Nokea
During the breast examination of a perimenopausal woman, the NP detects a bloody spontaneous discharge from the right nipple. This indicates further evaluation:
- A. Fibroadenoma
- B. Polycystic breast disease
- C. An intraductal papilloma
- D. Pituitary prolactinoma
Correct Answer: C
Rationale: The correct answer is C: An intraductal papilloma. Bloody spontaneous discharge from the nipple in a perimenopausal woman is concerning for an intraductal papilloma, which is a benign growth in the milk ducts. Further evaluation with imaging studies and possibly a biopsy is necessary to rule out malignancy.
Choice A: Fibroadenoma is a common benign breast tumor but does not typically present with bloody discharge.
Choice B: Polycystic breast disease is not associated with bloody discharge and is characterized by multiple fluid-filled cysts in the breast tissue.
Choice D: Pituitary prolactinoma is a benign tumor of the pituitary gland that can cause elevated prolactin levels leading to nipple discharge, but it is not typically bloody and would not present with spontaneous discharge from the nipple.
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A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon?
- A. Direct reaction
- B. Consensual reaction
- C. Near reaction
- D. Accommodation
Correct Answer: B
Rationale: The correct term for the phenomenon described is "Consensual reaction" (Choice B). This occurs because the optic nerves from both eyes are connected, causing stimulation of one eye to result in a simultaneous response in the other eye due to the consensual pupillary reflex. The other choices are incorrect because:
A: Direct reaction refers to the pupil directly exposed to light contracting.
C: Near reaction refers to the pupillary response when focusing on a near object.
D: Accommodation refers to the ability of the eye to adjust focus for near and far objects, not pupil constriction.
You want to start pharmacologic treatment for depression in an older patient who is taking numerous medications. Which of the following antidepressants is the least likely to cause drug-drug interactions?
- A. Citalopram
- B. Fluoxetine
- C. Paroxetine
- D. Venlafaxine
Correct Answer: E
Rationale: I believe you made a typo in listing the correct answer as "E" while there is no "E" option in the choices provided. Could you please confirm the correct answer choice so I can provide you with a detailed explanation and summary of why the correct answer is correct and why the other choices are incorrect?
A patient presents with claudication symptoms and diminished pulses. Which of the following is consistent with chronic arterial insufficiency?
- A. Pallor of the foot when raised to 60 degrees for one minute
- B. Return of color to the skin within 5 seconds of allowing legs to dangle
- C. Filling of the veins of the ankles within 10 seconds of allowing the legs to dangle
- D. Hyperpigmentation of the skin
Correct Answer: A
Rationale: The correct answer is A. Pallor of the foot when raised to 60 degrees for one minute is consistent with chronic arterial insufficiency. When the foot is raised, blood flow decreases, leading to decreased oxygenation and pallor in the presence of arterial insufficiency. This is known as the dependent rubor test, and the delayed return of color is indicative of impaired blood flow.
Choice B is incorrect because a quick return of color within 5 seconds suggests normal vascular perfusion. Choice C is incorrect as filling of veins within 10 seconds indicates venous insufficiency rather than arterial insufficiency. Choice D, hyperpigmentation of the skin, is not a typical finding in chronic arterial insufficiency.
Symptoms of heartburn and regurgitation are associated with:
- A. Hiatal hernia
- B. Gastroesophageal reflux
- C. Peptic ulcer disease
- D. Esophageal cancer
Correct Answer: B
Rationale: The correct answer is B: Gastroesophageal reflux. Heartburn and regurgitation are classic symptoms of GERD, where stomach acid flows back into the esophagus. This causes a burning sensation in the chest and sour taste in the mouth. Hiatal hernia (A) can contribute to GERD but is not directly associated with these symptoms. Peptic ulcer disease (C) typically presents with stomach pain, not heartburn. Esophageal cancer (D) may present with difficulty swallowing and weight loss, not just heartburn and regurgitation. Therefore, choice B is the most appropriate answer.
You are obtaining an arterial blood gas in the radial artery on a retired cab driver who has been hospitalized in the intensive care unit for a stroke. You are concerned about the possibility of arterial insufficiency. You perform the Allen test. This means that you:
- A. Checked for patency of the radial artery
- B. Checked for patency of the brachial artery
- C. Checked for patency of the ulnar artery
- D. Checked for patency of the femoral artery
Correct Answer: C
Rationale: The Allen test assesses collateral circulation by checking for patency of the ulnar artery. This is important before obtaining an arterial blood gas from the radial artery to ensure adequate blood flow and prevent ischemia. If the ulnar artery is not patent, using the radial artery could lead to arterial insufficiency. Checking the radial artery's patency (Choice A) is not the purpose of the Allen test. Checking the patency of the brachial artery (Choice B) or the femoral artery (Choice D) is not relevant in this context. The correct answer is C because ensuring ulnar artery patency is crucial for arterial blood gas sampling from the radial artery.