A 64-year-old man with 5-cm thigh mass, fixed to muscle. Most appropriate management?

Correct Answer: D

Rationale: The correct answer is D: Refer for surgical biopsy. In this case, a 5-cm thigh mass that is fixed to muscle in a 64-year-old man raises concern for a potential malignant tumor. Surgical biopsy is the most appropriate next step to establish a definitive diagnosis and determine the nature of the mass. This will help guide further management, whether it requires surgical excision, chemotherapy, or other treatments. Reexamining in 3 months (choice A) may delay diagnosis and treatment if the mass is indeed malignant. A bone scan (choice B) is not the initial investigation for a soft tissue mass. Treating with cephalexin (choice C) is not indicated as this mass is likely not an infectious process.

Correct Answer: D

Rationale: The correct answer is D: White blood cell count of 16,000/mm³. Elevated WBC count could indicate an infection, which is crucial to report before knee arthroscopy to prevent complications. Hematocrit (A) and hemoglobin level (B) are important but not as urgent for this procedure. Platelet count (C) is not directly related to infection detection.

Correct Answer: C

Rationale: The correct answer is C because it demonstrates active listening and empathy, allowing the patient to express their concerns fully. By saying "Tell me more about your fear," the healthcare provider acknowledges the patient's feelings and opens up a dialogue to address their specific worries. This approach can help build trust and rapport, leading to a more effective therapeutic relationship. Choice A is incorrect as it generalizes the patient's fear without addressing the individual's concerns. Choice B is also incorrect as it jumps to suggesting medication without fully understanding the root of the patient's fear. Choice D, although true, does not directly address the patient's emotional needs or provide support in coping with their fear of dying.

Correct Answer: B

Rationale: The most concerning symptom for a patient on cyclosporine post-transplant is nontender groin swelling (Choice B) due to the risk of developing nephrotoxicity from cyclosporine. Groin swelling may indicate lymphoproliferative disorder or nephrotic syndrome, both associated with cyclosporine use. Bleeding gums (Choice A) may be due to gum disease but are not directly related to cyclosporine. Occasional nausea (Choice C) is a common side effect of cyclosporine but is usually mild and not as concerning. Numbness and tingling of feet (Choice D) may indicate peripheral neuropathy, which can be a side effect of cyclosporine but is less concerning than the potential kidney damage indicated by groin swelling.

Correct Answer: B

Rationale: Rationale: Von Willebrand factor plays a crucial role in primary hemostasis by binding platelets to the subendothelium at sites of vascular injury, facilitating platelet adhesion and aggregation. This is important for forming a platelet plug to stop bleeding. Choices A and C are incorrect because von Willebrand factor does not directly bind platelets to each other or to a phospholipid surface. Choice D is incorrect because von Willebrand factor does not carry factor VII, but it does carry factor VIII.