A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do?

Correct Answer: D

Rationale: The correct answer is D: Do a skin biopsy in the office. This is the most appropriate action to take in this scenario as the presence of multiple small, blood-red, raised lesions without pain or bleeding warrants further investigation to determine the underlying cause. A skin biopsy would provide histological information about the nature of the lesions, helping to differentiate between various skin conditions such as angiomas, petechiae or purpura. This would guide the appropriate management and rule out any serious underlying conditions. Choice A (Reassure him that there is nothing to worry about) is incorrect as the appearance of these lesions warrants further investigation rather than immediate reassurance. Choice B (Do laboratory work to check for platelet problems) is not the most appropriate initial step without first obtaining more specific information about the nature of the lesions. Choice C (Obtain an extensive history regarding blood problems and bleeding disorders) may be necessary later but is not the initial step in this case.

Correct Answer: B

Rationale: The correct answer is B: Connects the second metatarsal head to the first cuneiform. The Lisfranc ligament plays a crucial role in maintaining the stability of the midfoot by connecting the second metatarsal to the first cuneiform bone. This connection is essential in weight-bearing activities to prevent excessive movement and maintain proper alignment of the bones in the midfoot. The other choices are incorrect because: A) The distal tibia is not connected to the talus by the Lisfranc ligament, C) The preservation of the medial longitudinal arch is primarily achieved by other ligaments in the foot, and D) The primary ankle stabilizer is the deltoid ligament on the medial side of the ankle, not the Lisfranc ligament.

Correct Answer: D

Rationale: Boutonnière deformity is characterized by the rupture of the central slip and volar migration of lateral bands. This leads to hyperextension of the PIP joint and flexion of the DIP joint. This deformity is due to the disruption of the extensor mechanism, specifically the central slip. Rupture of the central slip allows the lateral bands to migrate volarly, causing the characteristic deformity. Options A, B, and C do not accurately describe the mechanism of Boutonnière deformity, making them incorrect choices. Option A describes mallet finger deformity, option B refers to trigger finger, and option C relates to carpal tunnel syndrome.

Correct Answer: A

Rationale: The correct answer is A: Hip joint dysfunction. FABERE test assesses for hip joint dysfunction by examining flexion, abduction, external rotation, and extension of the hip joint. It specifically evaluates the range of motion and stability of the hip joint, helping to identify issues such as arthritis, labral tears, or hip impingement. Gluteus medius weakness (B) is not directly tested by FABERE. Femoral nerve irritation (C) and iliotibial band tightness (D) are also not assessed by this test.

Correct Answer: D

Rationale: The correct answer is D: Smoking. Smoking is considered the greatest single modifiable risk factor for cardiac disease due to its direct negative impact on cardiovascular health. Smoking increases the risk of heart disease by damaging blood vessels, raising blood pressure, increasing heart rate, and promoting the buildup of fatty deposits in the arteries. Quitting smoking has been shown to significantly reduce the risk of developing heart disease. A: Obesity is a significant risk factor for heart disease, but smoking has a greater impact on cardiovascular health. B: Hypertension is a major risk factor for heart disease, but smoking has a more significant impact on cardiovascular health. C: Hyperlipidemia (high cholesterol) is a significant risk factor for heart disease, but smoking is considered the greatest single modifiable risk factor for cardiac disease.