Nokea
Which of the following events occurs at the start of diastole?
- A. Closure of the tricuspid valve
- B. Opening of the pulmonic valve
- C. Closure of the aortic valve
- D. Production of the first heart sound (S )
Correct Answer: B
Rationale: At the start of diastole, the ventricles relax and begin to fill with blood from the atria. As this relaxation phase begins, the pulmonic valve opens to allow blood to flow from the right ventricle to the pulmonary artery and then to the lungs for oxygenation. This marks the beginning of diastole, the period of the cardiac cycle when the heart is filling with blood. The closure of the tricuspid valve, closure of the aortic valve, and production of the first heart sound (S1) occur during systole, the phase of the cardiac cycle when the heart is contracting to pump blood out to the body.
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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
A patient is concerned about a dark skin lesion on her anterolateral abdomen. It has not changed, and there is no discharge or bleeding. On examination there is a medium brown circular lesion on the anterolateral wall of the abdomen. It is soft, has regular borders, is evenly pigmented, and is about 7 mm in diameter. What is this lesion?
- A. Melanoma
- B. Dysplastic nevus
- C. Supernumerary nipple
- D. Dermatofibroma
Correct Answer: D
Rationale: Given the description provided, the lesion appears to be a dermatofibroma. Dermatofibromas are common benign skin lesions that typically present as a firm, solitary nodule on the skin. They commonly occur on the lower extremities but can also be found on the trunk. The characteristics of a dermatofibroma include being firm to the touch, having regular borders, being evenly pigmented, and a diameter typically less than 1 cm to 2 cm. They are usually painless and do not change significantly over time.
A 58-year-old teacher presents to your clinic with a complaint of breathlessness with activity. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems?
- A. Abdominal pain
- B. Orthopnea
- C. Hematochezia
- D. Tenesmus
Correct Answer: B
Rationale: Orthopnea is a symptom characterized by difficulty breathing while lying flat that improves when sitting or standing upright. This symptom is specifically related to cardiovascular conditions, such as heart failure, in which fluid accumulates in the lungs when lying down. Considering the patient's complaint of breathlessness with activity and the need to assess for cardiovascular issues, asking about orthopnea would be most appropriate to gain insights into potential heart-related causes of the symptoms. Abdominal pain (A), hematochezia (C), and tenesmus (D) are not typically associated with cardiovascular conditions and are less relevant to the patient's presentation.
A high school soccer player "blew out his knee" when the opposing goalie's head and shoulder struck his flexed knee while the goalie was diving for the ball. All of the following structures were involved in some way in his injury, but which of the following is actually an extra-articular structure?
- A. Synovium
- B. Joint capsule
- C. Juxta-articular bone
- D. Tendons
Correct Answer: D
Rationale: Tendons are the correct answer as they are an extra-articular structure. Tendons are fibrous connective tissue that attach muscles to bones, providing stability and transmitting forces during movements. In the context of the scenario provided, the player's knee injury involved structures within the joint such as the synovium (A), joint capsule (B), and juxta-articular bone (C), but the tendons (D) are located outside of the joint itself.
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.