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In gout, a man has developed large, hard nodules around his toes and elbows. The phase of gout he is in is:
- A. asymptomatic.
- B. acute flare.
- C. the intercritical period.
- D. chronic gout.
Correct Answer: D
Rationale: The man's presentation of large, hard nodules around his toes and elbows is indicative of tophi formation, which is characteristic of chronic gout. Tophi are deposits of uric acid crystals that can develop over time in untreated or poorly managed gout. During the chronic phase of gout, tophi can form in joints, soft tissues, and organs. Asymptomatic refers to a phase where there are no symptoms present. Acute flare is characterized by sudden and severe joint pain and inflammation. The intercritical period is the time between gout attacks when the patient is symptom-free.
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A 25-year-old just had a colonoscopy and was diagnosed with Crohn disease. Which of the following symptoms is consistent with this diagnosis?
- A. Right lower quadrant cramping
- B. Severe bloody diarrhea
- C. Nausea and vomiting
- D. Mostly affects the rectum
Correct Answer: A
Rationale: The correct answer is A: Right lower quadrant cramping. Crohn's disease commonly presents with abdominal pain, particularly in the right lower quadrant. Choice B, severe bloody diarrhea, is more characteristic of ulcerative colitis, another type of inflammatory bowel disease. Choice C, nausea and vomiting, are not typical symptoms of Crohn's disease. Choice D is incorrect as Crohn's disease can affect any part of the gastrointestinal tract, not just the rectum.
A 60-year-old man presents with painless hematuria. Which of the following should be the next step in the evaluation?
- A. Urinalysis
- B. Renal ultrasound
- C. Cystoscopy
- D. Intravenous pyelogram
Correct Answer: C
Rationale: In a 60-year-old man presenting with painless hematuria, the next step in the evaluation should be cystoscopy. Cystoscopy is recommended to assess the cause of hematuria, particularly to rule out bladder cancer, which is more common in older individuals. Urinalysis (Choice A) can provide initial information but may not definitively diagnose the underlying cause. Renal ultrasound (Choice B) and intravenous pyelogram (Choice D) are imaging studies that may be considered later in the evaluation process but are not the initial step for painless hematuria.
Which of the following conditions is associated with a positive Homan's sign?
- A. Deep vein thrombosis
- B. Peripheral artery disease
- C. Varicose veins
- D. Lymphedema
Correct Answer: A
Rationale: A positive Homan's sign is indicative of deep vein thrombosis. This sign is elicited by dorsiflexing the foot of a patient with the knee slightly flexed, resulting in calf pain. Peripheral artery disease (choice B) is associated with decreased blood flow to the extremities, but it does not produce a positive Homan's sign. Varicose veins (choice C) are enlarged, twisted veins that are typically not related to Homan's sign. Lymphedema (choice D) is swelling caused by a lymphatic system blockage or dysfunction and is not linked to Homan's sign.
Which of the following chronic inflammatory skin disorders is characterized by angiogenesis, immune cell activation (particularly T cells), and keratinocyte proliferation?
- A. Psoriasis
- B. Melanoma
- C. Atopic dermatitis
- D. Urticaria
Correct Answer: A
Rationale: Psoriasis is the correct answer. Psoriasis is a chronic inflammatory skin disorder characterized by angiogenesis, immune cell activation (particularly T cells), and keratinocyte proliferation. Choice B, Melanoma, is a type of skin cancer involving melanocytes, not characterized by the features mentioned. Choice C, Atopic dermatitis, is a different inflammatory skin condition associated with pruritus and eczematous lesions, not primarily characterized by angiogenesis. Choice D, Urticaria, is a skin condition characterized by hives and wheals due to histamine release, not typically involving the features mentioned in the question.
A 70-year-old woman has difficulty with driving, and she has been frequently getting lost. Her husband said she has also been acting strangely and seems to want to sleep a lot. He said the other night she kept saying she was seeing animals such as lions in her room. He says her memory is not too bad, but he is very concerned about her health. Physical examination reveals an alert woman with stable vital signs. Bradykinesia and limb rigidity are noted. These findings are consistent with:
- A. Alzheimer's disease.
- B. vascular dementia.
- C. dementia with Lewy bodies.
- D. frontotemporal dementia.
Correct Answer: C
Rationale: The correct answer is dementia with Lewy bodies (DLB). Hallucinations, parkinsonian symptoms (like bradykinesia and limb rigidity), and fluctuating cognition are characteristic of DLB. Alzheimer's disease (Choice A) typically presents with memory loss as a prominent feature. Vascular dementia (Choice B) is associated with a history of strokes and step-wise cognitive decline. Frontotemporal dementia (Choice D) often presents with changes in behavior and personality rather than the parkinsonian symptoms seen in this case.