A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient?

Correct Answer: B

Rationale: The correct answer is B: Hair colour. The rationale for this is that fair skin, family history of melanoma, freckles, and heavy sun exposure are all known risk factors for melanoma. Reddish-blonde hair alone is not a significant risk factor for melanoma compared to the other mentioned factors. Age is a risk factor as melanoma incidence increases with age. Actinic lentigines, also known as sunspots, are associated with chronic sun exposure and are a risk factor for melanoma. Heavy sun exposure is a well-established risk factor for melanoma due to the damaging effects of UV radiation on the skin.

Correct Answer: D

Rationale: The correct answer is D: Right sternocleidomastoid. The sternocleidomastoid muscle is responsible for rotating the head to the opposite side. In this case, with the chin rotated towards the left and ear close to the right shoulder, the right sternocleidomastoid is primarily implicated. The left sternocleidomastoid would cause the opposite head rotation. The cervical paraspinal muscles primarily provide support and stabilization to the spine, not head rotation.

Correct Answer: C

Rationale: The correct answer is C: the third intermetatarsal space. Morton's neuroma is most commonly found between the third and fourth metatarsal heads. This is due to the anatomical arrangement of the intermetatarsal spaces and the compression and irritation that can occur in this specific area. Choices A, B, and D are incorrect because Morton's neuroma typically occurs in the third intermetatarsal space. The condition is less commonly associated with the other intermetatarsal spaces.

Correct Answer: C

Rationale: The correct answer is C: Long thoracic nerve. Scapula winging is primarily caused by injury to the long thoracic nerve, which innervates the serratus anterior muscle responsible for stabilizing the scapula against the thoracic wall. Damage to this nerve results in dysfunction of the serratus anterior, leading to abnormal scapular movement. The other choices are incorrect because: A: Radial nerve - primarily involved in elbow, wrist, and finger extension, not scapular stabilization. B: Suprascapular nerve - innervates the supraspinatus and infraspinatus muscles, not directly related to scapular winging. D: Axillary nerve - innervates the deltoid and teres minor muscles, not directly involved in scapular stabilization.

Correct Answer: A

Rationale: The correct answer is A: Resistive exercises in that limb. Bony metastases can weaken bones and increase the risk of fractures. Resistive exercises can put excessive stress on the bones, potentially leading to fractures. It is important to focus on gentle, low-impact exercises to maintain mobility without risking further damage. Active range of motion exercises (choice B) can help maintain flexibility without stressing the bones. Bracing (choice C) can provide support and stability. Cold therapy (choice D) can help with pain and inflammation management but does not directly impact bone strength.