A 60-year-old man presents with difficulty swallowing. He has a history of smoking and chronic alcohol use. He also reports weight loss and a hoarse voice. What is the most likely diagnosis?

Correct Answer: A

Rationale: The most likely diagnosis for the 60-year-old man with difficulty swallowing, weight loss, hoarse voice, smoking, and alcohol use is esophageal cancer. This is supported by the symptoms of dysphagia, weight loss, and hoarseness, which are common in esophageal cancer. Smoking and alcohol use are risk factors for developing esophageal cancer. Achalasia presents with dysphagia without weight loss or hoarseness. Gastroesophageal reflux disease typically presents with heartburn and regurgitation, not hoarseness or weight loss. Peptic ulcer disease usually presents with epigastric pain, not difficulty swallowing or hoarseness.

Correct Answer: A

Rationale: The correct answer is A: Asthma. Wheezing on expiration is a classic finding in asthma due to airway constriction. During expiration in asthma, the narrowed airways cause turbulent airflow, leading to the characteristic high-pitched wheezing sound. Asthma is a chronic inflammatory condition of the airways that results in reversible airflow obstruction. Pneumonia (B) typically presents with crackles on auscultation, not wheezing. Pulmonary edema (C) is associated with crackles and possibly wheezing on inspiration. COPD (D) may present with wheezing on both inspiration and expiration, but it is less likely than asthma to present with wheezing on expiration alone.

Correct Answer: B

Rationale: The correct answer is B: Mitral stenosis. During diastole, the mitral valve should be closed, allowing blood to flow from the left atrium to the left ventricle. A murmur during diastole indicates turbulent blood flow across a stenotic mitral valve. Mitral stenosis causes decreased flow from the left atrium to the left ventricle during diastole, leading to increased pressure in the left atrium and the pulmonary circulation. Aortic regurgitation (A) would present with a murmur during diastole, but it is typically heard in early diastole. Tricuspid regurgitation (C) would present with a murmur during systole. Systolic heart failure (D) is not associated with a diastolic murmur.

Correct Answer: B

Rationale: Step-by-step rationale: 1. Choice B, Cranial nerve VII (facial nerve), is correct. This nerve innervates the muscles responsible for facial expressions, including raising the eyebrows. 2. Cranial nerve III (choice A) controls eye movements, not eyebrow elevation. 3. Cranial nerve IX (choice C) is involved in swallowing and taste sensation, not eyebrow movement. 4. Cranial nerve X (choice D) is responsible for various functions including regulating the heart and digestive system, not eyebrow movement. Summary: Choice B is correct as the facial nerve controls the muscles involved in raising the eyebrows. Choices A, C, and D are incorrect as they are not specifically associated with eyebrow movement.

Correct Answer: C

Rationale: A well-established physiological principle states that for every 1°F increase in body temperature, the pulse rate typically rises by about 5 beats per minute, making Choice C correct. This occurs because fever increases metabolic demand, prompting the heart to pump faster to deliver oxygen and nutrients. 3, and 4, underestimate this effect, while 6, slightly overestimates it based on standard clinical observations. For example, a person with a normal pulse of 70 bpm at 98.6°F might see it rise to 75 bpm at 99.6°F. This relationship is part of the bodys compensatory response to heat stress or infection, mediated by the autonomic nervous system. While individual variations exist due to age or fitness, 5 bpm is the widely accepted average in nursing and medical literature, making C the most accurate choice here.