A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of her problem?

An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per night. His other lower urinary tract symptoms are slow stream, occasional urgency, and urgency-related leakage once weekly. Medical problems include poorly controlled hypertension, diastolic heart failure, hyperlipidemia, osteoarthritis, and prediabetes. His medications include lisinopril 20 mg daily, metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg twice daily, hydrocodone-acetaminophen as needed, and aspirin 81 mg daily. Amlodipine 5 mg daily was recently added by his cardiologist. On review of systems, Mr. A complains that nocturia is causing daytime fatigue, and he is more constipated. Physical examination is notable for blood pressure 162/83 mmHg, heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged prostate, and 21 pre-tibial edema.

Explain the procedure for measuring vibratory sense using a tuning fork. What anatomical location is commonly used for this assessment?

Which condition is caused by an insufficient production of intrinsic factor by gastric mucosa and vitamin B insufficiency?

Which group of lymph nodes are located on the medial surface of the arm approximately 3 cm above the elbow?