Nokea
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.
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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.
On abdominal examination she has active bowel sounds, is nontender in all quadrants, and has no hepatosplenomegaly. Inspection of the anus reveals inflammation on the posterior side with erythema. Digital rectal examination is painful for the patient, but no abnormalities are palpated. Anoscopic examination reveals no inflammation or bleeding. What is the anal disorder that best describes her symptoms?
- A. Anorectal fistula
- B. External hemorrhoids
- C. Anal fissure
- D. Anorectal cancer
Correct Answer: C
Rationale: Rationale: The patient's symptoms of painful digital rectal examination and inflammation on the posterior side of the anus with erythema are consistent with an anal fissure. The absence of palpable abnormalities and bleeding on anoscopic examination further support this diagnosis. Anal fissures are common and typically present with these symptoms due to a tear in the anal lining.
Incorrect Choices:
A: Anorectal fistula typically presents with discharge, recurrent abscesses, and may have palpable tracks.
B: External hemorrhoids usually present with painless bleeding, swelling, and itching, not with the described symptoms.
D: Anorectal cancer would typically present with more severe symptoms like rectal bleeding, changes in bowel habits, and weight loss, which are not described in this case.
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.
Which of the following drugs is not contraindicated for concurrent use with warfarin (Coumadin)?
- A. Amoxicillin (Amoxil)
- B. Trimethoprim/sulfamethoxazole (Bactrim)
- C. Ciprofloxacin (Cipro)
- D. Clarithromycin (Biaxin)
Correct Answer: A
Rationale: Rationale for correct answer (A): Amoxicillin does not significantly interact with warfarin. It is an antibiotic that works through a different mechanism than warfarin and is not known to affect its anticoagulant activity.
Summary of incorrect choices:
B (Trimethoprim/sulfamethoxazole): This drug combination can enhance the effects of warfarin, increasing the risk of bleeding.
C (Ciprofloxacin): Ciprofloxacin can increase warfarin's effects, leading to a higher risk of bleeding.
D (Clarithromycin): Clarithromycin can interact with warfarin, potentially increasing the risk of bleeding.
Which form of urinary incontinence is present in a patient with Alzheimer’s disease who is unable to reach the toilet in time?
- A. Functional incontinence
- B. Overflow incontinence
- C. Urge incontinence
- D. Stress incontinence
Correct Answer: A
Rationale: Functional incontinence is the correct answer. This occurs when a person has physical or cognitive impairments that prevent them from reaching the toilet in time. In Alzheimer's disease, the patient's cognitive decline may impede their ability to recognize the need to urinate or navigate to the restroom. Overflow incontinence is due to bladder overdistention, urge incontinence is characterized by a sudden and overwhelming urge to urinate, and stress incontinence is associated with physical activities that increase intra-abdominal pressure. Hence, in this scenario, functional incontinence aligns with the patient's inability to reach the toilet promptly due to their Alzheimer's disease-related cognitive limitations.