Nokea
Upon arriving at a scene where a patient has been involved in a minor car accident, she reports feeling faint and states that she has a history of diabetes. Given this information, what is the primary concern that the patient is expressing?
- A. Her blood sugar levels are likely unstable
- B. She is experiencing a headache
- C. She has a history of hypertension
- D. She is feeling nauseous
Correct Answer: A
Rationale: The correct answer is A: Her blood sugar levels are likely unstable. Given the patient's history of diabetes and feeling faint after a minor car accident, the primary concern is hypoglycemia, which can occur due to stress or delayed food intake. Symptoms may include feeling faint, weakness, and confusion. It is important to address this immediately as untreated hypoglycemia can lead to serious complications.
Choice B is incorrect as a headache is not typically a primary concern for a diabetic patient feeling faint. Choice C is incorrect as hypertension is not directly related to the symptoms described. Choice D is incorrect as nausea is not a typical symptom of hypoglycemia in this context. It is crucial to focus on the patient's diabetic history and potential hypoglycemia in this scenario.
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A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings?
- A. Eczema
- B. Pityriasis rosea
- C. Psoriasis
- D. Tinea infection
Correct Answer: C
Rationale: The correct answer is C: Psoriasis. The key clinical features described, such as pruritic rash with scabbing, crusting, silvery scale, and nail pitting, are classic signs of psoriasis. The presence of small "pits" in the nails, known as nail pitting, is a common finding in psoriasis. The worsening of symptoms in winter and improvement with sun exposure is also typical of psoriasis. Eczema (choice A) typically presents with red, inflamed, and weeping skin lesions. Pityriasis rosea (choice B) presents with a herald patch followed by smaller similar lesions. Tinea infection (choice D) presents with scaling, redness, and itching but does not typically cause nail pitting. In this case, the combination of symptoms and nail pitting point to psoriasis as the most likely diagnosis.
A 78-year-old woman with cardiovascular disease declines creating an advance directive. Which characteristic is necessary for a healthcare agent?
- A. Geographic proximity to the patient’s home
- B. Knows how the patient defines quality of life
- C. Is a member of the patient’s immediate family
- D. Has medical training or experience
Correct Answer: B
Rationale: The correct answer is B because knowing how the patient defines quality of life is crucial for making healthcare decisions aligned with the patient's values and preferences. This ensures the healthcare agent can advocate for the patient's wishes effectively. Geographic proximity (A) is not necessary as communication can be maintained remotely. Being a family member (C) may create biases, and medical training (D) is not essential for understanding the patient's values.
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.
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.
Which of the following is an early sign of dehydration in older adults?
- A. Weight gain
- B. Dry mouth and skin
- C. Decreased urine output
- D. Increased thirst
Correct Answer: B
Rationale: The correct answer is B: Dry mouth and skin. Dehydration in older adults can lead to dry mouth and skin due to the lack of proper hydration. This is an early sign as the body starts to lose water. Weight gain (A) is not indicative of dehydration, as it typically occurs with fluid retention. Decreased urine output (C) is a later sign of dehydration, as the body conserves water. Increased thirst (D) is a response to dehydration but not an early sign. Therefore, dry mouth and skin are the most relevant early indicators of dehydration in older adults.