Nokea
Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?
- A. Sigmoid mass
- B. Tumor in the abdominal wall
- C. Hernia
- D. Enlarged bladder
Correct Answer: D
Rationale: Rationale for D (Enlarged bladder): The presentation of a smooth lower abdominal mass that is minimally tender and associated with dullness to percussion above the symphysis pubis suggests an enlarged bladder. This is a common finding in elderly individuals due to various reasons such as urinary retention or bladder outlet obstruction. The location and characteristics of the mass align with an enlarged bladder.
Summary of other choices:
A: Sigmoid mass - Unlikely as sigmoid mass typically presents with different characteristics such as irregular shape and may not cause dullness to percussion above the symphysis pubis.
B: Tumor in the abdominal wall - Less likely as tumors in the abdominal wall would have a different presentation and wouldn't be associated with urinary symptoms.
C: Hernia - Less likely as hernias typically manifest with a bulge that can be reduced and may not cause dullness to percussion above the symphysis pubis.
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A patient tells you about her experience with prolonged therapy for her breast cancer. You comment, "That must have been a very trying time for you." What is this an example of?
- A. Reassurance
- B. Empathy
- C. Summarization
- D. Validation
Correct Answer: B
Rationale: The correct answer is B: Empathy. By acknowledging the patient's emotional experience and showing understanding of her feelings, the response demonstrates empathy. This response validates the patient's emotions and fosters a sense of connection and understanding.
Choice A: Reassurance implies providing comfort or support, but in this scenario, the focus is on acknowledging the patient's feelings rather than providing reassurance.
Choice C: Summarization involves restating key points or information, which is not demonstrated in the given scenario where the focus is on acknowledging the patient's emotional experience.
Choice D: Validation involves recognizing and affirming the patient's emotions as legitimate, which aligns closely with empathy. However, in this specific scenario, the response does not explicitly confirm the validity of the patient's emotions, making it less appropriate than the answer choice of empathy.
A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis?
- A. Dacryocystitis
- B. Chalazion
- C. Hordeolum
- D. Xanthelasma
Correct Answer: C
Rationale: The correct answer is C: Hordeolum. A hordeolum, also known as a stye, presents as a red raised tender area at the margin of the eyelid. In this case, the absence of tearing upon palpation of the lesion suggests it is localized to the eyelid itself. Dacryocystitis (choice A) involves the lacrimal sac and would present with tearing. A chalazion (choice B) is a painless nodule on the eyelid, unlike the tender lesion described here. Xanthelasma (choice D) is characterized by yellowish plaques on the eyelids, not a red raised tender area.
A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?
- A. Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.
- B. Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.
- C. Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.
- D. Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.
Correct Answer: C
Rationale: The correct answer is C because tenderness in the right upper quadrant with inspiration points towards Murphy's sign, indicative of cholecystitis. This sign is elicited by palpating the right upper quadrant while the patient takes a deep breath. This maneuver causes the gallbladder to descend and come into contact with the inflamed peritoneum, reproducing pain and halting inspiration. Choices A, B, and D do not describe physical examination findings specific to cholecystitis such as Murphy's sign or tenderness in the right upper quadrant with inspiration. Therefore, they are incorrect.
Why is it important to inquire about the age of the first period when taking a sexual history from female patients?
- A. It helps to determine the patient's current level of physical fitness.
- B. It provides insight into the patient's reproductive health and potential risks.
- C. It indicates the patient's dietary habits.
- D. It is irrelevant to sexual health assessments.
Correct Answer: B
Rationale: The correct answer is B because knowing the age of the first period can give insight into the patient's reproductive health and potential risks. Early or late onset of menstruation can be indicators of hormonal imbalances, reproductive disorders, or potential fertility issues. This information is crucial for assessing the patient's overall gynecological health and guiding appropriate interventions.
Choice A is incorrect because the age of the first period is not directly related to determining the patient's current level of physical fitness. Choice C is incorrect because the age of the first period does not indicate the patient's dietary habits. Choice D is incorrect because the age of the first period is relevant to sexual health assessments as it provides valuable information about the patient's reproductive health.
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.