Nokea
A patient is examined with the ophthalmoscope and found to have red reflexes bilaterally. Which of the following have you essentially excluded from your differential?
- A. Retinoblastoma
- B. Cataract
- C. Artificial eye
- D. Hypertensive retinopathy
Correct Answer: A
Rationale: Retinoblastoma typically presents with a white reflex, known as leukocoria or a cat's eye reflex, instead of the normal red reflex seen during ophthalmoscopy. The presence of red reflexes bilaterally in this case essentially rules out retinoblastoma as a differential diagnosis.
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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 area of the arm drains to the epitrochlear nodes?
- A. Ulnar surface of the forearm and hand, little and ring fingers, and ulnar middle finger
- B. Radial surface of the forearm and hand, thumb and index fingers, and radial middle finger
- C. Ulnar surface of the forearm and hand; second, third, and fourth fingers
- D. Radial surface of the forearm and hand; second, third, and fourth fingers
Correct Answer: A
Rationale: The area of the arm that drains to the epitrochlear nodes includes the ulnar surface of the forearm and hand, little and ring fingers, and the ulnar side of the middle finger. The epitrochlear nodes are located in the medial aspect of the arm above the elbow, close to the insertion of the biceps brachii muscle. These nodes receive lymphatic drainage from the above-mentioned areas and play a role in the immune response against infections in these regions.
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.
It started a few hours ago, and she has noted nausea with sensitivity to light; she has had headaches like this in the past, usually less than one per week, but not as severe. She does not know of any inciting factors. There has been no change in the frequency of her headaches. She usually takes an over- the-counter analgesic, and this results in resolution of the headache. Based on this description, what is the most likely diagnosis of the type of headache?
- A. Tension
- B. Migraine
- C. Cluster
- D. Analgesic rebound
Correct Answer: B
Rationale: The description of the headache as starting a few hours ago, associated with nausea, sensitivity to light, and being severe in intensity suggests a migraine headache. Migraine headaches are often accompanied by these symptoms, known as migraine features. The fact that the patient experiences headaches like this less than once a week and typically uses over-the-counter analgesics to relieve them is also suggestive of migraines. Tension headaches typically present as a more mild to moderate, band-like pressure around the head, without the associated symptoms of nausea and sensitivity to light. Cluster headaches are characterized by excruciating pain around one eye, often accompanied by other symptoms like redness or tearing in the eye. Analgesic rebound headaches occur due to overuse of pain medications and typically present as daily headaches that improve with the same medication that caused them in the first place.
A 23-year-old graduate student comes to your clinic for evaluation of a urethral discharge. As the provider, you need to get a sexual history. Which one of the following questions is inappropriate for eliciting the information?
- A. Are you sexually active?
- B. When was the last time you had intimate physical contact with someone, and did that contact include sexual intercourse?
- C. Do you have sex with men, women, or both?
- D. How many sexual partners have you had in the last 6 months?
Correct Answer: B
Rationale: While it is important to ask about recent sexual activity and whether it included sexual intercourse, using the term "intimate physical contact" is not specific enough. This question could potentially lead to misinterpretation or confusion regarding what types of activities are being referred to. It is more appropriate to directly ask about sexual intercourse when obtaining a sexual history. The other options are all appropriate questions to elicit information about the patient's sexual history.