A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of 16, but he is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?

Correct Answer: A

Rationale: The correct answer is A: Intermittent claudication. Intermittent claudication is a classic symptom of peripheral vascular disease, characterized by cramping leg pain that occurs with exertion and improves with rest. This is due to inadequate blood flow to the muscles during activity. In this case, the patient's history of smoking increases his risk for peripheral vascular disease. Choice B, chest pressure with exertion, is more indicative of cardiac issues like angina. Choice C, shortness of breath, is more associated with respiratory or cardiac conditions like heart failure. Choice D, knee pain, is not typically related to peripheral vascular disease but could be due to musculoskeletal issues.

Correct Answer: D

Rationale: The correct answer is D because cerebrospinal fluid (CSF) typically separates into concentric rings when placed on a white pad due to its high protein content. This phenomenon is known as the "halo sign." Additionally, CSF should test positive for glucose as it is a clear, colorless fluid that contains glucose. Choices A, B, and C are incorrect because CSF is clear and tests positive for glucose, not negative. It is not typically bloody in appearance with a pH of 6, clumping together with a pH of 7, or showing any other characteristics mentioned in the incorrect choices.

Correct Answer: C

Rationale: The correct answer is C: Peripheral edema. Peripheral edema is the accumulation of fluid in the extremities, indicating fluid volume overload. This is due to increased hydrostatic pressure in the capillaries. Dry mucous membranes (A) suggest dehydration, decreased skin turgor (B) is also a sign of dehydration, and postural hypotension (D) is often associated with hypovolemia. Peripheral edema is the most specific finding for fluid volume overload as it directly reflects an excess of fluid in the body.

Correct Answer: C

Rationale: The correct technique for assessing the carotid arteries is to auscultate for bruits before palpating. This is important because listening for bruits can indicate the presence of any abnormal sounds or blockages in the arteries, which can affect the palpation results. Palpating before auscultating may disrupt any potential bruits that should be detected. Auscultating both arteries simultaneously (Choice A) is not recommended as it may lead to missing subtle differences between the two sides. Palpating both arteries simultaneously (Choice B) is not ideal as it may not allow for accurate assessment of each artery individually. Palpating the arteries firmly to assess for strength (Choice D) is not recommended as excessive pressure can lead to inaccurate results and potential harm.

Correct Answer: B

Rationale: The correct answer is B because the Weber test is performed by striking a tuning fork and placing it on the patient's forehead. This causes vibrations that are conducted through the skull to both cochleas. In a normal hearing individual, the sound will be heard equally in both ears. If there is unilateral conductive hearing loss, the sound will be louder in the affected ear, and if there is unilateral sensorineural hearing loss, the sound will be louder in the unaffected ear. Choice A is incorrect because the Weber test does not involve whispering words for the patient to repeat. Choice C is incorrect because it describes the Rinne test, not the Weber test. Choice D is incorrect because it does not involve identifying different tones, but rather assessing for lateralization of sound.