Nokea
A high school soccer player "blew out his knee" when the opposing goalie's head and shoulder struck his flexed knee while the goalie was diving for the ball. All of the following structures were involved in some way in his injury, but which of the following is actually an extra-articular structure?
- A. Synovium
- B. Joint capsule
- C. Juxta-articular bone
- D. Tendons
Correct Answer: D
Rationale: Tendons are the correct answer as they are an extra-articular structure. Tendons are fibrous connective tissue that attach muscles to bones, providing stability and transmitting forces during movements. In the context of the scenario provided, the player's knee injury involved structures within the joint such as the synovium (A), joint capsule (B), and juxta-articular bone (C), but the tendons (D) are located outside of the joint itself.
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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.
Which of the following is consistent with good percussion technique?
- A. Allow all of the fingers to touch the chest while performing percussion.
- B. Maintain a stiff wrist and hand.
- C. Leave the plexor finger on the pleximeter after each strike.
- D. Strike the pleximeter over the distal interphalangeal joint.
Correct Answer: C
Rationale: Leaving the plexor finger on the pleximeter after each strike is consistent with good percussion technique. This helps to maintain stability and precision during percussion by providing a consistent point of contact for accurate assessment of the underlying structures. This technique also helps to control the force and angle of the percussive strike, ensuring accurate interpretation of the resulting sounds produced. Maintaining this contact can enhance the effectiveness of percussion as a diagnostic tool in physical examinations.
A tender, painful swelling of the scrotum should suggest which of the following?
- A. Acute epididymitis
- B. Strangulated inguinal hernia
- C. Torsion of the spermatic cord
- D. All of the above
Correct Answer: A
Rationale: A tender, painful swelling of the scrotum is a common symptom of acute epididymitis, which is the inflammation of the epididymis. The epididymis is a tube located at the back of the testicle that stores and transports sperm. In acute epididymitis, the swelling is usually accompanied by pain, tenderness, redness, and warmth in the affected area. Other symptoms may include fever, chills, and discharge from the penis. Prompt medical evaluation and treatment are necessary to prevent complications such as abscess formation or chronic epididymitis. Strangulated inguinal hernia and torsion of the spermatic cord may present with severe pain and swelling in the scrotum, but they have distinct mechanisms and require different management approaches.
A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to?
- A. Musculoskeletal
- B. Reproductive
- C. Urinary
- D. Endocrine
Correct Answer: A
Rationale: The symptom described - sharp, aching chest pain that increases with breathing - is typically associated with musculoskeletal issues. The pain worsening with breathing suggests a connection to the movements of the chest wall, which could involve the muscles, bones, or joints in that area. Conditions such as costochondritis (inflammation of the cartilage that connects a rib to the breastbone) or muscle strains in the chest wall are common causes of chest pain that worsens with breathing. This localization to the musculoskeletal system is based on the characteristics of the pain and how it is affected by breathing, helping to narrow down the differential diagnosis.
A 58-year-old teacher presents to your clinic with a complaint of breathlessness with activity. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems?
- A. Abdominal pain
- B. Orthopnea
- C. Hematochezia
- D. Tenesmus
Correct Answer: B
Rationale: Orthopnea is a symptom characterized by difficulty breathing while lying flat that improves when sitting or standing upright. This symptom is specifically related to cardiovascular conditions, such as heart failure, in which fluid accumulates in the lungs when lying down. Considering the patient's complaint of breathlessness with activity and the need to assess for cardiovascular issues, asking about orthopnea would be most appropriate to gain insights into potential heart-related causes of the symptoms. Abdominal pain (A), hematochezia (C), and tenesmus (D) are not typically associated with cardiovascular conditions and are less relevant to the patient's presentation.