A 19-year-old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis?

Correct Answer: C

Rationale: The correct answer is C. Meningitis typically presents with neck stiffness due to meningeal irritation. In choice C, the patient has a tender neck to palpation and is unable to perform range of motion, indicating meningeal inflammation. Choices A, B, and D all describe a normal head and fundi exam, which is not consistent with meningitis. Choice B mentions muscle spasm and limited range of motion to the right, but this is more suggestive of a musculoskeletal issue rather than meningitis. Choice D describes a normal neck exam, which is not in line with the presentation of meningitis.

Correct Answer: D

Rationale: The correct answer is D: Dry and rough. In hypothyroidism, there is reduced secretion of sweat and oils, leading to dry skin. The lack of hydration causes the skin to become rough. This correlates with the clinical presentation of fatigue, weight gain, and hair loss, which are common symptoms of hypothyroidism. Choices A and B are incorrect because moisture is reduced in hypothyroidism, resulting in dry skin. Choice C is incorrect because the lack of oils in hypothyroidism leads to rough skin texture, not smooth.

Correct Answer: A

Rationale: The correct answer is A because dopamine, serotonin, and norepinephrine are neurotransmitters commonly associated with mood regulation. Medications that affect these neurotransmitters can lead to symptoms of depression as a side effect. B: Gabapentin is not primarily associated with mood regulation. C: Milnacipran is an SNRI used to treat depression, not cause it. D: Cortisol is a stress hormone, not a neurotransmitter directly linked to depression symptoms.

Correct Answer: D

Rationale: The correct answer is D because beneficiaries do have out-of-pocket expenses for each prescription filled under Medicare Part D. This is typically in the form of copayments or coinsurance. A: Medicare Advantage plans often include Part D coverage, making statement A true. B: There are indeed multiple companies offering Part D plans, so statement B is true. C: The monthly premium for Part D coverage can vary, but in 2019 it was indeed around $30, making statement C true as well.

Correct Answer: C

Rationale: The correct answer is C: Regularly irregular rhythm. This is the appropriate documentation for Ms. Wright's presentation as her pulse demonstrates a pattern of irregularity with every fourth beat sounding different. This indicates a regularly irregular rhythm, where there is a discernible pattern to the irregularity. Rationale: 1. Regular rate and rhythm (Choice A) is incorrect as Ms. Wright's palpitations and the irregularity in her pulse indicate an irregular rhythm. 2. Irregularly irregular rhythm (Choice B) is incorrect as this term is used to describe arrhythmias like atrial fibrillation, which do not have a discernible pattern of irregularity. 3. Bradycardia (Choice D) is incorrect as it refers to a slow heart rate, which is not the primary concern in this scenario where the focus is on the irregular rhythm. In summary, the correct choice (C) accurately describes the specific irregular pattern observed in Ms. Wright's pulse, distinguishing it from

Correct Answer: B

Rationale: The correct answer is B: Lymph node. A mobile mass that is palpable and moves in multiple directions is characteristic of a lymph node. Lymph nodes are small, bean-shaped structures that are part of the immune system and can move freely when touched. Incorrect choices: A: Cancer - A cancerous mass would typically be fixed and not mobile. C: Deep scar - Scars are usually fixed and do not move when touched. D: Muscle - Muscles are usually deeper in the body and not typically palpable as a mobile mass.

Correct Answer: D

Rationale: The correct answer is D: Take it with food. Glucocorticosteroids can irritate the stomach lining, leading to gastritis or ulcers. Taking them with food helps reduce stomach irritation and the risk of gastrointestinal side effects. Crushing it in applesauce (A) or chewing it prior to a high-fat meal (B) can exacerbate stomach irritation. Taking it on an empty stomach (C) can increase the risk of stomach upset and decrease absorption. Therefore, taking it with food (D) is the best option to minimize stomach irritation and improve medication effectiveness.

Correct Answer: B

Rationale: The correct answer is B: Spinal stenosis. The symptoms described suggest neurogenic claudication, which is a hallmark of spinal stenosis. Pain worsening with ambulation and improving with lumbar flexion is characteristic of spinal stenosis due to narrowing of the spinal canal leading to compression of nerves. Ankylosing spondylitis (A) presents with inflammatory back pain and stiffness, not neurogenic claudication. Bursitis (C) involves inflammation of bursae, not typically associated with leg pain and numbness. Cauda equina syndrome (D) presents with sudden-onset severe back pain, urinary retention, and saddle anesthesia, which are not consistent with the described symptoms.

Correct Answer: A

Rationale: The correct answer is A because in an older adult with an indwelling urinary catheter, a fever >100°F can be a sign of urinary tract infection (UTI) or urosepsis. Given her acute decline in mental status and fever, empiric antibiotic therapy is warranted to treat a potential infection. Choice B is incorrect because older adults with indwelling catheters are at increased risk for UTIs and bloodstream infections. Choice C is incorrect as obtaining a urine culture is important to confirm the diagnosis and guide appropriate antibiotic therapy. Choice D is incorrect as the duration of antibiotic treatment for a UTI is typically longer than 3 days.