A 68-year-old mechanic presents to the emergency room for shortness of breath. You are concerned about a cardiac cause and measure his jugular venous pressure (JVP). It is elevated. Which one of the following conditions is a potential cause of elevated JVP?

Correct Answer: C

Rationale: Constrictive pericarditis is a condition where the pericardium becomes thickened and rigid, impairing diastolic filling of the heart. This leads to an increase in venous pressure, including the jugular venous pressure (JVP). The elevated JVP in constrictive pericarditis is a result of impaired ventricular filling rather than forward failure seen in heart failure. Mitral stenosis can lead to an increased JVP due to elevated left atrial pressure, but constrictive pericarditis is a more common cause of elevated JVP in this scenario. Aortic aneurysm is not typically associated with elevated JVP.

Correct Answer: A

Rationale: When crackles, wheezes, or rhonchi clear with a cough, it is suggestive of bronchitis. Bronchitis is inflammation of the bronchial tubes, often due to a viral infection, leading to the production of excess mucus. The characteristic sounds such as crackles, wheezes, or rhonchi can be heard on auscultation due to the presence of mucus in the airways. The act of coughing helps to clear the mucus from the airways, resulting in the temporary resolution of these abnormal sounds. In contrast, asthma, cystic fibrosis, and heart failure are not typically associated with crackles, wheezes, or rhonchi that clear with a cough.

Correct Answer: B

Rationale: The dullness in the last intercostal space in the anterior axillary line on the left side with a deep breath is suggestive of splenomegaly. However, this finding alone is not definitive for an enlarged spleen. The size of the spleen can vary, and further examination is required to confirm if the spleen is indeed enlarged. Therefore, Option B is the most appropriate choice as it indicates that the spleen is possibly enlarged, and close attention should be paid to further examination to confirm its status. Further workup, such as imaging studies or blood tests, may be necessary to evaluate the size and function of the spleen in this case.

Correct Answer: C

Rationale: Marion's presentation of back pain associated with constipation and urinary retention is concerning for cauda equina syndrome. Cauda equina syndrome is a rare but serious condition caused by the compression of the bundle of nerves at the bottom of the spinal cord, known as the cauda equina. This compression can result in a variety of symptoms, including back pain, sciatica, changes in bowel and bladder function (such as constipation and urinary retention), as well as lower extremity weakness or numbness.

Correct Answer: C

Rationale: Diminished radial pulses may be seen in patients with arterial emboli. Arterial emboli are blood clots that travel through the bloodstream and get lodged in a blood vessel, blocking blood flow to a certain area. When an embolus affects the arteries supplying the arm, it can lead to diminished pulses in the affected arm, such as the radial pulse in the wrist. This diminished pulse is due to decreased blood flow to the area beyond the blockage caused by the embolus. This distinguishes arterial emboli from the other options listed, as aortic insufficiency, hyperthyroidism, and early "warm" septic shock typically do not cause isolated diminished radial pulses.

Correct Answer: D

Rationale: The given symptoms of distant air sounds, late inspiratory crackles in both lower lobes, distant S1 and S2 heart sounds, and an S3 heart sound heard over the apex are all characteristic findings of left-sided heart failure. Distant air sounds and late inspiratory crackles indicate pulmonary congestion due to fluid accumulation in the lungs as a result of left-sided heart failure. The distant heart sounds and presence of an S3 are signs of left ventricular dysfunction. In contrast, pneumonia would typically present with more localized abnormal breath sounds and other symptoms such as fever and productive cough. Chronic obstructive pulmonary disease (COPD) would manifest with prolonged expiratory phase and wheezing, not late inspiratory crackles. Pleural pain is typically associated with sharp chest pain exacerbated by breathing movements, and it does not explain the constellation of symptoms described in this case. Therefore, the most likely diagnosis based on the provided symptoms

Correct Answer: B

Rationale: The presentation of multiple burning erosions on the shaft of the penis along with tender inguinal adenopathy is indicative of genital herpes caused by the herpes simplex virus (HSV). Primary herpes simplex infection typically presents with painful ulcers and lymphadenopathy. The ulcers are often shallow with well-defined borders and can be associated with systemic symptoms such as fever and malaise. In contrast, primary syphilis is characterized by a painless chancre at the site of infection, usually on the genitals. Chancroid can also present with painful ulcers, but it is less common in developed countries. Gonorrhea typically presents with urethral discharge, dysuria, or other symptoms of urethritis, rather than erosions on the penis shaft.

Correct Answer: A

Rationale: When examining a patient with known peripheral vascular disease in the legs, it is important to note the size, symmetry, and skin color of the lower extremities. These aspects can provide valuable information about the circulation and potential complications related to the disease. Changes in size, such as muscle wasting or atrophy, can indicate poor circulation and muscle ischemia. Asymmetry between the two legs may point to a significant difference in blood supply to the limbs. Skin color changes, such as pallor or cyanosis, can suggest impaired blood flow. Monitoring and documenting these findings are crucial for assessing the progression or improvement of the disease and guiding treatment interventions.

Correct Answer: D

Rationale: The group of lymph nodes that lie just behind the sternocleidomastoid muscles bilaterally are known as the posterior cervical lymph nodes. These lymph nodes are part of the superficial cervical lymph node chain, which is involved in draining lymph from the head and neck region. In the case described, the presence of sore throat, fever, and enlarged tonsils with exudates suggests a likely upper respiratory tract infection or tonsillitis, leading to the enlargement of the nearby lymph nodes. The posterior cervical lymph nodes are commonly examined in cases of upper respiratory infections and tonsillitis due to their proximity to the area of infection and inflammation.