Nokea
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.
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Which lesion is dark, raised, and asymmetric with an irregular border?
- A. Nevus
- B. Actinic keratosis
- C. Keratoacanthoma
- D. Melanoma
Correct Answer: D
Rationale: The correct answer is D, Melanoma. Melanoma is a type of skin cancer that typically presents as a dark, raised lesion with an irregular border and asymmetry. This is due to the abnormal growth of melanocytes, the pigment-producing cells in the skin. Nevus (A) is a common mole that is usually symmetrical and has a regular border. Actinic keratosis (B) is a precancerous lesion that is typically rough and scaly, not dark or raised. Keratoacanthoma (C) is a low-grade skin cancer that often appears as a dome-shaped lesion with a central crater, not necessarily dark or asymmetric.
A patient presents with noticeable swelling in the neck area and difficulty breathing. Which key observation should be prioritized during the neck examination to assess the underlying issue?
- A. Thyroid fullness
- B. Pulsation
- C. Respiratory difficulty
- D. Trachea position
Correct Answer: D
Rationale: The correct answer is D: Trachea position. This is the key observation to prioritize during the neck examination because in a patient presenting with noticeable swelling in the neck area and difficulty breathing, a deviated trachea indicates a potential emergency situation such as a mediastinal mass or tension pneumothorax. Assessing the trachea position helps in identifying any life-threatening conditions that may be causing the respiratory distress.
A: Thyroid fullness may indicate thyroid issues, but in this case, the focus should be on the trachea position due to the acute presentation of difficulty breathing.
B: Pulsation may be relevant in other contexts but is not the priority when assessing a patient with difficulty breathing and neck swelling.
C: Respiratory difficulty is already mentioned in the patient presentation, and the focus should be on identifying the cause of this difficulty, which is best assessed by evaluating the trachea position.
Which is the most effective pattern of palpation for breast cancer?
- A. Beginning at the nipple, make an ever-enlarging spiral.
- B. Divide the breast into quadrants and inspect each systematically.
- C. Examine in lines resembling the back and forth pattern of mowing a lawn.
- D. Beginning at the nipple, palpate outward in a stripe pattern.
Correct Answer: B
Rationale: The correct answer is B. Dividing the breast into quadrants and inspecting each systematically is the most effective pattern of palpation for breast cancer because it ensures thorough coverage of the entire breast, making it easier to detect any abnormalities. This method allows for a structured approach, reducing the likelihood of missing any potential signs of cancer.
A: Beginning at the nipple and making an ever-enlarging spiral may not cover all areas of the breast equally, potentially leading to missed abnormalities.
C: Examining in lines resembling mowing a lawn may also result in uneven coverage and potentially missing crucial areas.
D: Beginning at the nipple and palpating outward in a stripe pattern may not provide comprehensive coverage of the entire breast, increasing the risk of overlooking abnormalities.
Unilateral rhinitis could be caused by all of the following except:
- A. A foreign body in the nasal canal
- B. A nasal polyp
- C. Drug-induced rhinitis
- D. A deviated septum
Correct Answer: D
Rationale: The correct answer is D: A deviated septum. Unilateral rhinitis typically refers to inflammation in one nostril. A deviated septum is a physical obstruction in the nasal passage that affects both nostrils, not just one. Choices A, B, and C can all cause unilateral rhinitis as they specifically affect one side of the nasal passage. A foreign body in the nasal canal, a nasal polyp, and drug-induced rhinitis can all lead to inflammation and symptoms in one nostril.
A 45-year-old electrical engineer presents to your clinic, complaining of spots on his scrotum. He first noticed the spots several months ago, and they have gotten bigger. He denies any pain with urination or with sexual intercourse. He has had no fever, night sweats, weight gain, or weight loss. His past medical history consists of a vasectomy 10 years ago and mild obesity. He is on medication for hyperlipidemia. He denies any tobacco or illegal drug use and drinks alcohol socially. His mother has Alzheimer's disease and his father died of leukemia. On examination he appears relaxed and has unremarkable vital signs. On visualization of his penis, he is circumcised and has no lesions on his penis. Visualization of his scrotum shows three yellow nodules 2-3 millimeters in diameter. During palpation they are firm and nontender. What abnormality of the male genitalia is this most likely to be?
- A. Condylomata acuminata
- B. Syphilitic chancre
- C. Peyronie's disease
- D. Epidermoid cysts
Correct Answer: D
Rationale: The correct answer is D: Epidermoid cysts. These cysts typically present as firm, non-tender nodules on the scrotum, consistent with the patient's presentation. The history of gradual growth without associated symptoms supports this diagnosis. Additionally, the lack of pain with urination or sexual intercourse rules out sexually transmitted infections like condylomata acuminata (choice A) and syphilitic chancre (choice B). Peyronie's disease (choice C) involves penile curvature and fibrous plaques, not scrotal nodules. In summary, the patient's presentation, physical examination findings, and absence of specific symptoms point towards epidermoid cysts as the most likely diagnosis.