An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?

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Question 1 of 9

An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?

Correct Answer: B

Rationale: In an elderly woman with a history of coronary bypass surgery presenting with severe, diffuse abdominal pain that is not worsened by abdominal palpation, neuropathy should be suspected. Neuropathy refers to nerve damage, which can result in abnormal sensations of pain, often described as burning, shooting, or stabbing. Abdominal neuropathy can be caused by various conditions such as diabetes, alcohol abuse, vitamin deficiencies, or certain medications. The absence of worsening pain upon palpation makes organic abdominal pathology less likely, suggesting a neuropathic etiology. In this case, further evaluation and testing for neuropathy would be warranted.

Question 2 of 9

A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to?

Correct Answer: A

Rationale: The symptom described - sharp, aching chest pain that increases with breathing - is typically associated with musculoskeletal issues. The pain worsening with breathing suggests a connection to the movements of the chest wall, which could involve the muscles, bones, or joints in that area. Conditions such as costochondritis (inflammation of the cartilage that connects a rib to the breastbone) or muscle strains in the chest wall are common causes of chest pain that worsens with breathing. This localization to the musculoskeletal system is based on the characteristics of the pain and how it is affected by breathing, helping to narrow down the differential diagnosis.

Question 3 of 9

An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?

Correct Answer: B

Rationale: In an elderly woman with a history of coronary bypass surgery presenting with severe, diffuse abdominal pain that is not worsened by abdominal palpation, neuropathy should be suspected. Neuropathy refers to nerve damage, which can result in abnormal sensations of pain, often described as burning, shooting, or stabbing. Abdominal neuropathy can be caused by various conditions such as diabetes, alcohol abuse, vitamin deficiencies, or certain medications. The absence of worsening pain upon palpation makes organic abdominal pathology less likely, suggesting a neuropathic etiology. In this case, further evaluation and testing for neuropathy would be warranted.

Question 4 of 9

Mrs. LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely?

Correct Answer: B

Rationale: Urge incontinence, also known as overactive bladder, is characterized by a sudden and strong urge to urinate which is difficult to control. In this case, Mrs. LaFarge is unable to get to the bathroom quickly enough when she senses the need to urinate, which indicates a lack of control over the urge to urinate. This is typically caused by involuntary contractions of the bladder muscle. Stress incontinence, on the other hand, is leakage of urine during activities that increase intra-abdominal pressure, such as coughing or exercising. Overflow incontinence is characterized by urinary retention and constant dribbling of urine due to the bladder being unable to empty properly. Functional incontinence occurs when a person has normal bladder control but is unable to reach the bathroom in time due to physical or cognitive impairments. Since Mrs. LaFarge is experiencing a sudden and strong urge to urinate that she cannot

Question 5 of 9

Which of the following events occurs at the start of diastole?

Correct Answer: B

Rationale: At the start of diastole, the ventricles relax and begin to fill with blood from the atria. As this relaxation phase begins, the pulmonic valve opens to allow blood to flow from the right ventricle to the pulmonary artery and then to the lungs for oxygenation. This marks the beginning of diastole, the period of the cardiac cycle when the heart is filling with blood. The closure of the tricuspid valve, closure of the aortic valve, and production of the first heart sound (S1) occur during systole, the phase of the cardiac cycle when the heart is contracting to pump blood out to the body.

Question 6 of 9

Which area of the arm drains to the epitrochlear nodes?

Correct Answer: A

Rationale: The area of the arm that drains to the epitrochlear nodes includes the ulnar surface of the forearm and hand, little and ring fingers, and the ulnar side of the middle finger. The epitrochlear nodes are located in the medial aspect of the arm above the elbow, close to the insertion of the biceps brachii muscle. These nodes receive lymphatic drainage from the above-mentioned areas and play a role in the immune response against infections in these regions.

Question 7 of 9

A 28-year-old married clothing sales clerk comes to your clinic for her annual examination. She requests a refill on her birth control pills. Her only complaint is painless bleeding after intercourse. She denies any other symptoms. Her past medical history consists of two spontaneous vaginal deliveries. Her past six Pap smears have all been normal. She is married and has two children. Her mother is in good health and her father has high blood pressure. On examination you see a young woman appearing healthy and relaxed. Her vital signs are unremarkable and her head, eyes, ears, throat, neck, cardiac, lung, and abdominal examinations are normal. Visualization of the perineum shows no lesions or masses. Speculum examination shows a red mass at the os. On taking a Pap smear the mass bleeds easily. Bimanual examination shows no cervical motion tenderness and both ovaries are palpated and nontender. What is the most likely diagnosis for the abnormality of her cervix?

Correct Answer: C

Rationale: Given the patient's history and presentation, the most likely diagnosis for the abnormality seen on examination is a cervical polyp. Cervical polyps are benign growths that arise from the mucosal surface of the cervix. They are typically red or purple in color and can bleed easily, especially when touched, as in this case with the Pap smear causing bleeding. Cervical polyps are usually asymptomatic but can present with painless bleeding, particularly after intercourse. In this patient, the visualization of a red mass at the os during speculum examination and the finding of bleeding with manipulation support the diagnosis of a cervical polyp. Additionally, the absence of other significant findings on examination and the patient's overall healthy appearance further support this benign diagnosis. Further evaluation with possible removal of the polyp may be warranted for confirmation and to alleviate the bleeding symptoms.

Question 8 of 9

His abdominal examination is normal. Visualization of the anus shows no masses, inflammation, or fissures. Digital rectal examination reveals a warm, boggy, tender prostate. No discrete masses are felt and there is no blood on the glove. The scrotum and penis appear normal. Urinalysis shows moderate amounts of white blood cells and bacteria. What disorder of the anus, prostate, or rectum best describes this situation?

Correct Answer: B

Rationale: Prostatitis is the most likely disorder based on the symptoms described. The warm, boggy, tender prostate upon digital rectal examination, along with the presence of moderate white blood cells and bacteria in the urinalysis, suggests an inflammatory condition of the prostate. In this case, there are no signs of masses or blood in the rectal examination, which would be more indicative of prostate cancer. Epididymitis typically presents with symptoms involving the scrotum and may be associated with testicular pain and swelling, which are not described in this scenario. Benign prostatic hyperplasia (BPH) is a nonmalignant enlargement of the prostate gland that typically presents with symptoms of urinary urgency, frequency, and nocturia, rather than the inflammatory signs seen in this case.

Question 9 of 9

A 58-year-old teacher presents to your clinic with a complaint of breathlessness with activity. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems?

Correct Answer: B

Rationale: Orthopnea is a symptom characterized by difficulty breathing while lying flat that improves when sitting or standing upright. This symptom is specifically related to cardiovascular conditions, such as heart failure, in which fluid accumulates in the lungs when lying down. Considering the patient's complaint of breathlessness with activity and the need to assess for cardiovascular issues, asking about orthopnea would be most appropriate to gain insights into potential heart-related causes of the symptoms. Abdominal pain (A), hematochezia (C), and tenesmus (D) are not typically associated with cardiovascular conditions and are less relevant to the patient's presentation.

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