A 68-year-old woman has come in for an assessment of her rheumatoid arthritis, and the nurse notices raised, firm, nontender nodules at the olecranon bursa and along the ulna. These nodules are most commonly diagnosed as:

Correct Answer: D

Rationale: The correct answer is D: Subcutaneous nodules. In rheumatoid arthritis, subcutaneous nodules are commonly found on extensor surfaces such as the olecranon bursa and along the ulna. These nodules are firm, nontender, and can be present in patients with longstanding disease. They are pathognomonic for rheumatoid arthritis. Explanation of other choices: A: Epicondylitis - Involves inflammation of tendons at the elbow, not the presence of nodules. B: Gouty arthritis - Typically presents with acute, painful, swollen joints due to uric acid crystal deposition, not subcutaneous nodules. C: Olecranon bursitis - Presents as swelling and inflammation of the olecranon bursa, not firm nodules.

Correct Answer: B

Rationale: The correct answer is B because the hypothalamus is indeed responsible for controlling body temperature and regulating sleep. It plays a crucial role in maintaining homeostasis in the body. The other choices are incorrect because: A: The cerebellum is primarily involved in coordination and balance, not speech and emotions. C: The basal ganglia are involved in motor control and not voluntary movements. D: Motor pathways typically synapse in the brainstem or spinal cord, not the thalamus.

Correct Answer: A

Rationale: The correct answer is A: Reflexes will be normal. In patients with a head injury resulting in unconsciousness without other injuries, deep tendon reflexes are expected to be normal. This is because the unconsciousness is likely due to cerebral dysfunction rather than spinal cord injury, which would affect reflexes. Choices B, C, and D are incorrect because in the absence of spinal cord injury, the deep tendon reflexes should not be affected. Choice B is incorrect as reflexes should be present and can be elicited in this scenario. Choice C is incorrect as reflexes should not be diminished unless there is spinal cord involvement. Choice D is incorrect as reflexes should not depend on the area of injury in this case.

Correct Answer: D

Rationale: The correct answer is D, Complete neurologic examination. This is because the patient's symptoms of weakness in the left arm and leg require a thorough assessment of all components of the nervous system to determine the cause accurately. A Glasgow Coma Scale (A) assesses level of consciousness, not focal weakness. A Neurologic recheck examination (B) is not appropriate as it assumes a previous neurological exam. A Screening neurologic examination (C) is too basic and may not provide enough information to diagnose the cause of the symptoms.

Correct Answer: C

Rationale: The correct answer is C: Peripheral neuropathy. In this case, the patient's inability to feel vibrations on the great toe or ankle bilaterally but being able to feel vibrations on both patellae indicates a sensory nerve dysfunction affecting distal lower extremities. This pattern of sensory loss is consistent with peripheral neuropathy, a common complication of diabetes leading to nerve damage. Hyperalgesia (choice A) is increased sensitivity to pain, which is not reflective of the patient's symptoms. Hyperesthesia (choice B) is increased sensitivity to touch, which is also not consistent with the patient's findings. Lesion of the sensory cortex (choice D) would typically present with more widespread sensory deficits rather than the specific pattern described in the question.