A 36-year-old female presents to the GP with painful hands which started two weeks ago. She describes the pain as constant but worst in the mornings where it takes an hour or so for her hands to loosen up and become fully functional. She has no significant past medical history and is functionally independent. On examination, there is erythema, swelling, and tenderness of the metacarpophalangeal joints on both hands. She is not able to make a tight fist due to the discomfort. On systemic examination, there is nothing else of note and vital signs are all within normal limits.

Correct Answer: B

Rationale: The correct answer is B: Rheumatoid arthritis. The key features suggesting rheumatoid arthritis in this case are the symmetrical involvement of the metacarpophalangeal joints, morning stiffness lasting more than an hour, and systemic symptoms such as erythema and swelling. Rheumatoid arthritis is an autoimmune condition that typically presents with these symptoms. Choice A: Gout typically presents with sudden onset of severe pain, redness, and swelling in a single joint, commonly the big toe. It is unlikely in this case due to the symmetrical joint involvement. Choice C: Osteoarthritis is characterized by joint pain that worsens with activity and improves with rest. It usually affects weight-bearing joints like the knees and hips, not typically presenting with the described symptoms in the hands. Choice D: Septic arthritis often presents with acute joint pain, fever, and systemic symptoms. It is less likely in this case as the patient does not have signs of systemic infection.

Correct Answer: C

Rationale: Objective data are measurable and observable, not based on personal feelings or interpretations. Choice C, "Clear breath sounds," is objective data because it can be directly heard and assessed by a healthcare provider. Feeling dizzy (A) and headache (D) are subjective symptoms reported by the patient, making them subjective data. Complaints of nausea (B) are also subjective as they are based on the patient's personal experience and cannot be directly observed or measured by a healthcare provider. Therefore, choice C is the correct answer as it represents objective data that can be observed and measured.

Correct Answer: B

Rationale: The patellar tendon reflex is mediated by the femoral nerve, which receives sensory input from the L4 nerve root. When the patellar tendon is tapped, the sensory information is transmitted via the L4 nerve root to the spinal cord, activating the motor response through the femoral nerve. Therefore, the correct answer is B: L4. A: L1 - Incorrect. The L1 nerve root does not innervate the patellar tendon reflex. C: L5 - Incorrect. The L5 nerve root does not play a direct role in the patellar tendon reflex. D: S1 - Incorrect. The S1 nerve root is not involved in the patellar tendon reflex pathway.

Correct Answer: C

Rationale: The correct answer is C: Brachialis. The brachialis muscle is the main flexor of the forearm as it lies deep to the biceps brachii and directly acts on the ulna to flex the elbow joint. It is responsible for flexing the forearm regardless of the position of the hand. The other choices are incorrect because: A. Anconeus is a small muscle involved in extension of the elbow, not flexion. B. Biceps brachii is a powerful supinator of the forearm and also assists in flexion, but it is not the main flexor. D. Brachioradialis is a synergist in forearm flexion but not the primary flexor.

Correct Answer: D

Rationale: The Q angle is the angle between the line of pull of the quadriceps muscle and the patellar tendon. Tight lateral retinaculum can pull the patella laterally, increasing the Q angle. Genu varum (A) and decreased femoral anteversion (B) would actually decrease the Q angle as they align the patella more centrally. Internal tibial torsion (C) might alter the patellar tracking but would not directly increase the Q angle. Therefore, the correct answer is D.