Nokea
You are at your family reunion playing football when your uncle takes a hit to his right lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a very remote area. What would your next step be?
- A. Call a medevac helicopter
- B. Drive him to the city (4 hours away)
- C. Press on his sternum and spine simultaneously
- D. Examine him for tenderness over the injured area
Correct Answer: D
Rationale: The correct answer is D: Examine him for tenderness over the injured area.
Rationale:
1. Start with a physical examination to assess for tenderness directly over the injured area.
2. Rib fractures often present with localized tenderness upon palpation.
3. If tenderness is present, suspect a rib fracture and advise immobilization.
4. Advise against unnecessary movement to prevent further injury.
Summary:
- Choice A: Calling a medevac helicopter is premature without assessing the severity of the injury.
- Choice B: Driving him 4 hours away could worsen his condition without proper assessment.
- Choice C: Pressing on the sternum and spine simultaneously is not recommended as it can cause further harm.
You may also like to solve these questions
Which of the following is an early sign of dehydration in older adults?
- A. Weight gain
- B. Dry mouth and skin
- C. Decreased urine output
- D. Increased thirst
Correct Answer: B
Rationale: The correct answer is B: Dry mouth and skin. Dehydration in older adults can lead to dry mouth and skin due to the lack of proper hydration. This is an early sign as the body starts to lose water. Weight gain (A) is not indicative of dehydration, as it typically occurs with fluid retention. Decreased urine output (C) is a later sign of dehydration, as the body conserves water. Increased thirst (D) is a response to dehydration but not an early sign. Therefore, dry mouth and skin are the most relevant early indicators of dehydration in older adults.
Which of the following is the most common presenting sign of substance abuse in adolescents?
- A. Poor school performance
- B. Change in sleep habits
- C. Increased blood pressure
- D. Changes in behavior
Correct Answer: D
Rationale: The correct answer is D: Changes in behavior. This is the most common presenting sign of substance abuse in adolescents because substance use often leads to noticeable changes in behavior, such as irritability, mood swings, aggression, and withdrawal from family and friends. These behavioral changes are typically the first noticeable signs of substance abuse.
A: Poor school performance may be a consequence of substance abuse, but it is not necessarily the most common presenting sign.
B: Change in sleep habits can be a sign of substance abuse, but changes in behavior are more prominent and common.
C: Increased blood pressure is a physical symptom of substance abuse, but changes in behavior are usually more readily apparent and commonly observed in adolescents with substance abuse issues.
A 19-year-old college student, Todd, is brought to your clinic by his mother. She is concerned that there is something seriously wrong with him. She states for the past 6 months his behavior has become peculiar and he has flunked out of college. Todd denies any recent illness or injuries. His past medical history is remarkable only for a broken foot. His parents are both healthy. He has a paternal uncle who had similar symptoms in college. The patient admits to smoking cigarettes and drinking alcohol. He also admits to marijuana use but none in the last week. He denies using any other substances. He denies any feelings of depression or anxiety. While speaking with Todd and his mother you do a complete physical examination, which is essentially normal. When you question him on how he is feeling, he says that he is very worried that Microsoft has stolen his software for creating a better browser. He tells you he has seen a black van in his neighborhood at night and he is sure that it is full of computer tech workers stealing his work through special gamma waves. You ask him why he believes they are trying to steal his programs. He replies that the technicians have been telepathing their intents directly into his head. He says he hears these conversations at night so he knows this is happening. Todd's mother then tells you, "See, I told you . . . he's crazy. What do I do about it?" While arranging for a psychiatry consult, what psychotic disorder do you think Todd has?
- A. Schizoaffective disorder
- B. Psychotic disorder due to a medical illness
- C. Substance-induced psychotic disorder
- D. Schizophrenia
Correct Answer: D
Rationale: The correct answer is D: Schizophrenia. Todd presents with a history of peculiar behavior, academic decline, paranoid delusions, and auditory hallucinations. These are classic symptoms of schizophrenia, a chronic and severe mental disorder. Schizoaffective disorder (A) involves a mix of schizophrenia symptoms and mood disturbances, but Todd does not exhibit significant mood symptoms. Psychotic disorder due to a medical illness (B) would require evidence of a medical condition causing Todd's symptoms, which is not present. Substance-induced psychotic disorder (C) would require Todd's symptoms to be solely due to substance use, but his symptoms persist despite marijuana abstinence. Therefore, based on Todd's symptoms and history, the most likely diagnosis is schizophrenia.
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.
Mr. Hunter, a 69-year-old man, complains of urinary frequency and urgency that have increased over the past several months. There is no dysuria, hematuria, or sensation of incomplete voiding. He drinks 2 cups of coffee daily and diet cola multiple times a day. His International Prostate Symptom Score (IPSS) is 6, with a bother score of 1 indicating mild voiding symptoms with low impact on his quality of life. His medical history includes hypertension, coronary artery disease, and benign prostatic hyperplasia. Current medications are aspirin, metoprolol, and hydrochlorothiazide. Physical examination reveals normal sized prostate. Which of the following is the best next step?
- A. Urinalysis
- B. Cystoscopy
- C. Lifestyle modifications
- D. Tamsulosin
Correct Answer: C
Rationale: The correct next step is C: Lifestyle modifications. Given the patient's history of mild voiding symptoms and benign prostatic hyperplasia, the first approach should be conservative management. Lifestyle modifications, such as reducing caffeine intake from coffee and diet cola, can help alleviate urinary symptoms. Additionally, optimizing fluid intake and bladder habits can also improve symptoms. Urinalysis (choice A) may be considered later if symptoms persist or worsen. Cystoscopy (choice B) is invasive and not indicated at this stage. Tamsulosin (choice D) is a medication for BPH, but since the patient's symptoms are mild and bother score is low, starting with lifestyle modifications is more appropriate.