Nokea
An 18-year-old college freshman presents to the clinic for evaluation of gastroenteritis. You measure the patient's temperature and it is 104 degrees Fahrenheit. What type of pulse would you expect to feel during his initial examination?
- A. Large amplitude, forceful
- B. Small amplitude, weak
- C. Normal
- D. Bigeminal
Correct Answer: A
Rationale: The correct answer is A: Large amplitude, forceful. A high fever, like 104 degrees Fahrenheit, typically leads to an increased heart rate and stronger pulse. This is the body's way of compensating for the fever and increased metabolic demands. A pulse with large amplitude and forceful quality indicates a higher cardiac output to support the body's needs during the fever. Choices B and C are incorrect because a small amplitude, weak pulse is unlikely with a high fever, and a normal pulse may not be expected in this scenario. Choice D, bigeminal, refers to an abnormal heart rhythm pattern characterized by every other beat being premature and is unrelated to the patient's fever.
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Which is a sign of benign prostatic hyperplasia?
- A. Weight loss
- B. Bone pain
- C. Fever
- D. Nocturia
Correct Answer: D
Rationale: The correct answer is D: Nocturia. Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, leading to urinary symptoms such as frequent urination at night (nocturia). This occurs due to the prostate pressing against the urethra, causing urinary flow issues. Weight loss (A) is not typically associated with BPH. Bone pain (B) is more indicative of conditions like prostate cancer or metastasis. Fever (C) is not a common symptom of BPH. Therefore, D is the most appropriate sign of BPH.
The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to?
- A. Chief complaint
- B. Present illness
- C. Personal and social history
- D. Review of systems
Correct Answer: D
Rationale: The correct answer is D: Review of systems. In this case, the information provided pertains to specific symptoms related to the cardiovascular system. The review of systems involves asking about symptoms in various body systems to identify any potential issues. This information helps in identifying any underlying health concerns that the patient may not have mentioned as their main complaint.
Summary of why other choices are incorrect:
A: Chief complaint - This is the main reason for the patient's visit or primary concern, not a list of symptoms.
B: Present illness - Focuses on the details of the current medical issue, not a general review of symptoms.
C: Personal and social history - Pertains to the patient's lifestyle, habits, and social support, not specific symptoms related to body systems.
A 79-year-old woman was admitted to the hospital a month ago with an acute ischemic stroke. Which would be the next best step in management?
- A. Start escitalopram 5 mg orally daily.
- B. Start eszopiclone 1 mg orally at bedtime.
- C. Start a high-calorie supplement twice a day.
- D. Change the time at which she gets physical therapy.
Correct Answer: C
Rationale: The correct answer is C: Start a high-calorie supplement twice a day. After an acute ischemic stroke, nutritional support is crucial for recovery and prevention of complications. Malnutrition is common post-stroke due to swallowing difficulties and decreased appetite. High-calorie supplements can help meet the patient's nutritional needs.
Choice A (escitalopram) is a selective serotonin reuptake inhibitor used for depression and anxiety, which may not be the immediate priority in this case. Choice B (eszopiclone) is a nonbenzodiazepine hypnotic used for insomnia, which is not directly related to managing the patient's stroke. Choice D (changing the time of physical therapy) may be beneficial, but ensuring adequate nutrition is more critical in the acute phase of stroke recovery.
Which of the following is a clinical identifier of metabolic syndrome?
- A. Waist circumference of 38 inches for a male
- B. Waist circumference of 34 inches for a female
- C. BP of 134/88 for a male
- D. BP of 128/84 for a female
Correct Answer: A
Rationale: The correct answer is A because a waist circumference of 38 inches for a male is a clinical identifier of metabolic syndrome. This measurement reflects abdominal obesity, a key component of metabolic syndrome. Excess abdominal fat is associated with insulin resistance, high blood pressure, and dyslipidemia, which are all features of metabolic syndrome.
Choice B is incorrect because a waist circumference of 34 inches for a female is not the correct measurement for identifying metabolic syndrome in females.
Choice C is incorrect because a blood pressure of 134/88 for a male, while elevated, is not a specific clinical identifier of metabolic syndrome.
Choice D is incorrect because a blood pressure of 128/84 for a female, although slightly elevated, is not a specific clinical identifier of metabolic syndrome.
An 84-year-old male with prostatic hypertrophy is at increased risk of:
- A. Constipation
- B. Fecal incontinence
- C. Urinary tract infections
- D. Prostate cancer
Correct Answer: C
Rationale: The correct answer is C: Urinary tract infections. Prostatic hypertrophy can cause obstruction of the urinary tract, leading to urinary retention and stasis, which increases the risk of urinary tract infections. Constipation (choice A) and fecal incontinence (choice B) are more related to issues with the gastrointestinal system rather than prostatic hypertrophy. Prostate cancer (choice D) is a separate condition that is not directly linked to prostatic hypertrophy. Therefore, the increased risk for an 84-year-old male with prostatic hypertrophy is urinary tract infections due to urinary obstruction.