Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted?

Correct Answer: B

Rationale: The correct answer is B: Associated manifestations. Associated manifestations refer to other symptoms or signs that accompany the primary symptom. In this case, the primary symptom is abdominal pain, and the description provided focuses solely on the characteristics of the pain itself (location, intensity, duration, aggravating factors), omitting any mention of other symptoms like nausea, vomiting, fever, or jaundice that may be present with certain conditions. By not including information about associated manifestations, the description lacks a complete picture of the symptom presentation, making choice B the correct answer. Choices A, C, and D are incorrect because the description does cover the setting in which the symptom occurs (after eating greasy foods), the quality of the pain (dull ache), and the timing of the pain (2 to 3 hours after eating).

Correct Answer: A

Rationale: The correct answer is A because it covers all essential aspects of the interview contract. Firstly, mentioning confidentiality ensures patient privacy. Secondly, addressing patient costs sets clear expectations. Lastly, explaining the role of each person involved establishes transparency. Choice B is incorrect as it only covers the purpose of the interview and the role of the interviewer, missing important elements like confidentiality and patient costs. Choice C is incorrect as it lacks information on patient costs and the expectations of each person, focusing solely on the time, place, and confidentiality statement. Choice D is incorrect as it only includes the purpose of the interview and a description of the physical examination, missing crucial aspects like confidentiality, patient costs, and roles of individuals involved.

Correct Answer: D

Rationale: The correct answer is D: Right sternocleidomastoid. The sternocleidomastoid muscle is responsible for rotating the head to the opposite side. In this case, with the chin rotated towards the left and ear close to the right shoulder, the right sternocleidomastoid is primarily implicated. The left sternocleidomastoid would cause the opposite head rotation. The cervical paraspinal muscles primarily provide support and stabilization to the spine, not head rotation.

Correct Answer: C

Rationale: The correct answer is C: the third intermetatarsal space. Morton's neuroma is most commonly found between the third and fourth metatarsal heads. This is due to the anatomical arrangement of the intermetatarsal spaces and the compression and irritation that can occur in this specific area. Choices A, B, and D are incorrect because Morton's neuroma typically occurs in the third intermetatarsal space. The condition is less commonly associated with the other intermetatarsal spaces.

Correct Answer: C

Rationale: The correct answer is C: Long thoracic nerve. Scapula winging is primarily caused by injury to the long thoracic nerve, which innervates the serratus anterior muscle responsible for stabilizing the scapula against the thoracic wall. Damage to this nerve results in dysfunction of the serratus anterior, leading to abnormal scapular movement. The other choices are incorrect because: A: Radial nerve - primarily involved in elbow, wrist, and finger extension, not scapular stabilization. B: Suprascapular nerve - innervates the supraspinatus and infraspinatus muscles, not directly related to scapular winging. D: Axillary nerve - innervates the deltoid and teres minor muscles, not directly involved in scapular stabilization.