A young woman comes to you with a cut on her finger caused by the lid of a can she was opening. She is pacing about the room, crying loudly, and through her sobs she says, "My career as a pianist is finished!" Which personality type exhibits these features?

Correct Answer: C

Rationale: The young woman in this scenario is exhibiting characteristics of histrionic personality disorder. Individuals with histrionic personality disorder tend to be overly dramatic, attention-seeking, and have a tendency to be excessively emotional in their reactions. The young woman's exaggerated response to a minor cut on her finger, along with her dramatic declaration that her career as a pianist is over, reflects the emotional and attention-seeking behaviors commonly associated with histrionic personality traits.

Correct Answer: A

Rationale: The description provided, which includes a clearly demarcated, round patch of hair loss without visible scaling or inflammation and absence of hair shafts, is characteristic of alopecia areata. Alopecia areata is an autoimmune condition that causes hair loss in round or oval patches on the scalp or other parts of the body. It is not associated with pulling or twisting of hair (trichotillomania), fungal infection (tinea capitis), or hair loss due to constant pulling force (traction alopecia). In alopecia areata, the affected area usually appears smooth and without visible signs of irritation. Treatment options for alopecia areata may include corticosteroid injections, topical immunotherapy, or minoxidil.

Correct Answer: B

Rationale: In this scenario, with a blood pressure of 168/94 on both arms, it indicates poorly controlled hypertension. Hypertension can have various causes, including kidney-related issues. Referring the patient to nephrology would be the appropriate next step to evaluate and manage any potential underlying kidney conditions contributing to the uncontrolled blood pressure. The nephrologist can conduct further tests and assessments to determine the root cause and provide specialized care for the patient's condition. This approach ensures a comprehensive evaluation and targeted management plan for the patient's hypertension.

Correct Answer: B

Rationale: A sudden, painful unilateral loss of vision is a medical emergency that may be caused by central retinal artery occlusion. This condition occurs when the main artery supplying blood to the retina becomes blocked, leading to a sudden and severe reduction in blood flow to the eye. The lack of blood flow can cause irreversible damage to the retina, resulting in a significant loss of vision. Patients with central retinal artery occlusion typically present with sudden, painless, and severe vision loss in one eye. Immediate medical attention is crucial to try to restore blood flow and minimize potential permanent vision loss in these cases. Vitreous hemorrhage, macular degeneration, and optic neuritis do not typically present with sudden, painful unilateral loss of vision as seen in central retinal artery occlusion.

Correct Answer: A

Rationale: Rectal prolapse occurs when the rectum protrudes through the anus. It typically appears as a moist, pink mass that protrudes outside the body. The prolapse is usually painless and can be seen and felt by the patient or the examiner. It is commonly seen in elderly individuals, especially women, and those with conditions like chronic constipation, pelvic floor weakness, or dementia. On the other hand, external hemorrhoids are swollen veins located around the anus, usually painful and may cause bleeding. Perianal fistula is an abnormal tunnel-like connection between the skin near the anus and the rectum, which can cause pain and discharge. Prolapsed internal hemorrhoids are internal hemorrhoids that have descended outside the anal canal and may require manual reduction. Given the symptoms described in the scenario - a moist pink mass protruding from the anus that is nontender and soft without bleeding - the most likely diagnosis is rectal prol

Correct Answer: C

Rationale: This categorization is based on the blood pressure readings. Stage 1 hypertension is defined as having a systolic blood pressure between 130-139 mmHg or a diastolic blood pressure between 80-89 mmHg. The blood pressure falls within this range, indicating mild hypertension. It is important to monitor and manage blood pressure to prevent complications associated with hypertension.

Correct Answer: B

Rationale: The third heart sound (S3) is a low-frequency sound heard in early diastole, immediately following the second heart sound (S2). It is generated by the abrupt deceleration of the column of blood against the ventricular wall during the rapid passive filling phase (early diastole) when the ventricle is suddenly stretched by a large volume of blood. The S3 sound typically reflects decreased ventricular compliance, rather than normal compliance. An S3 sound is often considered pathological and is commonly associated with conditions such as heart failure, volume overload, and dilated cardiomyopathy. Therefore, the statement that the third heart sound reflects normal compliance of the left ventricle (Choice B) is incorrect.

Correct Answer: A

Rationale: The description provided fits the criteria for tension-type headache. Tension-type headaches are typically described as a mild to moderate, dull, band-like pressure or tightness around the head. They can last from minutes to days and are often triggered by stress, anxiety, poor posture, or prolonged computer use. The absence of symptoms like photophobia and nausea, along with the response to over-the-counter medication, further support the diagnosis of tension-type headache in this case. Other headache types such as migraines or cluster headaches usually present with additional symptoms like nausea, photophobia, or tearing of the eye, which are not mentioned in this scenario. Analgesic rebound headaches typically occur in individuals who overuse pain medications, leading to worsening headaches when the medication wears off, but this patient's history does not suggest such misuse.

Correct Answer: B

Rationale: The clinical presentation described involves a patient with pericarditis. Pericarditis is inflammation of the pericardium, the sac surrounding the heart, which can lead to characteristic findings such as a scratching noise heard on auscultation, leaning forward relieving pain, and normal lung examination findings. The presence of pericarditis can also lead to a pericardial friction rub, which is often described as a scratching or grating sound heard best at the lower left sternal border.