A 50-year-old body builder is upset by a letter of denial from his life insurance company. He is very lean but has gained 2 pounds over the past 6 months. You personally performed his health assessment and found no problems whatsoever. He says he is classified as "high risk" because of obesity. What should you do next?

Correct Answer: D

Rationale: Since the life insurance company is classifying the body builder as "high risk" due to obesity, it is important to assess whether his weight gain is primarily fat accumulation around the waist. Measuring his waist circumference can provide valuable information about the distribution of body fat. Abdominal obesity, indicated by an increased waist measurement, is a significant risk factor for health issues such as heart disease, diabetes, and metabolic syndrome. By measuring his waist, you can determine if his weight gain is indeed a cause for concern in terms of health risks, rather than just considering the overall weight gain. This information can help you provide more targeted advice on how to address any potential health concerns related to the weight gain.

Correct Answer: D

Rationale: The group of lymph nodes that lie just behind the sternocleidomastoid muscles bilaterally are known as the posterior cervical lymph nodes. These lymph nodes are part of the superficial cervical lymph node chain, which is involved in draining lymph from the head and neck region. In the case described, the presence of sore throat, fever, and enlarged tonsils with exudates suggests a likely upper respiratory tract infection or tonsillitis, leading to the enlargement of the nearby lymph nodes. The posterior cervical lymph nodes are commonly examined in cases of upper respiratory infections and tonsillitis due to their proximity to the area of infection and inflammation.

Correct Answer: B

Rationale: The presentation of multiple burning erosions on the shaft of the penis along with tender inguinal adenopathy is indicative of genital herpes caused by the herpes simplex virus (HSV). Primary herpes simplex infection typically presents with painful ulcers and lymphadenopathy. The ulcers are often shallow with well-defined borders and can be associated with systemic symptoms such as fever and malaise. In contrast, primary syphilis is characterized by a painless chancre at the site of infection, usually on the genitals. Chancroid can also present with painful ulcers, but it is less common in developed countries. Gonorrhea typically presents with urethral discharge, dysuria, or other symptoms of urethritis, rather than erosions on the penis shaft.

Correct Answer: D

Rationale: HPV (human papillomavirus) infection is a very common sexually transmitted infection (STI) that can affect both men and women. It is the most common STI in the United States. While most cases of HPV infection are asymptomatic and resolve on their own, certain high-risk strains of HPV can lead to the development of various cancers, including cervical cancer. Therefore, HPV infections do cause a small but important number of cervical cancers, making option D the correct choice. Regular screening, such as Pap smears and HPV testing, are crucial for early detection and effective management of HPV-related abnormalities that could progress to cervical cancer.

Correct Answer: D

Rationale: A rectal polyp is a growth that originates from the inner lining of the rectum and protrudes into the rectal canal. It may present as a soft, smooth, nontender mass on digital rectal examination. Rectal polyps are usually benign, but some may have the potential to become cancerous if left untreated. Therefore, it is important to evaluate and remove polyps to prevent complications. In this case, the description of a pedunculated mass on the posterior wall of the rectum is most suggestive of a rectal polyp.

Correct Answer: A

Rationale: While the description provides information about the duration, frequency, onset, and relieving factors of Jason's shortness of breath, it does not mention the severity of the symptom. Severity refers to the intensity or degree of the symptom, such as mild, moderate, or severe. In this case, we do not have information about how Jason would rate the severity of his shortness of breath. It can be an important attribute to consider when assessing the impact of the symptom on the individual's quality of life and the potential urgency of intervention.

Correct Answer: D

Rationale: The presentation is highly suggestive of appendicitis, especially given the migration of pain from the periumbilical region to the right lower quadrant (just medial and inferior to the iliac crest). The worsening of pain with motion, along with associated symptoms such as nausea, vomiting, anorexia, and fever, are typical features of appendicitis. The classic presentation of appendicitis is pain starting around the umbilicus (due to visceral innervation) and then shifting to the right lower quadrant (due to irritation of the parietal peritoneum). Surgical intervention is usually required promptly to prevent complications like perforation, which can lead to peritonitis and sepsis.

Correct Answer: A

Rationale: In order to listen carefully for S splitting, one should use the diaphragm with light pressure over the 2nd right intercostal space. S splitting refers to a split of the second heart sound (S2) into its two components - A2 and P2. The A2 component is normally heard as the main heart sound when the aortic valve closes, and the P2 component is heard when the pulmonic valve closes. By placing the diaphragm lightly over the 2nd right intercostal space, one can best auscultate the aortic area and listen for the timing and splitting of the S2 components. Using the bell or applying firm pressure may not allow for optimal detection of S splitting in this specific case.

Correct Answer: B

Rationale: In the given scenario, being a 35-year-old archaeologist with fair skin, a family history of melanoma, and many freckles scattered across her skin are all risk factors for melanoma. Age (choice A) is a relevant risk factor as melanoma incidence increases with age. Actinic lentigines (choice C), also known as sunspots, are precancerous skin lesions that can increase the risk of developing melanoma. Heavy sun exposure (choice D) is a significant risk factor as cumulative sun exposure over time can contribute to the development of melanoma.