A patient is describing a very personal part of her history very quickly and in great detail. How should you react to this?

Correct Answer: D

Rationale: In this situation, it is important to prioritize active listening over taking detailed notes. By pushing away from the keyboard or putting down your pen, you are signaling to the patient that you are fully present and engaged in listening to their story. This will help foster trust and encourage the patient to continue sharing their personal history. Taking notes can be done later, but the immediate focus should be on providing a supportive and attentive environment for the patient to share their experiences.

Correct Answer: C

Rationale: The described clinical presentation is consistent with internal hemorrhoids. The typical symptoms of internal hemorrhoids include painless rectal bleeding, protrusion from the anus during straining, and a feeling of incomplete evacuation. In this case, the protrusion is observed to be red, moist, and enlarges with bearing down, all indicative of internal hemorrhoids. The enlarged tender area felt on digital rectal examination supports the diagnosis. Additionally, the presence of blood on the glove after the examination is also suggestive of internal hemorrhoids causing bleeding. Anal fissures typically present with sharp pain during defecation and may have visible tears in the anal mucosa. External hemorrhoids are usually more painful and can be felt as a lump around the anus. Anorectal fistulas have different signs and symptoms, including discharge of pus and recurrent infections.

Correct Answer: D

Rationale: Nodules are a characteristic finding in an inflammatory joint condition such as rheumatoid arthritis. Nodules are small, firm lumps that can develop near the affected joint and are often indicative of an underlying inflammatory process. Tenderness, cool temperature, and ecchymosis can be seen in various musculoskeletal conditions, but nodules specifically point towards an inflammatory process in the joint.

Correct Answer: A

Rationale: In hyperthyroidism, there is an increased metabolic rate and sympathetic activity. This can lead to increased cardiac output and left ventricular mass, causing the heart to work harder. As a result, the left ventricle becomes hypertrophied, leading to a sustained, high-amplitude Point of Maximum Impulse (PMI) that is displaced laterally and downward. This can be felt during a physical examination as a strong and forceful PMI. In contrast, conditions like anemia, fever, and hypertension are not typically associated with a sustained, high-amplitude PMI.

Correct Answer: B

Rationale: Secondary amenorrhea refers to the absence of menstruation for 3-6 months in a woman who previously had regular menstrual cycles. In this case, Jean's lack of menstruation after giving birth and while breastfeeding her child for 6 months likely indicates secondary amenorrhea. This temporary suppression of ovulation and menstruation commonly occurs during breastfeeding due to the high levels of the hormone prolactin, which is responsible for milk production and can inhibit ovulation and menstruation. It is a natural phenomenon known as lactational amenorrhea. Once breastfeeding decreases or stops, menstruation usually resumes within a few months.

Correct Answer: A

Rationale: When examining a newborn and noting that the right testicle is not in the scrotum, it is important to refer the newborn to a pediatric urologist for further evaluation and management. This condition could be a case of undescended testis (cryptorchidism), where the testicle fails to descend into the scrotum. Early intervention is crucial as the undescended testis may lead to complications such as infertility, testicular cancer, and inguinal hernia. Urology specialists can determine the best course of action to bring down the testis and ensure proper testicular development. Waiting or attempting manual descent without expertise could lead to complications, so it is best to involve a urologist for proper assessment and management.

Correct Answer: C

Rationale: It is recommended for women to conduct breast self-examination immediately prior to their menses. This is because the breasts are less likely to be tender, lumpy, or swollen during this time of the menstrual cycle, making it easier to detect any abnormalities such as lumps or changes in the breast tissue. Conducting breast self-examination around this time each month can help women become familiar with the normal look and feel of their breasts, making it easier to detect any changes that may indicate a potential issue.

Correct Answer: B

Rationale: The most likely pathologic process based on the patient's symptoms and history would be an inflammatory process. The patient's joint pain, fever, and family history of rheumatoid arthritis suggest the possibility of an autoimmune inflammatory condition like rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disorder that primarily affects the joints, causing pain, swelling, and stiffness. The bilateral involvement of the wrists and fingers along with a family history of rheumatoid arthritis make this diagnosis more likely than an infectious, hematologic, or traumatic process in this case.

Correct Answer: B

Rationale: A condylar joint is a type of synovial joint that allows movement in two planes, typically flexion/extension and abduction/adduction. The interphalangeal joints of the hand, which are the joints between the phalanges (finger bones), exhibit this type of movement, making them an example of a condylar joint. The hip joint (choice A) is a ball-and-socket joint, the temporomandibular joint (choice C) is a hinge joint, and the intervertebral joint (choice D) is a cartilaginous joint, none of which are examples of condylar joints.