Nokea
Which is the most effective pattern of palpation for breast cancer?
- A. Beginning at the nipple, make an ever-enlarging spiral.
- B. Divide the breast into quadrants and inspect each systematically.
- C. Examine in lines resembling the back and forth pattern of mowing a lawn.
- D. Beginning at the nipple, palpate outward in a stripe pattern.
Correct Answer: B
Rationale: The correct answer is B. Dividing the breast into quadrants and inspecting each systematically is the most effective pattern of palpation for breast cancer because it ensures thorough coverage of the entire breast, making it easier to detect any abnormalities. This method allows for a structured approach, reducing the likelihood of missing any potential signs of cancer.
A: Beginning at the nipple and making an ever-enlarging spiral may not cover all areas of the breast equally, potentially leading to missed abnormalities.
C: Examining in lines resembling mowing a lawn may also result in uneven coverage and potentially missing crucial areas.
D: Beginning at the nipple and palpating outward in a stripe pattern may not provide comprehensive coverage of the entire breast, increasing the risk of overlooking abnormalities.
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When treating a patient with asthma who is experiencing acute wheezing, which medication should be given to relieve the symptoms?
- A. Short acting bronchodilator
- B. Long acting bronchodilator
- C. Inhaled corticosteroid
- D. Combination of methylxanthine and long acting bronchodilator
Correct Answer: A
Rationale: The correct answer is A: Short acting bronchodilator. During an acute asthma attack, a short-acting bronchodilator (such as albuterol) is the preferred medication to relieve symptoms quickly by dilating the airways. This medication acts rapidly to open up the airways and provide immediate relief of wheezing and shortness of breath. Long-acting bronchodilators (choice B) are not recommended for acute symptom relief. Inhaled corticosteroids (choice C) are used for long-term control of asthma symptoms and not for immediate relief during an acute attack. Combining methylxanthine and long-acting bronchodilator (choice D) is not the standard treatment for acute wheezing in asthma.
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 conditions is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman?
- A. Hirsutism
- B. Gynecomastia
- C. Oligomenorrhea
- D. Acne
Correct Answer: D
Rationale: Rationale for correct answer D: Acne is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman because hyperprolactinemia usually presents with symptoms related to hormonal imbalance, such as irregular menstrual cycles (oligomenorrhea), breast changes (gynecomastia), and excess body hair (hirsutism). Acne is not directly associated with elevated prolactin levels.
Summary of incorrect choices:
A: Hirsutism - Hirsutism is a common finding in hyperprolactinemia due to hormonal imbalances.
B: Gynecomastia - Gynecomastia can occur in hyperprolactinemia due to the suppression of testosterone.
C: Oligomenorrhea - Oligomenorrhea is a typical finding in hyperprolactinemia due to disruptions in the menstrual cycle.
Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?
- A. Sigmoid mass
- B. Tumor in the abdominal wall
- C. Hernia
- D. Enlarged bladder
Correct Answer: D
Rationale: Rationale for D (Enlarged bladder): The presentation of a smooth lower abdominal mass that is minimally tender and associated with dullness to percussion above the symphysis pubis suggests an enlarged bladder. This is a common finding in elderly individuals due to various reasons such as urinary retention or bladder outlet obstruction. The location and characteristics of the mass align with an enlarged bladder.
Summary of other choices:
A: Sigmoid mass - Unlikely as sigmoid mass typically presents with different characteristics such as irregular shape and may not cause dullness to percussion above the symphysis pubis.
B: Tumor in the abdominal wall - Less likely as tumors in the abdominal wall would have a different presentation and wouldn't be associated with urinary symptoms.
C: Hernia - Less likely as hernias typically manifest with a bulge that can be reduced and may not cause dullness to percussion above the symphysis pubis.
Which one of the following is most true about the rule of fourths?
- A. One-fourth of geriatric problems are iatrogenic.
- B. Little can be done to prevent three-fourths of the problems of aging.
- C. For every medical complaint a patient presents with, a careful assessment can identify three other diagnoses.
- D. What used to be called normal aging can be largely explained by processes that are not normal.
Correct Answer: A
Rationale: Step 1: The rule of fourths states that one-fourth of geriatric problems are iatrogenic, meaning they are caused by medical treatment.
Step 2: This statement is true because iatrogenic problems in the elderly are common due to multiple medications, procedures, etc.
Step 3: A careful assessment can indeed identify iatrogenic issues, making this statement accurate.
Summary:
A is correct because it aligns with the concept of iatrogenic problems in the elderly.
B is incorrect because interventions can help prevent many problems of aging.
C is incorrect as it does not specifically address iatrogenic problems.
D is incorrect as it does not focus on the iatrogenic aspect of geriatric problems.