A 49-year-old truck driver comes to the emergency room for shortness of breath and swelling in his ankles. He is diagnosed with congestive heart failure and admitted to the hospital. You are the student assigned to do the patient's complete history and physical examination. When you palpate the pulse, what do you expect to feel?

Correct Answer: B

Rationale: The correct answer is B: Small amplitude, weak. In congestive heart failure, the heart's ability to pump effectively is compromised, leading to decreased cardiac output. This results in a weakened pulse with reduced amplitude. Palpating a small, weak pulse in this patient is expected due to poor cardiac function. Choices A and C are incorrect because a large, forceful pulse is not expected in congestive heart failure, and a normal pulse may not reflect the compromised cardiac function. Choice D, bigeminal, refers to an abnormal rhythm characterized by every other heartbeat being premature and is not typically associated with congestive heart failure.

Correct Answer: D

Rationale: The correct answer is D: Dry and rough. In hypothyroidism, there is reduced secretion of sweat and oils, leading to dry skin. The lack of hydration causes the skin to become rough. This correlates with the clinical presentation of fatigue, weight gain, and hair loss, which are common symptoms of hypothyroidism. Choices A and B are incorrect because moisture is reduced in hypothyroidism, resulting in dry skin. Choice C is incorrect because the lack of oils in hypothyroidism leads to rough skin texture, not smooth.

Correct Answer: B

Rationale: The correct answer is B: A sebaceous cyst. A sebaceous cyst typically presents as a lump underneath the skin that can be squeezed to release a cheesy substance, consistent with Jacob's description. The formation of a prominent dimple when gently pinched is characteristic of a cyst, indicating it is filled with fluid or semi-solid material. Sebaceous cysts are usually benign and can grow slowly over time. Incorrect choices: A: An enlarged lymph node - Unlikely as lymph nodes are typically not associated with cheesy discharge or the formation of a dimple when pinched. C: An actinic keratosis - Unlikely as actinic keratosis is a precancerous skin condition caused by sun exposure, not presenting with cheesy discharge or a dimple. D: A malignant lesion - Unlikely as malignant lesions usually do not produce cheesy discharge and are more aggressive in growth compared to a sebaceous cyst.

Correct Answer: B

Rationale: The correct answer is B: Exophthalmos. Exophthalmos refers to protrusion of the eyeball, which is a hallmark sign of thyroid eye disease. This condition commonly presents with forward bulging of one or both eyes due to inflammation and swelling of the eye muscles and tissues behind the eye. It is often associated with hyperthyroidism. A: Ptosis is drooping of the upper eyelid, not protrusion of the eyeball. C: Ectropion is an outward turning of the eyelid, not protrusion of the eyeball. D: Epicanthus is a vertical fold of skin on the upper eyelid near the nose, not protrusion of the eyeball.

Correct Answer: A

Rationale: The correct answer is A: The fovea. The fovea is the central focal point for incoming images because it contains a high concentration of cones, which are responsible for detailed central vision. Cones are essential for color vision and visual acuity. The macula, while important for central vision, refers to the area surrounding the fovea. The optic disk is where the optic nerve exits the eye, and it does not receive incoming images. The physiologic cup is a normal depression in the optic nerve head and is not involved in image reception. In conclusion, the fovea is the correct answer as it is the area with the highest visual acuity due to the dense concentration of cones.