An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is concerned because an aunt had severe osteoporosis. Which of the following is a risk factor for osteoporosis?

Correct Answer: C

Rationale: Family history of osteoporosis is a significant risk factor, as genetics play a key role in determining a person's risk for developing osteoporosis. Having a close relative, such as an aunt, with severe osteoporosis increases this woman's risk as there is a strong genetic component to the disease. Factors such as obesity (choice A), late menopause (choice B), and delayed menarche (choice D) do not directly increase the risk of osteoporosis, unlike having a familial history of the condition.

Correct Answer: B

Rationale: The information provided - "The patient had a stent placed in the left anterior descending artery (LAD)" - is related to a medical procedure, specifically a surgical intervention involving the placement of a stent in a coronary artery. This information falls under the category of surgeries because it describes a surgical treatment to address a cardiovascular issue. It does not pertain to adult illnesses, obstetrics/gynecology, or psychiatric conditions, making option B the most appropriate category for this information.

Correct Answer: B

Rationale: Paraphimosis is a condition where the foreskin is retracted behind the glans penis and cannot be returned to its original position. This can lead to swelling and constriction of the penis, causing pain and potential damage to the tissue due to decreased blood flow. Phimosis (Choice A) refers to a tight prepuce that cannot be retracted over the glans penis. Balanitis (Choice C) is inflammation of the glans penis, often associated with poor hygiene or infections. Balanoposthitis (Choice D) refers to inflammation of both the glans penis and the foreskin.

Correct Answer: B

Rationale: The clinical presentation described in the question is consistent with Candida vaginitis, also known as vaginal yeast infection. Candida vaginitis typically presents with a thick, white, curdy discharge that can be visualized on examination. The low pH of 1 is characteristic of Candida infection. The negative KOH whiff test and absence of an unusual smell help differentiate Candida vaginitis from other types of vaginitis.

Correct Answer: B

Rationale: When using an interpreter to facilitate an interview, it is recommended that the interpreter be positioned next to the patient. This allows the examiner to maintain eye contact with the patient and observe their nonverbal cues, while also being able to hear the interpreter clearly. Placing the interpreter between the examiner and the patient may create a barrier to communication and make it difficult for all parties to observe each other's expressions and body language. Having the interpreter behind the examiner could make it challenging to fully see the patient's lips and nonverbal cues, which are essential in communication. Placing the interpreter in a corner of the room may also lead to decreased engagement and interaction among the participants. Therefore, positioning the interpreter next to the patient provides the most effective communication flow and allows for better observation and understanding during the interview.

Correct Answer: C

Rationale: The next step would be to discuss the physical therapy plan with Mr. Larson. It is important to communicate openly with him, explain the recommendation for physical therapy, and ensure that he understands and agrees with the plan before proceeding further. This allows for any questions or concerns to be addressed, and ensures that the treatment plan is tailored to his needs and preferences. By discussing the plan with Mr. Larson first, you can also provide him with the opportunity to ask any questions and actively involve him in his own care, which can lead to better compliance and outcomes.

Correct Answer: C

Rationale: Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, and multiple tender points on palpation, especially in the neck, shoulders, back, and hips. The patient's symptoms of widespread pain and tenderness at specific points on the muscles without arthritis, joint swelling, or limitation in range of motion are consistent with fibromyalgia. Fibromyalgia is often associated with poor sleep quality, morning stiffness, and fatigue, which the patient in the case provided experiences. Other conditions like rheumatoid arthritis, osteoarthritis, or polymyalgia rheumatica would typically present differently with specific joint involvement, swelling, and additional systemic symptoms, which are not seen in this patient.

Correct Answer: D

Rationale: Chronic arterial insufficiency results in poor blood flow to the lower extremities. This leads to inadequate oxygen and nutrient supply to the tissues, causing damage and changes in the skin. A common physical examination finding in chronic arterial insufficiency is thin, shiny, atrophic skin. The skin may appear pale, cool to the touch, and may have decreased hair growth. It is important to note that other findings such as diminished or absent pulses and reduced temperatures may also be present with chronic arterial insufficiency.

Correct Answer: A

Rationale: Inspiratory splitting of S occurs due to the normal physiological delay in the closure of the aortic and pulmonic valves during inspiration. During inspiration, the negative intrathoracic pressure leads to increased venous return to the right side of the heart, causing a slight delay in the closure of the pulmonic valve. This results in the aortic valve closing first, followed by the closure of the pulmonic valve, leading to the splitting of S during inspiration.