A 20-year-old man with asymptomatic scrotal mass. Most appropriate first step?

Correct Answer: A

Rationale: The correct answer is A: Palpation and transillumination. This is the most appropriate first step because it allows for a physical examination of the scrotal mass to determine its characteristics and location. Palpation can help assess the size, shape, consistency, and tenderness of the mass. Transillumination can differentiate between fluid-filled (e.g., hydrocele) and solid masses (e.g., testicular tumor). This initial assessment helps guide further diagnostic workup and management decisions. Choices B, C, and D are incorrect because performing tumor markers (HCG and α-fetoprotein) or scrotal ultrasonography or referring for orchiectomy without a proper initial physical examination would be premature and may lead to unnecessary interventions or delays in appropriate management.

Correct Answer: C

Rationale: The correct answer is C: Recipient antibodies vs. donor. Delayed hemolysis post-transfusion is often due to the recipient developing antibodies against the donor's red blood cells. This immune response can lead to hemolysis days to weeks after the transfusion. Options A and B are incorrect as they do not involve an immune response causing hemolysis. Option D involves a different type of immune response (IgE vs. IgA) that is not typically responsible for delayed hemolysis post-transfusion.

Correct Answer: D

Rationale: The correct answer is D: White blood cell count of 16,000/mm³. Elevated WBC count could indicate an infection, which is crucial to report before knee arthroscopy to prevent complications. Hematocrit (A) and hemoglobin level (B) are important but not as urgent for this procedure. Platelet count (C) is not directly related to infection detection.

Correct Answer: C

Rationale: The correct answer is C because it demonstrates active listening and empathy, allowing the patient to express their concerns fully. By saying "Tell me more about your fear," the healthcare provider acknowledges the patient's feelings and opens up a dialogue to address their specific worries. This approach can help build trust and rapport, leading to a more effective therapeutic relationship. Choice A is incorrect as it generalizes the patient's fear without addressing the individual's concerns. Choice B is also incorrect as it jumps to suggesting medication without fully understanding the root of the patient's fear. Choice D, although true, does not directly address the patient's emotional needs or provide support in coping with their fear of dying.

Correct Answer: B

Rationale: The most concerning symptom for a patient on cyclosporine post-transplant is nontender groin swelling (Choice B) due to the risk of developing nephrotoxicity from cyclosporine. Groin swelling may indicate lymphoproliferative disorder or nephrotic syndrome, both associated with cyclosporine use. Bleeding gums (Choice A) may be due to gum disease but are not directly related to cyclosporine. Occasional nausea (Choice C) is a common side effect of cyclosporine but is usually mild and not as concerning. Numbness and tingling of feet (Choice D) may indicate peripheral neuropathy, which can be a side effect of cyclosporine but is less concerning than the potential kidney damage indicated by groin swelling.