A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings?

Correct Answer: C

Rationale: The correct answer is C: Psoriasis. The key clinical features described, such as pruritic rash with scabbing, crusting, silvery scale, and nail pitting, are classic signs of psoriasis. The presence of small "pits" in the nails, known as nail pitting, is a common finding in psoriasis. The worsening of symptoms in winter and improvement with sun exposure is also typical of psoriasis. Eczema (choice A) typically presents with red, inflamed, and weeping skin lesions. Pityriasis rosea (choice B) presents with a herald patch followed by smaller similar lesions. Tinea infection (choice D) presents with scaling, redness, and itching but does not typically cause nail pitting. In this case, the combination of symptoms and nail pitting point to psoriasis as the most likely diagnosis.

Correct Answer: B

Rationale: The correct term for the phenomenon described is "Consensual reaction" (Choice B). This occurs because the optic nerves from both eyes are connected, causing stimulation of one eye to result in a simultaneous response in the other eye due to the consensual pupillary reflex. The other choices are incorrect because: A: Direct reaction refers to the pupil directly exposed to light contracting. C: Near reaction refers to the pupillary response when focusing on a near object. D: Accommodation refers to the ability of the eye to adjust focus for near and far objects, not pupil constriction.

Correct Answer: C

Rationale: The correct answer is C: Efferent nerve damage on the right. When both pupils dilate but only the right pupil constricts briskly in response to light, it indicates a problem with the efferent pathway controlling the right eye's pupillary constriction. This suggests damage to the parasympathetic fibers of the oculomotor nerve (CN III) that innervate the pupillary sphincter muscle. Choices A and B (optic nerve damage) do not involve pupil constriction. Choice D (efferent nerve damage on the left) would not explain the brisk constriction in the right eye.

Correct Answer: D

Rationale: The correct answer is D because the 5th intercostal space is the recommended location for chest tube insertion to drain the pleural space effectively. This space is ideal as it allows for adequate drainage without causing injury to vital structures. A: The 2nd intercostal space is actually used for needle decompression in tension pneumothorax. B: T6 is the level at which the tip of the endotracheal tube should ideally lie to ensure proper placement and ventilation. C: The sternal angle corresponds to the 2nd rib, not the 4th rib, making this association incorrect. In summary, choice D is correct as it aligns with the standard practice for chest tube insertion, while choices A, B, and C are incorrect due to their association with different anatomic landmarks and procedures.

Correct Answer: D

Rationale: The correct answer is D: Examine him for tenderness over the injured area. Rationale: 1. Start with a physical examination to assess for tenderness directly over the injured area. 2. Rib fractures often present with localized tenderness upon palpation. 3. If tenderness is present, suspect a rib fracture and advise immobilization. 4. Advise against unnecessary movement to prevent further injury. Summary: - Choice A: Calling a medevac helicopter is premature without assessing the severity of the injury. - Choice B: Driving him 4 hours away could worsen his condition without proper assessment. - Choice C: Pressing on the sternum and spine simultaneously is not recommended as it can cause further harm.