Nokea
When examining the breast, the "tail of Spence" would be located:
- A. In the upper inner quadrant
- B. In the lower inner quadrant
- C. In the lower outer quadrant
- D. Laterally across the anterior axillary fold
Correct Answer: D
Rationale: The "tail of Spence" is an extension of breast tissue into the axilla. To locate it, visualize an imaginary line extending laterally from the breast towards the arm, crossing the anterior axillary fold. This is where the tail of Spence is found.
A: Incorrect. The upper inner quadrant is closer to the sternum.
B: Incorrect. The lower inner quadrant is below the nipple.
C: Incorrect. The lower outer quadrant is towards the armpit but not in the axilla like the tail of Spence.
Therefore, choice D is correct because the tail of Spence extends laterally across the anterior axillary fold.
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The nurse is teaching an older client with hypertension about lifestyle changes. Which of the following is most effective in managing high blood pressure?
- A. Reducing sodium intake
- B. Increasing intake of fatty foods
- C. Limiting physical activity
- D. Reducing fiber in the diet
Correct Answer: A
Rationale: The correct answer is A: Reducing sodium intake. High sodium intake can lead to fluid retention and increased blood pressure. By reducing sodium intake, blood pressure can be effectively managed. Increasing intake of fatty foods (B) can contribute to heart disease and worsen hypertension. Limiting physical activity (C) can lead to weight gain and higher blood pressure. Reducing fiber in the diet (D) can negatively impact overall health and increase the risk of hypertension.
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.
An 81-year-old transgender female with a history of depression and hyperlipidemia presents to your clinic for routine care. She endorses a history of smoking, currently smoking 1 pack per day, and occasionally drinks a glass of wine, although she denies illicit drug use. She reports she takes atorvastatin 20 mg and subcutaneous estrogen therapy.
- A. Counseling on starting aspirin
- B. Counseling on alcohol cessation
- C. Counseling on smoking cessation
- D. Counseling on mammogram
Correct Answer: C
Rationale: The correct answer is C: Counseling on smoking cessation. Smoking is a major risk factor for numerous health issues such as cardiovascular disease, respiratory problems, and cancer. Given the patient's age, history of smoking, and other risk factors like depression and hyperlipidemia, counseling on smoking cessation is crucial to improve her overall health and reduce the risk of future complications.
Choice A: Counseling on starting aspirin may be appropriate for some individuals based on their cardiovascular risk profile, but in this case, smoking cessation is a more urgent priority due to the direct impact of smoking on health.
Choice B: Counseling on alcohol cessation is important, but in this scenario, smoking cessation takes precedence due to the immediate and significant health risks associated with smoking.
Choice D: Counseling on mammogram is important for breast cancer screening, but addressing smoking cessation should be the primary focus given the patient's current health risks.
In summary, counseling on smoking cessation is the most critical intervention for this patient to improve her overall health
A patient with bulimia is likely to be:
- A. Very overweight
- B. Very underweight
- C. Of average weight
- D. Not concerned with weight
Correct Answer: C
Rationale: The correct answer is C: Of average weight. Patients with bulimia often maintain a normal weight or fluctuate between weight extremes due to their binge-eating and compensatory behaviors. They may engage in purging to counteract the effects of binge eating, preventing significant weight gain. Choice A is incorrect as bulimia is not typically associated with being very overweight. Choice B is incorrect as individuals with bulimia can have a normal or slightly underweight body weight. Choice D is incorrect as individuals with bulimia are often preoccupied with weight and body image.