Nokea
To hear a soft murmur or bruit, which of the following may be necessary?
- A. Asking the patient to hold her breath
- B. Asking the patient in the next bed to turn down the TV
- C. Checking your stethoscope for air leaks
- D. All of the above
Correct Answer: D
Rationale: To hear a soft murmur or bruit clearly, it is important to minimize any background noise or distractions that may interfere with your ability to auscultate effectively. Therefore, asking the patient to hold her breath (choice A) can help reduce noise caused by the patient's respiration. Asking the patient in the next bed to turn down the TV (choice B) can also help eliminate external noise that may disrupt your ability to hear subtle sounds. Checking your stethoscope for air leaks (choice C) is crucial to ensure that you are hearing sounds accurately and not being affected by any equipment issues. By combining these strategies, you can create an optimal environment for listening to soft murmurs or bruits.
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Mrs. LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely?
- A. Stress incontinence
- B. Urge incontinence
- C. Overflow incontinence
- D. Functional incontinence
Correct Answer: B
Rationale: Urge incontinence, also known as overactive bladder, is characterized by a sudden and strong urge to urinate which is difficult to control. In this case, Mrs. LaFarge is unable to get to the bathroom quickly enough when she senses the need to urinate, which indicates a lack of control over the urge to urinate. This is typically caused by involuntary contractions of the bladder muscle. Stress incontinence, on the other hand, is leakage of urine during activities that increase intra-abdominal pressure, such as coughing or exercising. Overflow incontinence is characterized by urinary retention and constant dribbling of urine due to the bladder being unable to empty properly. Functional incontinence occurs when a person has normal bladder control but is unable to reach the bathroom in time due to physical or cognitive impairments. Since Mrs. LaFarge is experiencing a sudden and strong urge to urinate that she cannot
A high school soccer player "blew out his knee" when the opposing goalie's head and shoulder struck his flexed knee while the goalie was diving for the ball. All of the following structures were involved in some way in his injury, but which of the following is actually an extra-articular structure?
- A. Synovium
- B. Joint capsule
- C. Juxta-articular bone
- D. Tendons
Correct Answer: D
Rationale: Tendons are the correct answer as they are an extra-articular structure. Tendons are fibrous connective tissue that attach muscles to bones, providing stability and transmitting forces during movements. In the context of the scenario provided, the player's knee injury involved structures within the joint such as the synovium (A), joint capsule (B), and juxta-articular bone (C), but the tendons (D) are located outside of the joint itself.
Which area of the arm drains to the epitrochlear nodes?
- A. Ulnar surface of the forearm and hand, little and ring fingers, and ulnar middle finger
- B. Radial surface of the forearm and hand, thumb and index fingers, and radial middle finger
- C. Ulnar surface of the forearm and hand; second, third, and fourth fingers
- D. Radial surface of the forearm and hand; second, third, and fourth fingers
Correct Answer: A
Rationale: The area of the arm that drains to the epitrochlear nodes includes the ulnar surface of the forearm and hand, little and ring fingers, and the ulnar side of the middle finger. The epitrochlear nodes are located in the medial aspect of the arm above the elbow, close to the insertion of the biceps brachii muscle. These nodes receive lymphatic drainage from the above-mentioned areas and play a role in the immune response against infections in these regions.
His head, eyes, ears, nose, and throat examinations are unremarkable. His cardiac examination is normal. On examination of his chest, the diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi are heard over all lung fields. There is no area of dullness and no increased or decreased fremitus. What thorax or lung disorder is most likely causing his symptoms?
- A. Spontaneous pneumothorax
- B. Chronic obstructive pulmonary disease (COPD)
- C. Asthma
- D. Pneumonia
Correct Answer: B
Rationale: The patient's presentation with an enlarged chest diameter, decreased breath sounds throughout all lobes, and the presence of rhonchi over all lung fields is suggestive of a chronic condition that affects the entire respiratory system. These findings are classic for COPD, a progressive lung disease characterized by airflow limitation. The breath sounds are decreased due to airflow obstruction, and the presence of rhonchi indicates mucus production and airway inflammation commonly seen in COPD. In contrast, a spontaneous pneumothorax would typically present with sudden chest pain and shortness of breath, often in a younger patient with risk factors such as smoking. Asthma would present with wheezing, shortness of breath, and possibly a history of atopy or allergies. Pneumonia would typically present with fever, cough, and focal findings on chest examination, such as crackles or bronchial breath sounds over a consolidated area. In
You ask a patient to draw a clock. He fills in all the numbers on the right half of the circle. What do you suspect?
- A. Hemianopsia
- B. Fatigue
- C. Oppositional defiant disorder
- D. Depression
Correct Answer: A
Rationale: Filling in all the numbers on just one side of the clock when asked to draw a clock suggests a visual field deficit, typically seen in hemianopsia. Hemianopsia is a visual impairment where half of the visual field is lost due to neurological damage or injury, such as a stroke. This causes the individual to have difficulty perceiving or attending to objects in the affected visual field. In this case, the patient's right visual field may be affected, leading to the specific pattern of filling numbers on the right half of the clock. It is essential to further assess and refer the patient for a complete visual field evaluation and neurological examination.