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: D

Rationale: The patient's presentation of new onset tremors, slow movements with shuffling steps (bradykinesia), decreased facial mobility, and blunt expression are characteristic features of Parkinson's disease. Parkinson's disease is a neurodegenerative disorder that affects movement, typically presenting with tremors, rigidity, and bradykinesia. The presence of these symptoms in this patient, along with the absence of any other medical conditions or medication use, points toward a diagnosis of Parkinson's disease. Other conditions like Cushing's syndrome, nephrotic syndrome, and myxedema are unlikely based on the patient's clinical presentation.

Correct Answer: C

Rationale: The symptoms described, such as sneezing, itchy watery eyes, clear nasal discharge, ear pain, and nonproductive cough, are classic signs of allergic rhinitis, commonly known as seasonal allergies. Allergic rhinitis is an inflammatory response triggered by allergens in the environment such as pollen, dust mites, or pet dander. The immune system overreacts to these allergens, releasing histamine and other chemicals that cause the symptoms experienced by the patient. In this case, the most likely pathologic process underlying the symptoms is an allergic response rather than infection, inflammation, or vascular issues.

Correct Answer: C

Rationale: The presentation of severe testicular pain with a red, tense scrotum, and absent cremasteric reflex on one side is highly concerning for testicular torsion. Testicular torsion is a urologic emergency that occurs when the spermatic cord twists, leading to compromised blood flow to the testicle. The affected testicle can become ischemic and necrotic within hours, necessitating prompt diagnosis and intervention to avoid permanent damage or loss of the testicle.

Correct Answer: D

Rationale: A rectal polyp is a growth that originates from the inner lining of the rectum and protrudes into the rectal canal. It may present as a soft, smooth, nontender mass on digital rectal examination. Rectal polyps are usually benign, but some may have the potential to become cancerous if left untreated. Therefore, it is important to evaluate and remove polyps to prevent complications. In this case, the description of a pedunculated mass on the posterior wall of the rectum is most suggestive of a rectal polyp.

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: D

Rationale: HPV (human papillomavirus) infection is a very common sexually transmitted infection (STI) that can affect both men and women. It is the most common STI in the United States. While most cases of HPV infection are asymptomatic and resolve on their own, certain high-risk strains of HPV can lead to the development of various cancers, including cervical cancer. Therefore, HPV infections do cause a small but important number of cervical cancers, making option D the correct choice. Regular screening, such as Pap smears and HPV testing, are crucial for early detection and effective management of HPV-related abnormalities that could progress to cervical cancer.

Correct Answer: D

Rationale: Audiometric testing is a very sensitive method for detecting hearing loss. It involves a series of tests that measure a person's ability to hear sounds at various frequencies and volumes. These tests can detect even subtle changes in hearing ability and provide detailed information on the type and degree of hearing loss. The whisper test and finger rub test are basic screening tests and are not as sensitive or comprehensive as audiometric testing. The tuning fork test is also used in evaluating hearing loss, but it is not as accurate or sensitive as audiometric testing. Overall, audiometric testing is considered the gold standard for diagnosing hearing loss due to its high sensitivity and ability to provide detailed information on the individual's hearing capabilities.