A young patient presents with a left-sided mass in her abdomen. You confirm that it is present in the left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen?

Correct Answer: A

Rationale: The correct answer is A: A palpable "notch" along its edge. This supports an enlarged kidney over the spleen because the kidney has a concave shape with a notch where the renal vessels enter. This notch is palpable in an enlarged kidney. Choice B is incorrect because the inability to push fingers between the mass and the costal margin is indicative of a spleen, which is a solid organ located close to the ribs. Choice C is incorrect as normal tympany over the area suggests gas-filled structures like the stomach or intestines, not a solid organ like the kidney or spleen. Choice D is incorrect as the ability to push fingers medial and deep to the mass would be more typical of an enlarged spleen, which can displace other organs medially due to its size.

Correct Answer: C

Rationale: The correct answer is C because clinical diagnosis of anxiety or depression can indeed have an effect on frailty rates. Anxiety and depression can contribute to the development and progression of frailty through various mechanisms such as decreased physical activity, poor nutrition, and social isolation. This can lead to a higher risk of frailty in individuals with mental health issues. Choices A, B, and D are incorrect because both prominent frailty models (e.g., Fried's phenotype model and Rockwood's accumulation of deficits model) do consider age as a component for defining frailty, individuals who are prefrail are at a higher risk of progressing to frailty rather than becoming robust, and frailty diagnosis has been shown to be valuable in preoperative assessment as it helps identify patients who may not do well with surgical interventions.

Correct Answer: C

Rationale: The correct answer is C. During the secondary stage of syphilis, a rash marked by red or reddish-brown, penny-sized lesions over the palms and soles is a common clinical manifestation. This rash, known as a syphilitic rash, is a hallmark symptom of secondary syphilis. The rash can also appear on other parts of the body. It is important to note that syphilis progresses through distinct stages, and the secondary stage typically occurs a few weeks to a few months after the initial infection. Now, let's analyze why the other choices are incorrect: A: Absence of symptoms - This is incorrect as syphilis does present symptoms, especially during the secondary stage. B: Single painless lesion, chancre on the genital area - This is characteristic of the primary stage of syphilis, not the secondary stage. D: Poor muscle coordination - This symptom is associated with the late or tertiary stage of syphilis, not the secondary stage

Correct Answer: C

Rationale: The correct answer is C: Persistent vomiting. This is because persistent vomiting is not typically associated with later-stage HIV disease. Night sweats, lymphadenopathy for more than 3 months, and persistent, unexplained fatigue are commonly seen in later-stage HIV. Vomiting may occur in earlier stages due to opportunistic infections, but it is not a hallmark symptom of advanced HIV.

Correct Answer: B

Rationale: The correct answer is B: Chest pain and pleuritic breathing. This indicates possible complications like pleurisy or pleural effusion, requiring further evaluation. A: Persistent cough with sputum production is common in pneumonia. C: Shortness of breath is a typical symptom of pneumonia. D: Fever and chills are also common in pneumonia. However, chest pain and pleuritic breathing are more indicative of potential complications that may require immediate attention.

Correct Answer: A

Rationale: The correct answer is A: Extrapyramidal symptoms. Selective serotonin reuptake inhibitors (SSRIs) are not known to cause extrapyramidal symptoms, which are more commonly associated with antipsychotic medications. SSRIs can cause gastrointestinal bleeding, irritation, and hyponatremia in older adults due to their effects on serotonin levels and platelet function. Extrapyramidal symptoms involve movement disorders like tremors and muscle rigidity, which are not typically seen with SSRIs. Therefore, A is the correct answer.

Correct Answer: B

Rationale: The correct answer is B (Pain) because pain is a common symptom in both inflammatory and non-inflammatory joint conditions. Tenderness, warmth, and redness are more specific to inflammatory joint problems. Tenderness indicates localized inflammation, warmth suggests increased blood flow and inflammation, and redness signifies dilated blood vessels and inflammation. Therefore, pain alone is less helpful in determining if a joint problem is inflammatory compared to the other symptoms.

Correct Answer: D

Rationale: The correct answer is D because asking the patient to describe what happened will provide crucial information about the onset, nature, and potential cause of the knee pain. This open-ended question allows the patient to share their experience freely, aiding in accurate diagnosis and appropriate treatment planning. Option A focuses solely on pain intensity, which is important but not as comprehensive as understanding the context of the pain (D). Options B and C are more specific to past injuries and onset time, respectively, which are relevant but not as immediate and all-encompassing as asking the patient to describe the current issue (D).

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.