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When palpating the prostate gland during the rectal exam, the prostate feels tender, swollen, boggy, and warm. This finding is consistent with:
- A. A normal prostate gland
- B. Acute bacterial prostatitis
- C. Benign prostatic hyperplasia
- D. Carcinoma of the prostate
Correct Answer: B
Rationale: The correct answer is B: Acute bacterial prostatitis. This is because the symptoms of tenderness, swelling, bogginess, and warmth are indicative of an acute inflammatory process, which is commonly seen in acute bacterial prostatitis. This condition typically presents with localized prostate tenderness and inflammation due to a bacterial infection. Other choices are incorrect because: A) A normal prostate gland should not exhibit these signs of inflammation. C) Benign prostatic hyperplasia is typically asymptomatic or may present with obstructive urinary symptoms, not acute inflammatory signs. D) Carcinoma of the prostate usually does not present with acute inflammatory findings on palpation.
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Dr. Smith is obtaining informed consent from Mr. Jones to perform a colonoscopy. Which element of decision-making capacity is impaired in this case?
- A. Understanding
- B. Appreciation
- C. Ability to express a choice
- D. None of the above
Correct Answer: B
Rationale: The correct answer is B: Appreciation. In this scenario, Mr. Jones may understand the information presented about the colonoscopy, but he may not fully appreciate the implications and consequences of undergoing the procedure. Appreciation involves the ability to understand the personal relevance of the information provided. This is crucial in ensuring that the individual can make a truly informed decision.
A: Understanding is not impaired as Mr. Jones may comprehend the information presented.
C: Ability to express a choice is not necessarily impaired in this case, as Mr. Jones may still be able to verbalize his decision.
D: None of the above is incorrect because Appreciation is indeed impaired in this situation.
Mr. Hunter, a 69-year-old man, complains of urinary frequency and urgency that have increased over the past several months. There is no dysuria, hematuria, or sensation of incomplete voiding. He drinks 2 cups of coffee daily and diet cola multiple times a day. His International Prostate Symptom Score (IPSS) is 6, with a bother score of 1 indicating mild voiding symptoms with low impact on his quality of life. His medical history includes hypertension, coronary artery disease, and benign prostatic hyperplasia. Current medications are aspirin, metoprolol, and hydrochlorothiazide. Physical examination reveals normal sized prostate. Which of the following is the best next step?
- A. Urinalysis
- B. Cystoscopy
- C. Lifestyle modifications
- D. Tamsulosin
Correct Answer: C
Rationale: The correct next step is C: Lifestyle modifications. Given the patient's history of mild voiding symptoms and benign prostatic hyperplasia, the first approach should be conservative management. Lifestyle modifications, such as reducing caffeine intake from coffee and diet cola, can help alleviate urinary symptoms. Additionally, optimizing fluid intake and bladder habits can also improve symptoms. Urinalysis (choice A) may be considered later if symptoms persist or worsen. Cystoscopy (choice B) is invasive and not indicated at this stage. Tamsulosin (choice D) is a medication for BPH, but since the patient's symptoms are mild and bother score is low, starting with lifestyle modifications is more appropriate.
Why is it important to inquire about the age of the first period when taking a sexual history from female patients?
- A. It helps to determine the patient's current level of physical fitness.
- B. It provides insight into the patient's reproductive health and potential risks.
- C. It indicates the patient's dietary habits.
- D. It is irrelevant to sexual health assessments.
Correct Answer: B
Rationale: The correct answer is B because knowing the age of the first period can give insight into the patient's reproductive health and potential risks. Early or late onset of menstruation can be indicators of hormonal imbalances, reproductive disorders, or potential fertility issues. This information is crucial for assessing the patient's overall gynecological health and guiding appropriate interventions.
Choice A is incorrect because the age of the first period is not directly related to determining the patient's current level of physical fitness. Choice C is incorrect because the age of the first period does not indicate the patient's dietary habits. Choice D is incorrect because the age of the first period is relevant to sexual health assessments as it provides valuable information about the patient's reproductive health.
A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis?
- A. Pityriasis rosea
- B. Tinea versicolor
- C. Psoriasis
- D. Atopic eczema
Correct Answer: A
Rationale: The correct answer is A: Pityriasis rosea. The key features that point towards this diagnosis include the sudden eruption of lesions in a Christmas tree pattern on the back and torso, along with itching. Pityriasis rosea commonly presents with a single large patch followed by smaller lesions in a distinct pattern. Other choices can be ruled out based on the description provided. Tinea versicolor typically presents with hypo- or hyperpigmented patches, not the erythematous papules and macules described. Psoriasis usually presents with thick, silvery scales, not erythematous lesions in a Christmas tree pattern. Atopic eczema may present with erythematous papules, but the Christmas tree pattern and acute onset described are not typical.
You want to start pharmacologic treatment for depression in an older patient who is taking numerous medications. Which of the following antidepressants is the least likely to cause drug-drug interactions?
- A. Citalopram
- B. Fluoxetine
- C. Paroxetine
- D. Venlafaxine
Correct Answer: E
Rationale: I believe you made a typo in listing the correct answer as "E" while there is no "E" option in the choices provided. Could you please confirm the correct answer choice so I can provide you with a detailed explanation and summary of why the correct answer is correct and why the other choices are incorrect?