Nokea
Which scientist is credited with the discovery of X-rays, and in what year did this discovery occur?
- A. Marie Curie in 1903
- B. Wilhelm Conrad Roentgen in 1895
- C. Thomas Edison in 1896
- D. Albert Einstein in 1905
Correct Answer: B
Rationale: The correct answer is B: Wilhelm Conrad Roentgen in 1895. Roentgen discovered X-rays by accident while experimenting with cathode rays. He noticed a glow from a nearby screen even though it was covered, leading to the discovery of X-rays. Marie Curie is known for her work on radioactivity, not X-rays. Thomas Edison is famous for inventing the light bulb and phonograph, not X-rays. Albert Einstein is known for his work on the theory of relativity, not the discovery of X-rays.
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A 40-year-old female, the overall texture of the breast is soft, with an uneven contour bilaterally. The NP informs the patient that:
- A. Warrants a mammogram
- B. Is considered normal
- C. May be suggestive of fibroadenoma
- D. May indicate cystic breast
Correct Answer: B
Rationale: Step-by-step rationale:
1. The patient is 40 years old, which is within the age range for routine screening mammograms.
2. The description of soft, uneven breasts is typical of normal breast tissue variations.
3. Given the patient's age and the benign characteristics described, no further investigation is needed.
Summary of other choices:
A: Warrants a mammogram - Not necessary as the breast characteristics described are normal for the patient's age.
C: May be suggestive of fibroadenoma - Fibroadenomas typically present as firm, well-defined lumps, not soft and uneven breasts.
D: May indicate cystic breast - Cystic breasts may feel lumpy or tender, but the overall texture is not described as soft and uneven.
Which of the following is a clinical identifier of metabolic syndrome?
- A. Waist circumference of 38 inches for a male
- B. Waist circumference of 34 inches for a female
- C. BP of 134/88 for a male
- D. BP of 128/84 for a female
Correct Answer: A
Rationale: The correct answer is A because a waist circumference of 38 inches for a male is a clinical identifier of metabolic syndrome. This measurement reflects abdominal obesity, a key component of metabolic syndrome. Excess abdominal fat is associated with insulin resistance, high blood pressure, and dyslipidemia, which are all features of metabolic syndrome.
Choice B is incorrect because a waist circumference of 34 inches for a female is not the correct measurement for identifying metabolic syndrome in females.
Choice C is incorrect because a blood pressure of 134/88 for a male, while elevated, is not a specific clinical identifier of metabolic syndrome.
Choice D is incorrect because a blood pressure of 128/84 for a female, although slightly elevated, is not a specific clinical identifier of metabolic syndrome.
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.
A 79-year-old woman was admitted to the hospital a month ago with an acute ischemic stroke. Which would be the next best step in management?
- A. Start escitalopram 5 mg orally daily.
- B. Start eszopiclone 1 mg orally at bedtime.
- C. Start a high-calorie supplement twice a day.
- D. Change the time at which she gets physical therapy.
Correct Answer: C
Rationale: The correct answer is C: Start a high-calorie supplement twice a day. After an acute ischemic stroke, nutritional support is crucial for recovery and prevention of complications. Malnutrition is common post-stroke due to swallowing difficulties and decreased appetite. High-calorie supplements can help meet the patient's nutritional needs.
Choice A (escitalopram) is a selective serotonin reuptake inhibitor used for depression and anxiety, which may not be the immediate priority in this case. Choice B (eszopiclone) is a nonbenzodiazepine hypnotic used for insomnia, which is not directly related to managing the patient's stroke. Choice D (changing the time of physical therapy) may be beneficial, but ensuring adequate nutrition is more critical in the acute phase of stroke recovery.
A 29-year-old computer programmer comes to the office for evaluation of a headache. The tightening sensation of moderate intensity is located all over the head. It used to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea. He spends several hours at a computer monitor/keyboard. He has tried over-the-counter medication; it has dulled the pain, but not taken it away. Based on this description, what is the most likely diagnosis?
- A. Cluster
- B. Analgesic rebound
- C. Tension
- D. Migraine
Correct Answer: C
Rationale: The correct answer is C: Tension headache. The key features in the scenario are the bilateral location of the headache, duration of 5 days, absence of nausea and photophobia, and the patient's occupation as a computer programmer. Tension headaches are typically bilateral, mild to moderate in intensity, and often related to stress, posture, and prolonged screen time. The fact that over-the-counter medication only dulled the pain supports the diagnosis of tension headache.
Summary of other choices:
A: Cluster headaches typically have a unilateral location, severe intensity, and are associated with autonomic symptoms like tearing of the eye.
B: Analgesic rebound headaches occur due to overuse of pain medications, leading to worsening of headaches when the medication wears off.
D: Migraine headaches often present with unilateral throbbing pain, nausea, and sensitivity to light and sound, which are not present in this case.