A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of breast cancer in his first-degree relatives. What is the most likely diagnosis?

Correct Answer: A

Rationale: In a 30-year-old man with a firm, 2-cm mass under his areola and no other symptoms, the most likely diagnosis is breast tissue. Gynecomastia is a common condition in males where there is proliferation of breast tissue. It typically presents as a firm subareolar mass and can occur due to hormonal imbalances, medication use, or underlying medical conditions. Given the lack of family history of breast cancer, absence of other symptoms, and the age of the patient, breast tissue is the most probable diagnosis in this case. Breast cancer is less likely in this scenario, especially without any additional concerning findings or family history. Fibrocystic disease and lymph node involvement are also less likely given the presentation of a firm mass under the areola.

Correct Answer: A

Rationale: Rectal prolapse occurs when the rectum protrudes through the anus. It typically appears as a moist, pink mass that protrudes outside the body. The prolapse is usually painless and can be seen and felt by the patient or the examiner. It is commonly seen in elderly individuals, especially women, and those with conditions like chronic constipation, pelvic floor weakness, or dementia. On the other hand, external hemorrhoids are swollen veins located around the anus, usually painful and may cause bleeding. Perianal fistula is an abnormal tunnel-like connection between the skin near the anus and the rectum, which can cause pain and discharge. Prolapsed internal hemorrhoids are internal hemorrhoids that have descended outside the anal canal and may require manual reduction. Given the symptoms described in the scenario - a moist pink mass protruding from the anus that is nontender and soft without bleeding - the most likely diagnosis is rectal prol

Correct Answer: B

Rationale: Relief of the pain with bending at the waist is a key hallmark of spinal stenosis. This position helps relieve the pressure on the nerves in the spinal canal, which is often the root cause of the leg symptoms experienced by the patient. The symptoms described by Mr. Edwards, such as cramps in the calves after walking a certain distance, followed by relief with rest and recurrence upon walking again, are highly suggestive of spinal stenosis. This condition involves narrowing of the spinal canal, leading to compression of the nerves and resulting in symptoms like leg cramps, weakness, and difficulty walking, especially with prolonged activity. The relief of symptoms when bending forward (e.g., leaning on a shopping cart while walking) is a characteristic feature of neurogenic claudication associated with spinal stenosis.

Correct Answer: B

Rationale: A sudden, painful unilateral loss of vision is a medical emergency that may be caused by central retinal artery occlusion. This condition occurs when the main artery supplying blood to the retina becomes blocked, leading to a sudden and severe reduction in blood flow to the eye. The lack of blood flow can cause irreversible damage to the retina, resulting in a significant loss of vision. Patients with central retinal artery occlusion typically present with sudden, painless, and severe vision loss in one eye. Immediate medical attention is crucial to try to restore blood flow and minimize potential permanent vision loss in these cases. Vitreous hemorrhage, macular degeneration, and optic neuritis do not typically present with sudden, painful unilateral loss of vision as seen in central retinal artery occlusion.

Correct Answer: B

Rationale: A varicocele is a common cause of a "bag of worms" feeling in the scrotum. It occurs due to the dilation of the veins within the spermatic cord, leading to a palpable mass above the testicle. Varicoceles are more commonly found on the left side due to the anatomy of the left testicular vein, which drains into the left renal vein at a right angle, making it more susceptible to increased pressure and dilation.

Correct Answer: C

Rationale: This categorization is based on the blood pressure readings. Stage 1 hypertension is defined as having a systolic blood pressure between 130-139 mmHg or a diastolic blood pressure between 80-89 mmHg. The blood pressure falls within this range, indicating mild hypertension. It is important to monitor and manage blood pressure to prevent complications associated with hypertension.

Correct Answer: B

Rationale: In this scenario, with a blood pressure of 168/94 on both arms, it indicates poorly controlled hypertension. Hypertension can have various causes, including kidney-related issues. Referring the patient to nephrology would be the appropriate next step to evaluate and manage any potential underlying kidney conditions contributing to the uncontrolled blood pressure. The nephrologist can conduct further tests and assessments to determine the root cause and provide specialized care for the patient's condition. This approach ensures a comprehensive evaluation and targeted management plan for the patient's hypertension.

Correct Answer: B

Rationale: The clinical presentation described involves a patient with pericarditis. Pericarditis is inflammation of the pericardium, the sac surrounding the heart, which can lead to characteristic findings such as a scratching noise heard on auscultation, leaning forward relieving pain, and normal lung examination findings. The presence of pericarditis can also lead to a pericardial friction rub, which is often described as a scratching or grating sound heard best at the lower left sternal border.

Correct Answer: D

Rationale: Following a severe rotator cuff tear, it typically takes around 2-3 months for muscular atrophy to develop with increased prominence of the scapular spine. This is due to disuse of the affected shoulder muscles leading to muscle wasting and changes in the bony structures around the shoulder blade. Over time, the lack of muscle activity causes the shoulder blade to become more prominent and noticeable, which can result in altered sensations during activities like hugging. The gradual onset of these changes aligns with the timeline provided in the question, where the wife started to feel discomfort in her husband's left shoulder blade after the recent severe rotator cuff tear.