A patient with longstanding COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next?

Correct Answer: D

Rationale: The correct answer is D: Obtain an ultrasound of the liver. This is the most appropriate next step to assess the patient's enlarged liver in the context of COPD. Ultrasound can provide detailed images of the liver to identify potential causes of enlargement, such as fatty liver disease or liver cirrhosis. Percussing the lower border (Choice A) or measuring the span of the liver (Choice B) may provide some information but are less specific and may not identify the underlying cause. Ordering a hepatitis panel (Choice C) would focus only on viral hepatitis as a potential cause, while an ultrasound can provide a broader evaluation of liver structure and function.

Correct Answer: B

Rationale: The correct answer is B: Every year. Annual assessment aligns with American Heart Association guidelines to monitor these key health indicators regularly for early detection and management of potential cardiovascular risks. More frequent assessments (A) may be unnecessary and burdensome. Less frequent assessments (C, D) increase the risk of missing important changes in health status that could lead to adverse outcomes. Regular yearly assessments allow for timely interventions and adjustments to promote optimal cardiovascular health.

Correct Answer: A

Rationale: The correct answer is A: It is moderately loud. A grade 4-intensity murmur indicates a moderately loud murmur that is readily heard with the stethoscope lightly on the chest. This intensity suggests a significant level of turbulence in blood flow, typically indicating a more pronounced cardiac abnormality. Explanation for why other choices are incorrect: B: It can be heard with the stethoscope off the chest - This is incorrect because a murmur would not be audible without the stethoscope. C: It can be heard with the stethoscope partially off the chest - This is incorrect as a murmur would still require direct contact with the chest for auscultation. D: It is associated with a "thrill" - This is incorrect as a thrill is a palpable vibration indicating turbulent blood flow and is not directly related to murmur intensity.

Correct Answer: B

Rationale: The correct answer is B: One breast larger than the other is most likely benign on breast examination. This is because breast asymmetry is a common and typically benign finding in women. It is important to note that a significant difference in breast size may warrant further evaluation, but in general, slight variations in size are normal. Now, let's discuss why the other choices are incorrect: A: Dimpling of the skin resembling that of an orange is concerning for peau d'orange appearance, which can be a sign of underlying breast cancer. C: One nipple inverted can be a sign of an underlying breast issue, such as a mass or tumor. D: One breast with a dimple when the patient leans forward can be a sign of an underlying breast abnormality, such as a tumor pulling on the skin. In summary, breast asymmetry (Choice B) is the most likely benign finding, while the other choices may indicate underlying breast issues that require further evaluation.

Correct Answer: D

Rationale: The correct answer is D, "All of the above." Bill's symptoms of epigastric pain lasting 30 minutes or more can be indicative of peptic ulcer, pancreatitis, or myocardial ischemia. Peptic ulcer can cause epigastric pain, pancreatitis presents with severe epigastric pain, and myocardial ischemia can manifest as epigastric discomfort. Considering all these possibilities is crucial for proper diagnosis and treatment. The other choices are incorrect because they do not encompass all potential causes of Bill's symptoms. It is important to consider a broad differential diagnosis to ensure comprehensive evaluation and management.