Nokea
You ask a patient to draw a clock. He fills in all the numbers on the right half of the circle. What do you suspect?
- A. Hemianopsia
- B. Fatigue
- C. Oppositional defiant disorder
- D. Depression
Correct Answer: A
Rationale: Filling in all the numbers on just one side of the clock when asked to draw a clock suggests a visual field deficit, typically seen in hemianopsia. Hemianopsia is a visual impairment where half of the visual field is lost due to neurological damage or injury, such as a stroke. This causes the individual to have difficulty perceiving or attending to objects in the affected visual field. In this case, the patient's right visual field may be affected, leading to the specific pattern of filling numbers on the right half of the clock. It is essential to further assess and refer the patient for a complete visual field evaluation and neurological examination.
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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.
You are excited about a positive test finding you have just noticed on physical examination of your patient. You go on to do more examination, laboratory work, and diagnostic tests, only to find that there is no sign of the disease you thought would correlate with the finding. This same experience happens several times. What should you conclude?
- A. Consider not doing this test routinely.
- B. Use this test when you have a higher suspicion for a certain correlating condition.
- C. Continue using the test, perhaps doing less laboratory work and diagnostics.
- D. Omit this test from future examinations.
Correct Answer: B
Rationale: The repeated scenario of finding a positive test result that does not correlate with the suspected disease indicates a lack of specificity for the test in question. In such cases, it is important to use the test when there is a higher suspicion for a specific condition that is known to correlate with the finding. By using the test selectively in situations where it is more likely to provide accurate information, its utility can be maximized and unnecessary further workup can be avoided. This approach allows for a more targeted and efficient use of resources in the diagnostic process.
It started a few hours ago, and she has noted nausea with sensitivity to light; she has had headaches like this in the past, usually less than one per week, but not as severe. She does not know of any inciting factors. There has been no change in the frequency of her headaches. She usually takes an over- the-counter analgesic, and this results in resolution of the headache. Based on this description, what is the most likely diagnosis of the type of headache?
- A. Tension
- B. Migraine
- C. Cluster
- D. Analgesic rebound
Correct Answer: B
Rationale: The description of the headache as starting a few hours ago, associated with nausea, sensitivity to light, and being severe in intensity suggests a migraine headache. Migraine headaches are often accompanied by these symptoms, known as migraine features. The fact that the patient experiences headaches like this less than once a week and typically uses over-the-counter analgesics to relieve them is also suggestive of migraines. Tension headaches typically present as a more mild to moderate, band-like pressure around the head, without the associated symptoms of nausea and sensitivity to light. Cluster headaches are characterized by excruciating pain around one eye, often accompanied by other symptoms like redness or tearing in the eye. Analgesic rebound headaches occur due to overuse of pain medications and typically present as daily headaches that improve with the same medication that caused them in the first place.
He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit?
- A. Refer the patient to a nutritionist because he is anorexic.
- B. Reassure the patient that he has a normal body weight.
- C. Give the patient information about reduction of fat, cholesterol, and calories because he is overweight.
- D. Give the patient information about reduction of fat and cholesterol because he is obese.
Correct Answer: C
Rationale: The appropriate counsel for the patient during the visit would be to give information about the reduction of fat, cholesterol, and calories because he is concerned about his weight. This option addresses the patient's concern and provides guidance on making healthier choices to manage weight. Referring the patient to a nutritionist because he is anorexic (Option A) is not appropriate based on the information provided. Reassuring the patient that he has a normal body weight (Option B) may not address his concerns about weight. Giving the patient information about reducing fat and cholesterol only because he is obese (Option D) does not cover all aspects of a healthy diet such as managing calorie intake.
Mr. Jackson is a 50-year-old African-American who has had discomfort between his scrotum and anus. He also has had some fevers and dysuria. Your rectal examination is halted by tenderness anteriorly, but no frank mass is palpable. What is your most likely diagnosis?
- A. Prostate cancer
- B. Colon cancer
- C. Prostatitis
- D. Colonic polyp
Correct Answer: C
Rationale: The most likely diagnosis in this case is prostatitis. Prostatitis is the inflammation or infection of the prostate gland, which can cause symptoms such as discomfort between the scrotum and anus (perineum), fevers, and dysuria (painful urination). The tenderness anteriorly during rectal examination is consistent with prostatitis as the prostate gland is located in front of the rectum and can be tender to touch when inflamed. Prostate cancer typically presents with symptoms such as urinary frequency, nocturia, hematuria, or bone pain, and is less likely to cause the symptoms described in this scenario. Colon cancer and colonic polyps are less likely as they would not typically cause discomfort in the perineal area or dysuria.