A 64-year-old man complains of leg pain and occasional numbness that worsens with ambulation and improves with lumbar flexion. The symptoms are consistent with:

Correct Answer: B

Rationale: The correct answer is B: Spinal stenosis. The symptoms described suggest neurogenic claudication, which is a hallmark of spinal stenosis. Pain worsening with ambulation and improving with lumbar flexion is characteristic of spinal stenosis due to narrowing of the spinal canal leading to compression of nerves. Ankylosing spondylitis (A) presents with inflammatory back pain and stiffness, not neurogenic claudication. Bursitis (C) involves inflammation of bursae, not typically associated with leg pain and numbness. Cauda equina syndrome (D) presents with sudden-onset severe back pain, urinary retention, and saddle anesthesia, which are not consistent with the described symptoms.

Correct Answer: A

Rationale: The correct answer is A: A palpable "notch" along its edge. This supports an enlarged kidney over the spleen because the kidney has a concave shape with a notch where the renal vessels enter. This notch is palpable in an enlarged kidney. Choice B is incorrect because the inability to push fingers between the mass and the costal margin is indicative of a spleen, which is a solid organ located close to the ribs. Choice C is incorrect as normal tympany over the area suggests gas-filled structures like the stomach or intestines, not a solid organ like the kidney or spleen. Choice D is incorrect as the ability to push fingers medial and deep to the mass would be more typical of an enlarged spleen, which can displace other organs medially due to its size.

Correct Answer: D

Rationale: The correct answer is D: Repeat PSA in 6 months. In this case, the patient's PSA levels have decreased from 12 ng/mL to 10 ng/mL after treatment with tamsulosin and removal of the Foley catheter. Given the improvement in PSA levels, it is reasonable to monitor for further changes before considering invasive procedures like transrectal ultrasound and biopsy (choice A), which may not be necessary at this time. Empiric finasteride (choice B) is not indicated as the patient is already responding well to tamsulosin. A bone scan (choice C) is not necessary at this stage as there are no indications of metastasis. Therefore, repeating the PSA in 6 months allows for continued monitoring of the patient's prostate health without subjecting him to unnecessary procedures.

Correct Answer: B

Rationale: The correct answer is B: Vomiting and pain. Small bowel obstruction typically leads to vomiting due to the blockage preventing food from passing through. Pain occurs as the intestine tries to push against the obstruction. Nausea and diarrhea (choice A) are more common in large bowel obstructions. Hematemesis and bloody stool (choice C) suggest bleeding in the upper gastrointestinal tract. Indigestion and anorexia (choice D) are not specific to small bowel obstruction. Therefore, the combination of vomiting and pain is indicative of small bowel obstruction.

Correct Answer: A

Rationale: The correct answer is A: Papilledema. Diabetic retinopathy is a microvascular complication of diabetes that primarily affects the retina's blood vessels. Papilledema, which is optic disc swelling due to increased intracranial pressure, is not a typical finding in diabetic retinopathy. Dot and blot hemorrhages, microaneurysms, and cotton wool spots are commonly seen in diabetic retinopathy due to retinal vessel damage and ischemia. Papilledema is more associated with conditions like intracranial hypertension or optic neuritis.

Correct Answer: D

Rationale: The correct answer is D: Take it with food. Glucocorticosteroids can irritate the stomach lining, leading to gastritis or ulcers. Taking them with food helps reduce stomach irritation and the risk of gastrointestinal side effects. Crushing it in applesauce (A) or chewing it prior to a high-fat meal (B) can exacerbate stomach irritation. Taking it on an empty stomach (C) can increase the risk of stomach upset and decrease absorption. Therefore, taking it with food (D) is the best option to minimize stomach irritation and improve medication effectiveness.

Correct Answer: A

Rationale: Rationale: 1. Cefuroxime and nitrofurantoin are safe for use in pregnancy and effective against UTIs. 2. Cefuroxime is a cephalosporin antibiotic, considered safe in pregnancy. 3. Nitrofurantoin is a first-line agent for UTIs in pregnancy due to its safety profile. 4. Ciprofloxacin and tetracycline are contraindicated in pregnancy due to potential harm to the fetus. 5. Amoxicillin is considered safe in pregnancy but not as effective as nitrofurantoin for UTIs.

Correct Answer: C

Rationale: Hyperkalemia is associated with diminished renal function because the kidneys play a crucial role in regulating potassium levels in the body. When renal function is impaired, the kidneys may not be able to excrete excess potassium effectively, leading to elevated potassium levels in the blood. - Choice A (Increase BP) is incorrect because hyperkalemia is not directly associated with increased blood pressure. - Choice B (Alpha-blockers) is incorrect as alpha-blockers are not typically linked to hyperkalemia. - Choice D (Loop diuretics) is incorrect as loop diuretics can actually lower potassium levels, not cause hyperkalemia.

Correct Answer: D

Rationale: The correct answer is D because beneficiaries do have out-of-pocket expenses for each prescription filled under Medicare Part D. This is typically in the form of copayments or coinsurance. A: Medicare Advantage plans often include Part D coverage, making statement A true. B: There are indeed multiple companies offering Part D plans, so statement B is true. C: The monthly premium for Part D coverage can vary, but in 2019 it was indeed around $30, making statement C true as well.