A mother brings her 11 month old to you because her mother-in-law and others have told her that her baby is jaundiced. She is eating and growing well and performing the developmental milestones she should for her age. On examination you indeed notice a yellow tone to her skin from head to toe. Her sclerae are white. To which area should your next questions be related?

Correct Answer: B

Rationale: Since the baby is exhibiting jaundice, which is a condition characterized by the yellowing of the skin, it is important to inquire about the family history of liver diseases. Jaundice can be a sign of liver dysfunction or disease, so understanding the family history of liver diseases can provide valuable insights into potential underlying causes for the baby's jaundice. In this case, it is crucial to explore this area further to determine if there may be any genetic predispositions or familial conditions that could be contributing to the baby's presentation of jaundice.

Correct Answer: A

Rationale: Mr. Patel's case involves an enlarged liver, which warrants further investigation to determine the underlying cause. An ultrasound of the liver would provide valuable information regarding the size, shape, and texture of the liver, helping to identify any potential abnormalities such as liver cirrhosis, fatty liver disease, or liver tumors. This imaging study can also help differentiate between different conditions that may be causing the liver enlargement, guiding subsequent diagnostic and treatment decisions. Therefore, obtaining an ultrasound of the liver is the most appropriate next step in evaluating Mr. Patel's condition.

Correct Answer: C

Rationale: Diplopia occurring when one eye is covered is a condition known as monocular diplopia. This symptom is typically not caused by problems within the eye itself, such as irregularities in the cornea or lens. Instead, monocular diplopia with one eye covered is more likely to be an indication of a neurological issue, often involving the brainstem. Lesions or damage in the brainstem can disrupt the normal coordination of eye movements, leading to the perception of double vision when one eye is closed. Weakness of CN III (oculomotor nerve) or CN IV (trochlear nerve) may cause diplopia when both eyes are open, but it would not typically manifest as monocular diplopia.

Correct Answer: C

Rationale: Splitting of the second heart sound is when the aortic and pulmonic valves close at slightly different times, resulting in two distinct components to the sound. This split is best heard over the apex of the heart, typically with the diaphragm of the stethoscope. The aortic component is heard first and represents closure of the aortic valve, followed by the pulmonic component, representing closure of the pulmonic valve. The split can narrow during inspiration and widen during expiration, which is important to keep in mind during assessment.

Correct Answer: B

Rationale: Coronary artery disease (CAD) is a significant risk factor for peripheral vascular disease (PVD). CAD is a condition where plaque builds up in the coronary arteries that supply blood to the heart muscle. This process is called atherosclerosis. Similarly, in PVD, atherosclerosis occurs in the peripheral arteries, affecting blood flow to the extremities, most commonly the legs. Individuals with CAD often have systemic atherosclerosis, which puts them at higher risk for developing PVD. Therefore, it is important for the 72-year-old teacher with CAD to be aware of this risk factor for PVD and consider appropriate screening and preventive measures.