All of the statements about Medicare are true except:

Correct Answer: B

Rationale: The correct answer is B because durable medical equipment under Medicare typically requires the patient to pay 20% of the Medicare-approved amount. A is incorrect because Medicare funding also comes from payroll taxes and individual premiums. C is incorrect as Part B covers outpatient services and physician fees only in outpatient settings. D is incorrect as patients are generally responsible for 20% of Part B bills, not no out-of-pocket cost for durable medical equipment.

Correct Answer: D

Rationale: The correct answer is D, Melanoma. Melanoma is a type of skin cancer that typically presents as a dark, raised lesion with an irregular border and asymmetry. This is due to the abnormal growth of melanocytes, the pigment-producing cells in the skin. Nevus (A) is a common mole that is usually symmetrical and has a regular border. Actinic keratosis (B) is a precancerous lesion that is typically rough and scaly, not dark or raised. Keratoacanthoma (C) is a low-grade skin cancer that often appears as a dome-shaped lesion with a central crater, not necessarily dark or asymmetric.

Correct Answer: C

Rationale: The correct answer is C: An intraductal papilloma. Bloody spontaneous discharge from the nipple in a perimenopausal woman is concerning for an intraductal papilloma, which is a benign growth in the milk ducts. Further evaluation with imaging studies and possibly a biopsy is necessary to rule out malignancy. Choice A: Fibroadenoma is a common benign breast tumor but does not typically present with bloody discharge. Choice B: Polycystic breast disease is not associated with bloody discharge and is characterized by multiple fluid-filled cysts in the breast tissue. Choice D: Pituitary prolactinoma is a benign tumor of the pituitary gland that can cause elevated prolactin levels leading to nipple discharge, but it is not typically bloody and would not present with spontaneous discharge from the nipple.

Correct Answer: D

Rationale: Rationale for correct answer D: Acne is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman because hyperprolactinemia usually presents with symptoms related to hormonal imbalance, such as irregular menstrual cycles (oligomenorrhea), breast changes (gynecomastia), and excess body hair (hirsutism). Acne is not directly associated with elevated prolactin levels. Summary of incorrect choices: A: Hirsutism - Hirsutism is a common finding in hyperprolactinemia due to hormonal imbalances. B: Gynecomastia - Gynecomastia can occur in hyperprolactinemia due to the suppression of testosterone. C: Oligomenorrhea - Oligomenorrhea is a typical finding in hyperprolactinemia due to disruptions in the menstrual cycle.

Correct Answer: D

Rationale: The correct answer is D: Changes in behavior. This is the most common presenting sign of substance abuse in adolescents because substance use often leads to noticeable changes in behavior, such as irritability, mood swings, aggression, and withdrawal from family and friends. These behavioral changes are typically the first noticeable signs of substance abuse. A: Poor school performance may be a consequence of substance abuse, but it is not necessarily the most common presenting sign. B: Change in sleep habits can be a sign of substance abuse, but changes in behavior are more prominent and common. C: Increased blood pressure is a physical symptom of substance abuse, but changes in behavior are usually more readily apparent and commonly observed in adolescents with substance abuse issues.