Correct Answer: A

Rationale: Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, specifically around the stapes bone. In cases of otosclerosis, the bone conduction is greater than air conduction on the affected side, which is seen in the scenario described. The Weber test localizes to the affected ear, meaning the patient hears the sound of the tuning fork better in the left ear in this case. This is because the abnormal bone growth can restrict the movement of the ossicles, leading to a conductive hearing loss. Otosclerosis typically affects one ear, and its presentation aligns with the results of the hearing tests performed in this case.

Correct Answer: D

Rationale: It is crucial to assess Adam's suicide risk immediately due to the statements he made about it being better if he were not here. This indicates possible suicidal ideation, which requires urgent attention and intervention. Asking directly about suicidal thoughts and intentions can help determine the level of risk and ensure that appropriate support and resources are provided to Adam. It is important to take any mention of suicide seriously and prioritize the safety and well-being of the individual in such situations.

Correct Answer: A

Rationale: The presentation of pain that is markedly worse when the left arm is drawn across the chest (adduction) is characteristic of a rotator cuff tear. This is because when the arm is adducted, it puts stress on the torn rotator cuff tendons, causing pain. In contrast, subacromial bursitis typically presents with pain during overhead movements, acromioclavicular joint involvement may present with pain localized to the joint itself, and adhesive capsulitis (frozen shoulder) typically presents with pain and stiffness that worsens with all movements.

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: A

Rationale: Mr. Kelly's scenario is consistent with the phenomenon called "white coat hypertension," where an individual's blood pressure readings are elevated in a medical setting due to anxiety or stress, but are normal when measured at home. This discrepancy between office and home readings is a key indicator of white coat hypertension. Additionally, the fact that Mr. Kelly has been consistently monitoring his blood pressure at home and has kept a log supports the likelihood that his elevated readings in the office are primarily due to the stress of being in that environment. It is important to acknowledge white coat hypertension as a common occurrence and not necessarily a reflection of true high blood pressure that requires immediate medical intervention.