Answer: C
Rationale: A stage 3 pressure ulcer involves full-thickness skin loss with damage and necrosis of the subcutaneous tissue, but the underlying muscle is not affected. In this case, the description of the full-thickness skin loss with involvement of the subcutaneous tissue but not the muscle corresponds to a stage 3 pressure ulcer. Stage 1 involves intact skin with non-blanchable redness, stage 2 involves partial-thickness skin loss with a shallow open ulcer, and stage 4 involves full-thickness tissue loss with the involvement of muscle, bone, or supporting structures.
You may also like to solve these questions
Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not have facial tenderness or tenderness of the scalp. Which of the following is the most likely cause of her pain?
- A. Trigeminal neuralgia
- B. Temporomandibular joint syndrome
- C. Temporal arteritis
- D. Tumor of the mandible
Correct Answer: B
Rationale: Mrs. Fletcher's symptoms of unilateral pain during chewing, which is chronic, without facial tenderness or tenderness of the scalp are more suggestive of temporomandibular joint (TMJ) syndrome rather than other conditions listed. TMJ syndrome is characterized by pain and dysfunction of the jaw muscles and the joints that connect the jaw to the skull. The pain is often worsened by chewing or opening the mouth widely. In this case, the absence of facial tenderness or signs of temporal arteritis makes these conditions less likely. Trigeminal neuralgia typically presents with sudden, severe facial pain in the distribution of the trigeminal nerve. Tumor of the mandible would likely present with other symptoms such as swelling, bone destruction, or difficulty with mouth opening and chewing. Temporal arteritis usually presents with symptoms such as headache, scalp tenderness, and visual disturbances. Given Mrs. Fletcher's presentation,
He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit?
- A. Refer the patient to a nutritionist because he is anorexic.
- B. Reassure the patient that he has a normal body weight.
- C. Give the patient information about reduction of fat, cholesterol, and calories because he is overweight.
- D. Give the patient information about reduction of fat and cholesterol because he is obese.
Correct Answer: C
Rationale: The appropriate counsel for the patient during the visit would be to give information about the reduction of fat, cholesterol, and calories because he is concerned about his weight. This option addresses the patient's concern and provides guidance on making healthier choices to manage weight. Referring the patient to a nutritionist because he is anorexic (Option A) is not appropriate based on the information provided. Reassuring the patient that he has a normal body weight (Option B) may not address his concerns about weight. Giving the patient information about reducing fat and cholesterol only because he is obese (Option D) does not cover all aspects of a healthy diet such as managing calorie intake.
A 42-year-old florist comes to your office, complaining of chronic constipation for the last 6 months. She has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons. What is the best choice for the cause of her constipation?
- A. Large bowel obstruction
- B. Irritable bowel syndrome
- C. Rectal cancer
- D. Hypothyroidism
Correct Answer: D
Rationale: The constellation of symptoms described in the scenario, including chronic constipation, fatigue, weight gain, irregular periods, cold intolerance, and delayed deep tendon reflexes, suggests hypothyroidism as the likely cause. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones, leading to a slowdown in bodily functions. Constipation is a common symptom of hypothyroidism due to the decreased motility of the bowel. The presence of cold intolerance, weight gain, and irregular periods further supports this diagnosis, as these are classic symptoms of hypothyroidism. The delayed deep tendon reflexes, especially in the Achilles tendons, are indicative of the myopathic changes that can occur in hypothyroidism. It is important to further investigate thyroid function through laboratory testing to confirm the diagnosis and initiate appropriate treatment. Other conditions such as large bowel obstruction, irritable bowel syndrome, and rectal cancer are less likely based
A 29-year-old married computer programmer comes to your clinic, complaining of "something strange" going on in his scrotum. Last month while he was doing his testicular self- examination he felt a lump in his left testis. He waited a month and felt the area again, but the lump was still there. He has had some aching in his left testis but denies any pain with urination or sexual intercourse. He denies any fever, malaise, or night sweats. His past medical history consists of groin surgery when he was a baby and a tonsillectomy as a teenager. He eats a healthy diet and works out at the gym five times a week. He denies any tobacco or illegal drugs and drinks alcohol occasionally. His parents are both healthy. On examination you see a muscular, healthy, young-appearing man with unremarkable vital signs. On visualization the penis is circumcised with no lesions; there is a scar in his right inguinal region. There is no lymphadenopathy. Palpation of his scrotum is unremarkable on the right but indicates a large mass on the left. Placing a finger through the inguinal ring on the right, you have the patient bear down. Nothing is felt. You attempt to place your finger through the left inguinal ring but cannot get above the mass. On rectal examination his prostate is unremarkable. What disorder of the testes is most likely the diagnosis?
- A. Hydrocele
- B. Scrotal hernia
- C. Scrotal edema
- D. Varicocele
Correct Answer: B
Rationale: The most likely diagnosis in this case is a scrotal hernia. The patient's history of a previous groin surgery as a baby is a key clue, as it increases the risk for developing a hernia. The lump in the left testis with aching, along with the inability to palpate above the mass through the left inguinal ring, suggests that the lump may be a hernia protruding through the inguinal canal into the scrotum. The presence of a scar in the right inguinal region also supports the likelihood of a hernia. The normal prostate on rectal examination rules out any involvement of the prostate in the presentation. Scrotal hernias may present as painless masses in the scrotum, often increasing in size with activities that increase intra-abdominal pressure, such as straining or coughing. Surgical repair is often necessary to prevent complications such as incarceration or strangulation
His head, eyes, ears, nose, and throat examinations are unremarkable. His cardiac examination is normal. On examination of his chest, the diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi are heard over all lung fields. There is no area of dullness and no increased or decreased fremitus. What thorax or lung disorder is most likely causing his symptoms?
- A. Spontaneous pneumothorax
- B. Chronic obstructive pulmonary disease (COPD)
- C. Asthma
- D. Pneumonia
Correct Answer: B
Rationale: The patient's presentation with an enlarged chest diameter, decreased breath sounds throughout all lobes, and the presence of rhonchi over all lung fields is suggestive of a chronic condition that affects the entire respiratory system. These findings are classic for COPD, a progressive lung disease characterized by airflow limitation. The breath sounds are decreased due to airflow obstruction, and the presence of rhonchi indicates mucus production and airway inflammation commonly seen in COPD. In contrast, a spontaneous pneumothorax would typically present with sudden chest pain and shortness of breath, often in a younger patient with risk factors such as smoking. Asthma would present with wheezing, shortness of breath, and possibly a history of atopy or allergies. Pneumonia would typically present with fever, cough, and focal findings on chest examination, such as crackles or bronchial breath sounds over a consolidated area. In