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A patient presents with noticeable swelling in the neck area and difficulty breathing. Which key observation should be prioritized during the neck examination to assess the underlying issue?
- A. Thyroid fullness
- B. Pulsation
- C. Respiratory difficulty
- D. Trachea position
Correct Answer: D
Rationale: The correct answer is D: Trachea position. This is the key observation to prioritize during the neck examination because in a patient presenting with noticeable swelling in the neck area and difficulty breathing, a deviated trachea indicates a potential emergency situation such as a mediastinal mass or tension pneumothorax. Assessing the trachea position helps in identifying any life-threatening conditions that may be causing the respiratory distress.
A: Thyroid fullness may indicate thyroid issues, but in this case, the focus should be on the trachea position due to the acute presentation of difficulty breathing.
B: Pulsation may be relevant in other contexts but is not the priority when assessing a patient with difficulty breathing and neck swelling.
C: Respiratory difficulty is already mentioned in the patient presentation, and the focus should be on identifying the cause of this difficulty, which is best assessed by evaluating the trachea position.
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A 29-year-old computer programmer comes to the office for evaluation of a headache. The tightening sensation of moderate intensity is located all over the head. It used to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends several hours at a computer monitor/keyboard. He has tried over-the-counter medication; it has dulled the pain, but not taken it away. Based on this description, what is the most likely diagnosis?
- A. Cluster
- B. Analgesic rebound
- C. Tension
- D. Migraine
Correct Answer: C
Rationale: The correct answer is C: Tension headache. The key features in the scenario are the bilateral location of the headache, duration of 5 days, absence of nausea and photophobia, and the patient's occupation as a computer programmer. Tension headaches are typically bilateral, mild to moderate in intensity, and often related to stress, posture, and prolonged screen time. The fact that over-the-counter medication only dulled the pain supports the diagnosis of tension headache.
Summary of other choices:
A: Cluster headaches typically have a unilateral location, severe intensity, and are associated with autonomic symptoms like tearing of the eye.
B: Analgesic rebound headaches occur due to overuse of pain medications, leading to worsening of headaches when the medication wears off.
D: Migraine headaches often present with unilateral throbbing pain, nausea, and sensitivity to light and sound, which are not present in this case.
What is the most important thing to address at today’s visit for an 81-year-old male with various health concerns, including weight loss, fatigue, and a history of falls?
- A. His elevated blood pressure noted on today’s vitals.
- B. Repeating his MoCA testing to assess for cognitive change.
- C. Suggesting completion of an advance directive at visit with his goals of care in mind.
- D. Reviewing his last colonoscopy report and discussing further screening procedures.
Correct Answer: C
Rationale: Correct Answer: C - Suggesting completion of an advance directive at the visit with his goals of care in mind.
Rationale:
1. Age and health concerns: At 81 years old with weight loss, fatigue, and a history of falls, addressing end-of-life planning becomes crucial.
2. Advance Directive: Helps the patient make decisions about the care they want if they become unable to communicate their wishes.
3. Goals of care: Understanding his wishes ensures healthcare decisions align with his values, enhancing patient autonomy and quality of care.
Summary:
- A: Blood pressure is important but not the priority compared to end-of-life planning.
- B: Cognitive testing is valuable, but addressing care preferences takes precedence.
- D: Colonoscopy report is not urgent compared to ensuring the patient's wishes are known for future care.
Which valve lesion typically produces a murmur of equal intensity throughout systole?
- A. Aortic stenosis
- B. Mitral insufficiency
- C. Pulmonic stenosis
- D. Aortic insufficiency
Correct Answer: C
Rationale: The correct answer is C: Pulmonic stenosis. This valve lesion typically produces a murmur of equal intensity throughout systole due to the obstruction of blood flow during both systole and diastole. Pulmonic stenosis results in turbulent blood flow across the pulmonary valve, creating a consistent murmur throughout the cardiac cycle.
Rationale for incorrect choices:
A: Aortic stenosis - Produces a crescendo-decrescendo murmur that peaks in mid-systole.
B: Mitral insufficiency - Causes a holosystolic murmur that is loudest at the apex.
D: Aortic insufficiency - Results in a diastolic murmur heard best at the left sternal border.
In summary, pulmonic stenosis is the correct answer as it uniquely presents with a murmur of equal intensity throughout systole, distinguishing it from the other valve lesions.
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.
An 82-year-old woman receives oral amoxicillin-clavulanate for a skin abscess on her leg. She develops new onset of frequent watery stool that persists for several days after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain reaction (PCR). The antigen and PCR are both positive. She has never had C. difficile infection before. What one statement is the best answer regarding her management?
- A. Metronidazole is the treatment of choice for C. difficile infection.
- B. Older adults with their first episode of C. difficile require a longer duration of treatment with vancomycin.
- C. Fecal transplantation is the treatment of choice for C. difficile infection.
- D. Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.
Correct Answer: D
Rationale: The correct answer is D: Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection.
1. Choice A is incorrect because metronidazole is no longer recommended as first-line treatment due to increasing resistance.
2. Choice B is incorrect because there is no evidence suggesting older adults require a longer duration of treatment with vancomycin for their first episode.
3. Choice C is incorrect because while fecal transplantation can be used in refractory cases, it is not typically the first-line treatment.
4. The rationale for D being correct is that both vancomycin and fidaxomicin are recommended as first-line treatments for the initial episode of C. difficile infection based on current guidelines. This allows for flexibility in selecting the appropriate antibiotic based on individual patient factors.