A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?

Correct Answer: B

Rationale: Based on the description provided, the skin lesions are most consistent with seborrheic keratosis. Seborrheic keratoses are common non-cancerous (benign) growths of the skin that often appear as brown, black, or light tan growths with a waxy, stuck-on appearance. They can vary in color and may be round or oval, with a well-defined border. Seborrheic keratoses are typically asymptomatic and can be found on various parts of the body including the face, arms, and legs. The dry, hard scale covering the lesion is typical for seborrheic keratoses.

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: A right homonymous hemianopsia refers to a visual field defect in which the patient is unable to see objects in the right half of the visual field in both eyes. In the case described, the stroke patient is unable to see your fingers on his entire right side with either eye covered, which is consistent with a right homonymous hemianopsia. This type of visual field defect typically occurs as a result of damage to the optic tract or optic radiation on one side of the brain, which affects the processing of visual information from the opposite visual field. It is important to note that bitemporal hemianopsia, right temporal hemianopsia, and binasal hemianopsia involve different patterns of visual field loss and are not fitting descriptions for the presented scenario.

Correct Answer: D

Rationale: The patient's symptoms point towards pneumonia. Pneumonia is characterized by infection and inflammation in the lung tissue, leading to symptoms such as decreased air movement, crackles on auscultation, dullness on percussion, increased fremitus on palpation, and abnormal breath sounds like egophony and whispered pectoriloquy. These findings are consistent with consolidation of the lung, which occurs in pneumonia as a result of fluid, inflammatory cells, and tissue debris filling the alveoli. The presence of nasal turbinates edema indicates a possible upper respiratory tract infection that may have preceded the development of pneumonia. Spontaneous pneumothorax would typically present with sudden-onset chest pain and dyspnea but would not typically cause findings of lung consolidation. Chronic obstructive pulmonary disease (COPD) and asthma are characterized by different patterns of lung damage and symptoms, such as chronic inflammation, airflow obstruction, and hyper

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.