A 64-year-old smoker with cough, shortness of breath, facial plethora, JVD, supraclavicular node. Most likely cause?

Correct Answer: D

Rationale: The correct answer is D: Lung cancer. The symptoms described, including cough, shortness of breath, facial plethora, JVD, supraclavicular node, are classic signs of advanced lung cancer. Lung cancer commonly presents with respiratory symptoms due to the obstruction of airways and spread to nearby structures. Long-standing hypertension (A) typically presents with symptoms related to high blood pressure, not respiratory symptoms. Gastric carcinoma (B) may present with gastrointestinal symptoms rather than respiratory symptoms. Emphysema (C) is a lung condition associated with chronic obstructive pulmonary disease and smoking but does not typically present with facial plethora, JVD, or supraclavicular node enlargement.

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: C

Rationale: The correct answer is C: Recipient antibodies vs. donor. Delayed hemolysis post-transfusion is often due to the recipient developing antibodies against the donor's red blood cells. This immune response can lead to hemolysis days to weeks after the transfusion. Options A and B are incorrect as they do not involve an immune response causing hemolysis. Option D involves a different type of immune response (IgE vs. IgA) that is not typically responsible for delayed hemolysis post-transfusion.

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.