Correct Answer: D

Rationale: The described findings of a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea are characteristic of a pterygium. A pterygium is a benign growth of conjunctival tissue that extends onto the cornea. It is often associated with chronic exposure to ultraviolet light and typically occurs on the nasal side of the eye. Pterygiums are usually asymptomatic but can cause irritation, redness, and foreign body sensation in some cases. Surgical removal may be considered if the pterygium causes significant symptoms or affects vision.

Correct Answer: C

Rationale: Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, and multiple tender points on palpation, especially in the neck, shoulders, back, and hips. The patient's symptoms of widespread pain and tenderness at specific points on the muscles without arthritis, joint swelling, or limitation in range of motion are consistent with fibromyalgia. Fibromyalgia is often associated with poor sleep quality, morning stiffness, and fatigue, which the patient in the case provided experiences. Other conditions like rheumatoid arthritis, osteoarthritis, or polymyalgia rheumatica would typically present differently with specific joint involvement, swelling, and additional systemic symptoms, which are not seen in this patient.

Correct Answer: C

Rationale: Epistaxis, also known as a nosebleed, should be considered in a patient complaining of coughing up blood along with a history of smoking. Epistaxis can sometimes lead to blood trickling down the throat and being coughed up. It is important to consider this differential diagnosis, especially in patients with risk factors such as smoking. Intestinal bleeding (choice A) has a different presentation and cause compared to epistaxis. Hematoma of the nasal septum (choice B) is unlikely to cause coughing up blood. Bruising of the tongue (choice D) is also less likely to be the cause of hemoptysis in this case.

Correct Answer: C

Rationale: Family history of osteoporosis is a significant risk factor, as genetics play a key role in determining a person's risk for developing osteoporosis. Having a close relative, such as an aunt, with severe osteoporosis increases this woman's risk as there is a strong genetic component to the disease. Factors such as obesity (choice A), late menopause (choice B), and delayed menarche (choice D) do not directly increase the risk of osteoporosis, unlike having a familial history of the condition.

Correct Answer: B

Rationale: Among the options presented, Hepatitis B (HBV) is most likely in this scenario. HBV can be transmitted through mucous membrane exposure to infectious blood or body fluids, including sexual contact. The daycare worker's history of not being sexually active for the past 10 months would not completely rule out the possibility of acquiring HBV through a past sexual encounter. Also, HBV can persist in the blood for prolonged periods, making it a likely cause of jaundice in this case. The other types of hepatitis (A, C, D) are less likely based on the information provided concerning the daycare worker's history and risk factors.