A 24-year-old secretary comes to your clinic, complaining of difficulty sleeping, severe nightmares, and irritability. She states it all began 6 months ago when she went to a fast food restaurant at midnight. While she was waiting in her car a man entered through the passenger door and put a gun to her head. He had her drive to a remote area, where he took her money and threatened to kill her. When the gun jammed he panicked and ran off. Ever since this occurred the patient has been having these symptoms. She states she jumps at every noise and refuses to drive at night. She states her anxiety has had such a marked influence on her job performance she is afraid she will be fired. She denies any recent illnesses or injuries. Her past medical history is unremarkable. On examination you find a nervous woman appearing her stated age. Her physical examination is unremarkable. You recommend medication and counseling. What anxiety disorder to you think this young woman has?

Correct Answer: C

Rationale: The young woman in this scenario is experiencing symptoms consistent with post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder that can develop after a person is exposed to a traumatic event, such as a life-threatening situation like a robbery with a gun involved. The symptoms she is experiencing, including difficulty sleeping, severe nightmares, irritability, hypervigilance, and avoidance of triggers such as driving at night, are all classic features of PTSD. These symptoms have persisted for at least 6 months since the traumatic event occurred, which is a key criterion for making a diagnosis of PTSD. Treatment for PTSD typically involves a combination of medication and therapy to help the individual process and cope with the traumatic experience.

Correct Answer: C

Rationale: Pain in the calf is a common symptom of atherosclerosis in the lower extremities, also known as peripheral artery disease (PAD). Atherosclerosis is the buildup of plaque in the arteries, leading to reduced blood flow. The calf pain associated with PAD is often described as cramping, aching, or fatigue that occurs during walking and is relieved with rest. This is called intermittent claudication. Thigh, knee, and ankle pain could have other causes, but calf pain specifically raises concerns for atherosclerosis in the lower extremities.

Correct Answer: C

Rationale: By connecting the patient's presenting symptoms (wheezing when exposed to cats) and family history of asthma, you have identified asthma as the most likely diagnosis for the 5-year-old girl. This initial conclusion, based on the available information, is known as a working diagnosis. Further evaluation and testing may be required to confirm the diagnosis, but at this stage, you have established a preliminary understanding of the likely condition affecting the patient.

Correct Answer: B

Rationale: The description of dark, granular material resembling coffee grounds in the vomitus suggests upper gastrointestinal bleeding. One common cause of upper GI bleeding is a peptic ulcer, which can present with symptoms such as vomiting blood or coffee ground material. Peptic ulcers can develop in the stomach or the upper part of the small intestine (duodenum). Risk factors for peptic ulcers include infection with Helicobacter pylori bacteria, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, and alcohol consumption. Prompt evaluation and management are necessary in cases of upper GI bleeding to address the underlying cause and prevent complications.

Correct Answer: D

Rationale: The scenario described with a strong pulse followed by a weak pulse is characteristic of pulsus paradoxus, a finding often associated with cardiac tamponade. Cardiac tamponade is a medical emergency where there is an accumulation of fluid (such as blood) in the pericardial sac that exerts pressure on the heart, limiting its ability to pump effectively. As a result, patients may exhibit this pulsus paradoxus, where the pulse strength varies with respiration. The other conditions listed (emphysema, asthma exacerbation, severe left heart failure) are not typically associated with this specific pulsatile pattern.

Correct Answer: B

Rationale: Leaning forward in the upright position increases venous return and systemic vascular resistance, which can help accentuate the intensity of aortic regurgitation murmur. This position helps to bring the heart closer to the chest wall, making the murmur easier to auscultate and potentially increasing its intensity.

Correct Answer: D

Rationale: Prostate cancer is more prevalent in certain ethnic groups, with African-American men having the highest risk of developing prostate cancer compared to men of other ethnicities. Additionally, men of Caribbean and West African descent also have an increased risk compared to men of Asian descent. This indicates that ethnicity plays a role in the risk of developing prostate cancer.

Correct Answer: B

Rationale: Even after a unilateral mastectomy, women should continue to self-examine and have regular clinical examinations for any signs of recurrence or new masses. It is important to closely monitor the surgical scar area for any changes or abnormalities, as breast cancer can still occur in the remaining breast tissue. Regular breast examinations remain important in the early detection of any potential issues, even after mastectomy.

Correct Answer: C

Rationale: Mrs. R. is exhibiting characteristics of a silent patient because she does not respond or engage in conversation when directly asked a question by the healthcare provider. In this case, Mrs. R.'s lack of verbal response could be due to various reasons such as shyness, anxiety, cognitive impairment, or communication barriers. It is important for healthcare providers to recognize and adapt to different communication styles and preferences of patients to ensure effective patient-provider interaction and care. In situations like these, it may be helpful to provide alternative communication methods or allow more time for the patient to respond comfortably.