Nokea
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.
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A 28-year-old married clothing sales clerk comes to your clinic for her annual examination. She requests a refill on her birth control pills. Her only complaint is painless bleeding after intercourse. She denies any other symptoms. Her past medical history consists of two spontaneous vaginal deliveries. Her past six Pap smears have all been normal. She is married and has two children. Her mother is in good health and her father has high blood pressure. On examination you see a young woman appearing healthy and relaxed. Her vital signs are unremarkable and her head, eyes, ears, throat, neck, cardiac, lung, and abdominal examinations are normal. Visualization of the perineum shows no lesions or masses. Speculum examination shows a red mass at the os. On taking a Pap smear the mass bleeds easily. Bimanual examination shows no cervical motion tenderness and both ovaries are palpated and nontender. What is the most likely diagnosis for the abnormality of her cervix?
- A. Carcinoma of the cervix
- B. Mucopurulent cervicitis
- C. Cervical polyp
- D. Retention cyst
Correct Answer: C
Rationale: Given the patient's history and presentation, the most likely diagnosis for the abnormality seen on examination is a cervical polyp. Cervical polyps are benign growths that arise from the mucosal surface of the cervix. They are typically red or purple in color and can bleed easily, especially when touched, as in this case with the Pap smear causing bleeding. Cervical polyps are usually asymptomatic but can present with painless bleeding, particularly after intercourse. In this patient, the visualization of a red mass at the os during speculum examination and the finding of bleeding with manipulation support the diagnosis of a cervical polyp. Additionally, the absence of other significant findings on examination and the patient's overall healthy appearance further support this benign diagnosis. Further evaluation with possible removal of the polyp may be warranted for confirmation and to alleviate the bleeding symptoms.
Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not have facial tenderness or tenderness of the scalp. Which of the following is the most likely cause of her pain?
- A. Trigeminal neuralgia
- B. Temporomandibular joint syndrome
- C. Temporal arteritis
- D. Tumor of the mandible
Correct Answer: B
Rationale: Mrs. Fletcher's symptoms of unilateral pain during chewing, which is chronic, without facial tenderness or tenderness of the scalp are more suggestive of temporomandibular joint (TMJ) syndrome rather than other conditions listed. TMJ syndrome is characterized by pain and dysfunction of the jaw muscles and the joints that connect the jaw to the skull. The pain is often worsened by chewing or opening the mouth widely. In this case, the absence of facial tenderness or signs of temporal arteritis makes these conditions less likely. Trigeminal neuralgia typically presents with sudden, severe facial pain in the distribution of the trigeminal nerve. Tumor of the mandible would likely present with other symptoms such as swelling, bone destruction, or difficulty with mouth opening and chewing. Temporal arteritis usually presents with symptoms such as headache, scalp tenderness, and visual disturbances. Given Mrs. Fletcher's presentation,
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
His abdominal examination is normal. Visualization of the anus shows no masses, inflammation, or fissures. Digital rectal examination reveals a warm, boggy, tender prostate. No discrete masses are felt and there is no blood on the glove. The scrotum and penis appear normal. Urinalysis shows moderate amounts of white blood cells and bacteria. What disorder of the anus, prostate, or rectum best describes this situation?
- A. Benign prostatic hyperplasia (BPH)
- B. Prostatitis
- C. Prostate cancer
- D. Epididymitis
Correct Answer: B
Rationale: Prostatitis is the most likely disorder based on the symptoms described. The warm, boggy, tender prostate upon digital rectal examination, along with the presence of moderate white blood cells and bacteria in the urinalysis, suggests an inflammatory condition of the prostate. In this case, there are no signs of masses or blood in the rectal examination, which would be more indicative of prostate cancer. Epididymitis typically presents with symptoms involving the scrotum and may be associated with testicular pain and swelling, which are not described in this scenario. Benign prostatic hyperplasia (BPH) is a nonmalignant enlargement of the prostate gland that typically presents with symptoms of urinary urgency, frequency, and nocturia, rather than the inflammatory signs seen in this case.
Which of the following is consistent with good percussion technique?
- A. Allow all of the fingers to touch the chest while performing percussion.
- B. Maintain a stiff wrist and hand.
- C. Leave the plexor finger on the pleximeter after each strike.
- D. Strike the pleximeter over the distal interphalangeal joint.
Correct Answer: C
Rationale: Leaving the plexor finger on the pleximeter after each strike is consistent with good percussion technique. This helps to maintain stability and precision during percussion by providing a consistent point of contact for accurate assessment of the underlying structures. This technique also helps to control the force and angle of the percussive strike, ensuring accurate interpretation of the resulting sounds produced. Maintaining this contact can enhance the effectiveness of percussion as a diagnostic tool in physical examinations.