A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor vehicle collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn't think that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her neck. On physical examination, you note pain and spasm over the paraspinous muscles on the left side of the neck, and pain when you make the patient do active range of motion of the cervical spine. What is the most likely cause of this neck pain?

Correct Answer: C

Rationale: The most likely cause of neck pain in this scenario is a cervical sprain. A cervical sprain is an injury to the ligaments in the neck as a result of sudden force or trauma, such as a motor vehicle collision. The symptoms of a cervical sprain typically include pain, stiffness in the neck, and muscle spasm. The fact that the patient has pain and spasm over the paraspinous muscles on one side of the neck, along with pain during active range of motion, is characteristic of a sprain. It is important to consider this diagnosis in individuals who have recently experienced trauma to the neck region. Treatment for a cervical sprain usually includes pain management, rest, and gentle stretching exercises to help with recovery.

Correct Answer: C

Rationale: In diabetic ketoacidosis (DKA), the body is in a state of metabolic acidosis due to the accumulation of ketones in the blood. One of the compensatory mechanisms to decrease the acidity in the body is increased breathing, known as Kussmaul breathing. This type of breathing is characterized by a rapid and deep pattern to blow off excess carbon dioxide and decrease the acidity of the blood. Therefore, in a patient with DKA, you would expect to observe rapid and deep breathing.

Correct Answer: D

Rationale: The presence of a palpable pulsatile abdominal mass in a patient like Mr. Martin, who is a smoker and at risk for vascular diseases, is concerning for an abdominal aortic aneurysm (AAA). Immediate referral to a vascular surgeon is essential for further evaluation and management. AAA can be a life-threatening condition if left untreated, as it can lead to rupture and severe internal bleeding. Therefore, prompt specialist evaluation and monitoring are crucial in such cases. Waiting for 3 or 6 months for reevaluation could potentially lead to a delayed diagnosis and increase the risk of complications. Abdominal ultrasound is typically the diagnostic test of choice to confirm the presence and size of the aneurysm.

Correct Answer: C

Rationale: The target heart rate during physical activity is typically calculated as a percentage of maximum heart rate, which is estimated using the formula: 220 - age. For a 30-year-old individual, the estimated maximum heart rate would be 190 beats per minute. Exercising at 60-70% of the maximum heart rate is usually recommended for moderate-intensity physical activity. For this individual, the target heart rate zone would be approximately 114-133 beats per minute. Therefore, achieving a heart rate of 120 beats per minute would fall within the target range and indicate an appropriate level of exertion for effective physical activity.

Correct Answer: C

Rationale: Pain in the calf is a common symptom of atherosclerosis in the lower extremities, also known as peripheral artery disease (PAD). Atherosclerosis is the buildup of plaque in the arteries, leading to reduced blood flow. The calf pain associated with PAD is often described as cramping, aching, or fatigue that occurs during walking and is relieved with rest. This is called intermittent claudication. Thigh, knee, and ankle pain could have other causes, but calf pain specifically raises concerns for atherosclerosis in the lower extremities.

Correct Answer: B

Rationale: The description of dark tan patches with a reddish cast that have sharp borders and fine scales, especially more prominent on the upper back, chest, neck, and upper arms, is classic for tinea versicolor. Tinea versicolor is a superficial fungal infection caused by Malassezia species, which commonly affects individuals who sweat more, such as those working outdoors like the construction worker in this case. The rash is often pruritic (itchy) and can vary in color from tan to pink or red. The fine scales on the patches are a result of the accumulation of the yeast in the affected areas.

Correct Answer: B

Rationale: The description of dark, granular material resembling coffee grounds in the vomitus suggests upper gastrointestinal bleeding. One common cause of upper GI bleeding is a peptic ulcer, which can present with symptoms such as vomiting blood or coffee ground material. Peptic ulcers can develop in the stomach or the upper part of the small intestine (duodenum). Risk factors for peptic ulcers include infection with Helicobacter pylori bacteria, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, and alcohol consumption. Prompt evaluation and management are necessary in cases of upper GI bleeding to address the underlying cause and prevent complications.

Correct Answer: C

Rationale: By connecting the patient's presenting symptoms (wheezing when exposed to cats) and family history of asthma, you have identified asthma as the most likely diagnosis for the 5-year-old girl. This initial conclusion, based on the available information, is known as a working diagnosis. Further evaluation and testing may be required to confirm the diagnosis, but at this stage, you have established a preliminary understanding of the likely condition affecting the patient.

Correct Answer: C

Rationale: Mrs. R. is exhibiting characteristics of a silent patient because she does not respond or engage in conversation when directly asked a question by the healthcare provider. In this case, Mrs. R.'s lack of verbal response could be due to various reasons such as shyness, anxiety, cognitive impairment, or communication barriers. It is important for healthcare providers to recognize and adapt to different communication styles and preferences of patients to ensure effective patient-provider interaction and care. In situations like these, it may be helpful to provide alternative communication methods or allow more time for the patient to respond comfortably.