A 65-year-old man with a history of hypertension presents with a complaint of shortness of breath on exertion and swelling in his legs. His physical examination reveals bilateral pedal edema, crackles at the lung bases, and jugular venous distention. What is the most likely diagnosis?

Correct Answer: B

Rationale: The correct answer is B: Congestive heart failure. Given the patient's history of hypertension, presenting symptoms of shortness of breath, pedal edema, crackles in the lungs, and jugular venous distention are classic signs of congestive heart failure. These symptoms are indicative of fluid overload and impaired cardiac function leading to fluid accumulation in the lungs and extremities. Other choices can be ruled out based on the lack of corresponding symptoms and physical examination findings related to those conditions. Chronic obstructive pulmonary disease (A) typically presents with chronic cough, wheezing, and sputum production. Pulmonary embolism (C) presents with sudden onset dyspnea, chest pain, and tachycardia. Renal failure (D) may present with decreased urine output, electrolyte abnormalities, and signs of uremia.

Correct Answer: C

Rationale: The correct answer is C: Psoriatic arthritis. The patient's history of psoriasis is a key clue. Psoriatic arthritis commonly affects individuals with psoriasis, presenting with joint pain and swelling. Rheumatoid arthritis (choice A) typically affects multiple joints symmetrically. Osteoarthritis (choice B) is more common in older individuals and does not have a strong association with psoriasis. Gout (choice D) is characterized by sudden, severe attacks of pain, usually in the joint at the base of the big toe, and is not typically associated with psoriasis.

Correct Answer: C

Rationale: The correct answer is C: Pulmonary edema. Crackles in the lower lung fields are indicative of fluid accumulation in the alveoli, which is characteristic of pulmonary edema. This condition is commonly seen in heart failure when the heart is unable to effectively pump blood, leading to fluid backup in the lungs. Pleural effusion (A) is the accumulation of fluid in the pleural space, not in the alveoli. Pneumonia (B) typically presents with other symptoms like fever and productive cough. COPD (D) is characterized by airflow limitation and is not directly associated with crackles due to fluid accumulation.

Correct Answer: B

Rationale: The correct answer is B, dry mouth and tongue. Dehydration often leads to decreased saliva production, resulting in a dry mouth and tongue. This is a more specific and direct sign of dehydration compared to the other choices. Increased skin turgor (choice A) is a sign of dehydration but can be influenced by other factors. Bounding pulse (choice C) is a sign of fluid overload, not dehydration. Moist mucous membranes (choice D) are a normal finding and not indicative of dehydration. Overall, dry mouth and tongue are the most specific and reliable indicators of dehydration in a patient assessment.

Correct Answer: B

Rationale: The correct answer is B: Fifth intercostal space, midclavicular line. This is where the apex of the heart is located, making it the normal position to palpate the apical pulse. Palpating at the second intercostal space (A) would be locating the aortic area, not the apical pulse. The fourth intercostal space (C) is where the tricuspid valve is auscultated, not where the apical pulse is palpated. The sixth intercostal space (D) is closer to the location of the mitral valve, but it is not the precise location of the apical pulse.