A 29-year-old married computer programmer comes to your clinic, complaining of "something strange" going on in his scrotum. Last month while he was doing his testicular self- examination he felt a lump in his left testis. He waited a month and felt the area again, but the lump was still there. He has had some aching in his left testis but denies any pain with urination or sexual intercourse. He denies any fever, malaise, or night sweats. His past medical history consists of groin surgery when he was a baby and a tonsillectomy as a teenager. He eats a healthy diet and works out at the gym five times a week. He denies any tobacco or illegal drugs and drinks alcohol occasionally. His parents are both healthy. On examination you see a muscular, healthy, young-appearing man with unremarkable vital signs. On visualization the penis is circumcised with no lesions; there is a scar in his right inguinal region. There is no lymphadenopathy. Palpation of his scrotum is unremarkable on the right but indicates a large mass on the left. Placing a finger through the inguinal ring on the right, you have the patient bear down. Nothing is felt. You attempt to place your finger through the left inguinal ring but cannot get above the mass. On rectal examination his prostate is unremarkable. What disorder of the testes is most likely the diagnosis?

Correct Answer: B

Rationale: The most likely diagnosis in this case is a scrotal hernia. The patient's history of a previous groin surgery as a baby is a key clue, as it increases the risk for developing a hernia. The lump in the left testis with aching, along with the inability to palpate above the mass through the left inguinal ring, suggests that the lump may be a hernia protruding through the inguinal canal into the scrotum. The presence of a scar in the right inguinal region also supports the likelihood of a hernia. The normal prostate on rectal examination rules out any involvement of the prostate in the presentation. Scrotal hernias may present as painless masses in the scrotum, often increasing in size with activities that increase intra-abdominal pressure, such as straining or coughing. Surgical repair is often necessary to prevent complications such as incarceration or strangulation

Correct Answer: D

Rationale: The constellation of symptoms described in the scenario, including chronic constipation, fatigue, weight gain, irregular periods, cold intolerance, and delayed deep tendon reflexes, suggests hypothyroidism as the likely cause. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones, leading to a slowdown in bodily functions. Constipation is a common symptom of hypothyroidism due to the decreased motility of the bowel. The presence of cold intolerance, weight gain, and irregular periods further supports this diagnosis, as these are classic symptoms of hypothyroidism. The delayed deep tendon reflexes, especially in the Achilles tendons, are indicative of the myopathic changes that can occur in hypothyroidism. It is important to further investigate thyroid function through laboratory testing to confirm the diagnosis and initiate appropriate treatment. Other conditions such as large bowel obstruction, irritable bowel syndrome, and rectal cancer are less likely based

Correct Answer: C

Rationale: A stage 3 pressure ulcer involves full-thickness skin loss with damage and necrosis of the subcutaneous tissue, but the underlying muscle is not affected. In this case, the description of the full-thickness skin loss with involvement of the subcutaneous tissue but not the muscle corresponds to a stage 3 pressure ulcer. Stage 1 involves intact skin with non-blanchable redness, stage 2 involves partial-thickness skin loss with a shallow open ulcer, and stage 4 involves full-thickness tissue loss with the involvement of muscle, bone, or supporting structures.

Correct Answer: B

Rationale: The patient's presentation with an enlarged chest diameter, decreased breath sounds throughout all lobes, and the presence of rhonchi over all lung fields is suggestive of a chronic condition that affects the entire respiratory system. These findings are classic for COPD, a progressive lung disease characterized by airflow limitation. The breath sounds are decreased due to airflow obstruction, and the presence of rhonchi indicates mucus production and airway inflammation commonly seen in COPD. In contrast, a spontaneous pneumothorax would typically present with sudden chest pain and shortness of breath, often in a younger patient with risk factors such as smoking. Asthma would present with wheezing, shortness of breath, and possibly a history of atopy or allergies. Pneumonia would typically present with fever, cough, and focal findings on chest examination, such as crackles or bronchial breath sounds over a consolidated area. In

Correct Answer: B

Rationale: Urge incontinence, also known as overactive bladder, is characterized by a sudden and strong urge to urinate which is difficult to control. In this case, Mrs. LaFarge is unable to get to the bathroom quickly enough when she senses the need to urinate, which indicates a lack of control over the urge to urinate. This is typically caused by involuntary contractions of the bladder muscle. Stress incontinence, on the other hand, is leakage of urine during activities that increase intra-abdominal pressure, such as coughing or exercising. Overflow incontinence is characterized by urinary retention and constant dribbling of urine due to the bladder being unable to empty properly. Functional incontinence occurs when a person has normal bladder control but is unable to reach the bathroom in time due to physical or cognitive impairments. Since Mrs. LaFarge is experiencing a sudden and strong urge to urinate that she cannot