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On abdominal examination she has active bowel sounds, is nontender in all quadrants, and has no hepatosplenomegaly. Inspection of the anus reveals inflammation on the posterior side with erythema. Digital rectal examination is painful for the patient, but no abnormalities are palpated. Anoscopic examination reveals no inflammation or bleeding. What is the anal disorder that best describes her symptoms?
- A. Anorectal fistula
- B. External hemorrhoids
- C. Anal fissure
- D. Anorectal cancer
Correct Answer: C
Rationale: Rationale: The patient's symptoms of painful digital rectal examination and inflammation on the posterior side of the anus with erythema are consistent with an anal fissure. The absence of palpable abnormalities and bleeding on anoscopic examination further support this diagnosis. Anal fissures are common and typically present with these symptoms due to a tear in the anal lining.
Incorrect Choices:
A: Anorectal fistula typically presents with discharge, recurrent abscesses, and may have palpable tracks.
B: External hemorrhoids usually present with painless bleeding, swelling, and itching, not with the described symptoms.
D: Anorectal cancer would typically present with more severe symptoms like rectal bleeding, changes in bowel habits, and weight loss, which are not described in this case.
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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.
All of the statements about Medicare are true except:
- A. All of the funding for Medicare comes from federal taxes.
- B. Durable medical equipment has no out-of-pocket cost to the patient.
- C. Part B covers outpatient services and all physician professional fees whether inpatient or outpatient.
- D. Patients are generally responsible for 20% of Part B bills.
Correct Answer: B
Rationale: The correct answer is B because durable medical equipment under Medicare typically requires the patient to pay 20% of the Medicare-approved amount.
A is incorrect because Medicare funding also comes from payroll taxes and individual premiums.
C is incorrect as Part B covers outpatient services and physician fees only in outpatient settings.
D is incorrect as patients are generally responsible for 20% of Part B bills, not no out-of-pocket cost for durable medical equipment.
A 19-year-old college student, Todd, is brought to your clinic by his mother. She is concerned that there is something seriously wrong with him. She states for the past 6 months his behavior has become peculiar and he has flunked out of college. Todd denies any recent illness or injuries. His past medical history is remarkable only for a broken foot. His parents are both healthy. He has a paternal uncle who had similar symptoms in college. The patient admits to smoking cigarettes and drinking alcohol. He also admits to marijuana use but none in the last week. He denies using any other substances. He denies any feelings of depression or anxiety. While speaking with Todd and his mother you do a complete physical examination, which is essentially normal. When you question him on how he is feeling, he says that he is very worried that Microsoft has stolen his software for creating a better browser. He tells you he has seen a black van in his neighborhood at night and he is sure that it is full of computer tech workers stealing his work through special gamma waves. You ask him why he believes they are trying to steal his programs. He replies that the technicians have been telepathing their intents directly into his head. He says he hears these conversations at night so he knows this is happening. Todd's mother then tells you, "See, I told you . . . he's crazy. What do I do about it?" While arranging for a psychiatry consult, what psychotic disorder do you think Todd has?
- A. Schizoaffective disorder
- B. Psychotic disorder due to a medical illness
- C. Substance-induced psychotic disorder
- D. Schizophrenia
Correct Answer: D
Rationale: The correct answer is D: Schizophrenia. Todd presents with a history of peculiar behavior, academic decline, paranoid delusions, and auditory hallucinations. These are classic symptoms of schizophrenia, a chronic and severe mental disorder. Schizoaffective disorder (A) involves a mix of schizophrenia symptoms and mood disturbances, but Todd does not exhibit significant mood symptoms. Psychotic disorder due to a medical illness (B) would require evidence of a medical condition causing Todd's symptoms, which is not present. Substance-induced psychotic disorder (C) would require Todd's symptoms to be solely due to substance use, but his symptoms persist despite marijuana abstinence. Therefore, based on Todd's symptoms and history, the most likely diagnosis is schizophrenia.
The earliest clinical manifestation of diabetic nephropathy is:
- A. An elevation in blood urea nitrogen (BUN)
- B. An elevation in blood urea nitrogen (BUN) and creatinine (CR)
- C. A decreased glomerular filtration rate
- D. Microalbuminuria
Correct Answer: D
Rationale: The correct answer is D: Microalbuminuria. In diabetic nephropathy, the earliest clinical manifestation is the presence of microalbuminuria, which indicates early kidney damage. This occurs before significant changes in BUN, creatinine, or glomerular filtration rate are observed. Microalbuminuria is a key indicator for monitoring and early intervention in diabetic nephropathy.
Incorrect Options:
A: An elevation in blood urea nitrogen (BUN) - BUN levels may rise in later stages of kidney damage.
B: An elevation in blood urea nitrogen (BUN) and creatinine (CR) - These markers typically increase as kidney function declines, not in the early stages.
C: A decreased glomerular filtration rate - GFR decreases as kidney function worsens, not typically an early sign in diabetic nephropathy.
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.