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: C

Rationale: The correct answer is C because the presence of normal tympany over the left upper quadrant indicates that gas-filled structures, such as the stomach or intestines, are present. This suggests that the mass is not the spleen, which is a solid organ that would produce dullness to percussion. A: A palpable 'notch' along its edge is more indicative of an enlarged spleen rather than a kidney. B: The inability to push your fingers between the mass and the costal margin suggests a mass that is closely adherent to the ribs, which could be seen in both enlarged kidney and spleen. D: The ability to push your fingers medial and deep to the mass could also be seen in both kidney and spleen enlargements.

Correct Answer: B

Rationale: The correct answer is B: To accustom the patient to being touched. This is because starting with light palpation helps the patient to relax and become accustomed to the examiner's touch, reducing discomfort and anxiety. This approach also allows the examiner to gradually assess for tenderness, muscle tone, and superficial masses before moving on to deep palpation to evaluate deeper structures. Incorrect answers: A: To assess for organ size - This is incorrect because assessing organ size is typically done through techniques such as percussion or imaging studies, not palpation. C: To detect deep masses - This is incorrect because deep masses are typically assessed during deep palpation, not light palpation. D: To check for rebound tenderness - This is incorrect because rebound tenderness is a specific test for peritoneal irritation, which is typically assessed after palpation, not before.

Correct Answer: A

Rationale: The correct answer is A: Barrel-shaped chest. In COPD, air trapping leads to hyperinflation of the lungs, causing the chest to become barrel-shaped. This is due to the increase in the anteroposterior diameter. Tracheal deviation (B) suggests a mediastinal shift, not common in COPD. Asymmetrical chest expansion (C) may indicate conditions like pleural effusion or pneumothorax, not typical in COPD. Decreased tactile fremitus (D) is seen in conditions with increased air content like emphysema, not always in COPD.

Correct Answer: C

Rationale: The correct answer is C: Pallor. Anemia is characterized by a decrease in red blood cells, leading to decreased oxygen supply to tissues. Pallor, or paleness of the skin, is a common physical finding in anemic patients due to reduced hemoglobin levels. Flushed skin (choice A) is more indicative of fever or increased blood flow. Cyanosis (choice B) occurs when there is insufficient oxygen in the blood, not necessarily related to anemia. Jaundice (choice D) is associated with liver dysfunction, not directly related to anemia. In summary, pallor is the most consistent finding in anemia due to decreased hemoglobin levels and subsequent tissue oxygenation.

Correct Answer: C

Rationale: The correct answer is C because wheezing during auscultation is considered abnormal in a respiratory assessment. Wheezing indicates narrowed airways, which can be a sign of conditions such as asthma or COPD. Resonance on percussion (A) and symmetrical chest expansion (B) are normal findings. A respiratory rate of 16 breaths per minute (D) falls within the normal range of 12-20 breaths per minute. Therefore, wheezing is the only abnormal finding among the choices provided.