Nokea
Pain, swelling, loss of both active and passive motion, locking, and deformity would be consistent with which of the following?
- A. Articular joint pain
- B. Bursitis
- C. Muscular injury
- D. Nerve damage
Correct Answer: A
Rationale: The correct answer is A: Articular joint pain. Pain, swelling, loss of motion, locking, and deformity are indicative of articular joint involvement. Articular joints are where two or more bones meet and allow movement. This type of pain is often associated with conditions like osteoarthritis, rheumatoid arthritis, or joint injuries. Bursitis (choice B) typically presents with localized pain and swelling around a joint. Muscular injury (choice C) usually results in pain and limited motion but does not typically involve locking or deformity. Nerve damage (choice D) may cause pain and numbness, but it does not typically lead to joint locking or deformity.
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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.
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.
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.
Which of the following anatomic landmark associations is correct?
- A. 2nd intercostal space for needle insertion in tension pneumothorax
- B. T6 for lower margin of endotracheal tube
- C. Sternal angle marks the 4th rib
- D. 5th intercostal space for chest tube insertion
Correct Answer: D
Rationale: The correct answer is D because the 5th intercostal space is the recommended location for chest tube insertion to drain the pleural space effectively. This space is ideal as it allows for adequate drainage without causing injury to vital structures.
A: The 2nd intercostal space is actually used for needle decompression in tension pneumothorax.
B: T6 is the level at which the tip of the endotracheal tube should ideally lie to ensure proper placement and ventilation.
C: The sternal angle corresponds to the 2nd rib, not the 4th rib, making this association incorrect.
In summary, choice D is correct as it aligns with the standard practice for chest tube insertion, while choices A, B, and C are incorrect due to their association with different anatomic landmarks and procedures.
A 33-year-old construction worker comes for evaluation and treatment of acute onset of low back pain. He notes that the pain is an aching located in the lumbosacral area. It has been present intermittently for several years; there is no known trauma or injury. He points to the left lower back. The pain does not radiate and there is no numbness or tingling in the legs or incontinence. He was moving furniture for a friend over the weekend. On physical examination, you note muscle spasm, with normal deep tendon reflexes and muscle strength. What is the most likely cause of this patient's low back pain?
- A. Herniated disc
- B. Compression fracture
- C. Mechanical low back pain
- D. Ankylosing spondylitis
Correct Answer: C
Rationale: The correct answer is C: Mechanical low back pain. This is the most likely cause as the patient's pain is aching, located in the lumbosacral region, intermittent for years, with no radiation, numbness, tingling, or incontinence. The physical exam findings of muscle spasm, normal reflexes, and muscle strength support this diagnosis. Mechanical low back pain is common and often related to muscle strain or overuse, as seen in this construction worker who was moving furniture.
Choice A (Herniated disc) is incorrect as the patient does not have radiation of pain or neurological symptoms. Choice B (Compression fracture) is unlikely without a history of trauma or injury. Choice D (Ankylosing spondylitis) is less likely given the lack of inflammatory symptoms and typical age of onset.