A 60-year-old man presents with a complaint of difficulty swallowing. He reports that the difficulty has been present for several months and is associated with weight loss. He has a history of smoking and heavy alcohol use. What is the most likely diagnosis?

Correct Answer: A

Rationale: The most likely diagnosis for a 60-year-old man with difficulty swallowing, weight loss, history of smoking, and heavy alcohol use is esophageal cancer. 1. Difficulty swallowing over months could indicate a progressive condition like cancer. 2. Weight loss may be due to malnutrition from impaired swallowing. 3. History of smoking and alcohol use are risk factors for esophageal cancer. 4. Symptoms are more consistent with cancer than other conditions listed. Other choices are less likely: - B: Achalasia presents with dysphagia but typically not associated with weight loss. - C: GERD can cause swallowing difficulties but is less likely to lead to significant weight loss. - D: Peptic ulcer disease usually presents with upper abdominal pain, not primarily difficulty swallowing and weight loss.

Correct Answer: A

Rationale: The correct diagnosis is A: Myocardial infarction. The ST-segment elevation in leads II, III, and aVF on the ECG indicates an inferior wall myocardial infarction. This presentation, along with the patient's age, history of coronary artery disease, and diabetes mellitus, strongly suggests myocardial infarction. Angina (B) typically presents with transient chest pain that is relieved with rest or medication. Pulmonary embolism (C) presents with sudden-onset dyspnea and chest pain, often accompanied by tachycardia. Aortic dissection (D) commonly presents with severe tearing chest pain radiating to the back, not ST-segment elevation on ECG.

Correct Answer: B

Rationale: The positive Babinski sign indicates upper motor neuron dysfunction. When the sole of the foot is stroked, the big toe extends upward instead of curling down. This suggests damage to the corticospinal tract, characteristic of upper motor neuron lesions. Choices A, C, and D are incorrect because a positive Babinski sign is not a normal finding in adults, not related to peripheral neuropathy, and not indicative of cerebellar dysfunction.

Correct Answer: B

Rationale: The correct answer is B: Pleuritis. A pleural friction rub is caused by the inflammation of the pleural surfaces rubbing against each other during breathing. Pleuritis is the most likely cause as it directly involves inflammation of the pleura. Pneumonia (choice A) typically presents with crackles or decreased breath sounds. Pulmonary embolism (choice C) may present with pleuritic chest pain but not a friction rub. Chronic obstructive pulmonary disease (COPD) (choice D) is characterized by wheezing and decreased breath sounds, not a friction rub. Pleuritis is the only choice directly related to the inflammation of the pleura, leading to a pleural friction rub.

Correct Answer: B

Rationale: The correct answer is B, respiratory distress. When a patient is using accessory muscles to breathe, it indicates increased effort to maintain adequate ventilation, a hallmark of respiratory distress. This can be due to various conditions such as asthma, pneumonia, or acute respiratory distress syndrome. Accessory muscle use is a compensatory mechanism to help increase airflow in the presence of respiratory compromise. Choices A, C, and D are incorrect because the use of accessory muscles is not indicative of a normal breathing pattern, pulmonary embolism, or COPD specifically. It is important to recognize and address respiratory distress promptly to prevent further complications.