A 45-year-old woman presents with a complaint of chronic back pain. She describes the pain as dull, aching, and constant, with no radiation. She has a history of rheumatoid arthritis and takes nonsteroidal anti-inflammatory drugs. On examination, she has tenderness over the lower lumbar spine. Which of the following is the most likely diagnosis?

Correct Answer: D

Rationale: The most likely diagnosis for the 45-year-old woman with chronic back pain, tenderness over the lower lumbar spine, and a history of rheumatoid arthritis is mechanical low back pain (Choice D). 1. Chronic dull, aching, constant pain with no radiation is characteristic of mechanical low back pain. 2. Presence of tenderness over the lower lumbar spine suggests a musculoskeletal origin, consistent with mechanical low back pain. 3. History of rheumatoid arthritis increases the likelihood of musculoskeletal issues like mechanical low back pain. Summary: - A: Osteoporotic fracture is less likely due to absence of acute onset, severe pain, and risk factors like advanced age or prolonged corticosteroid use. - B: Herniated disc typically presents with radicular pain (radiating pain down the leg), which is not described in this case. - C: Spinal stenosis usually presents with neurogenic claudication (pain with walking) and neurological

Correct Answer: A

Rationale: The most likely diagnosis for a 50-year-old man with chronic cough and a history of smoking is Chronic Obstructive Pulmonary Disease (COPD). 1) History of smoking is a major risk factor for COPD. 2) Chronic cough is a common symptom of COPD due to airway inflammation and mucus production. 3) COPD typically develops over years of smoking. Other choices are less likely: B) Pneumonia usually presents with acute symptoms; C) Lung cancer may present with cough but usually in later stages; D) Tuberculosis is less common in a chronic smoker without other risk factors. Therefore, the correct answer is A.

Correct Answer: A

Rationale: The correct answer is A: Esophageal cancer. Given the patient's age, symptoms of progressive dysphagia, and risk factors such as smoking and heavy alcohol use, esophageal cancer is the most likely diagnosis. Further evaluation with imaging studies and endoscopy is warranted to confirm the diagnosis. B: Achalasia is less likely as it typically presents with dysphagia to both solids and liquids, not just worsening dysphagia over time. C: Gastroesophageal reflux disease (GERD) may cause heartburn and regurgitation but is less likely to present with progressive dysphagia. D: Peptic ulcer disease typically presents with abdominal pain and may cause dysphagia if there is stricture formation but is less likely in this case.

Correct Answer: D

Rationale: The correct answer is D, Cranial nerve XI (spinal accessory nerve). This nerve controls the trapezius and sternocleidomastoid muscles, responsible for shoulder shrugging. Cranial nerve V (A) controls facial sensation and jaw movement. Cranial nerve VII (B) controls facial expression. Cranial nerve IX (C) controls swallowing and taste sensation. By process of elimination, D is the only nerve related to shoulder shrugging.

Correct Answer: B

Rationale: The correct action after palpating the carotid pulse is to auscultate for bruits. Bruits are abnormal sounds caused by turbulent blood flow, which may indicate vascular disease. Auscultating for bruits specifically at the carotid arteries is important in assessing for potential arterial blockages that can lead to serious complications like stroke. Palpating the femoral pulse (Choice A) is not the next immediate step in a cardiovascular assessment after assessing the carotid pulse. Comparing the pulse rate with the apical pulse (Choice C) is important but not the immediate action required after palpating the carotid pulse. Palpating the radial pulse (Choice D) is also an important part of the assessment, but in this scenario, auscultating for bruits takes precedence for further evaluation.