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: A

Rationale: It is crucial to keep the patient's torso at a 45-degree angle when measuring the jugular venous pressure (JVP). This position allows the internal jugular vein to partially collapse, ensuring accurate observation of the pulsations. Keeping the patient at a 45-degree angle provides a standardized position for JVP measurement and helps avoid errors in assessment.

Correct Answer: C

Rationale: The most likely explanation for Mrs. Lenzo noticing a 4-pound weight gain over just 2 days is fluctuations in body fluid. Our body weight can fluctuate throughout the day due to factors such as hydration levels, sodium intake, and hormonal changes. It is not physically possible to gain 4 pounds of actual body mass (e.g., fat or muscle) in such a short period of time by overeating or wearing different clothing. Additionally, if Mrs. Lenzo's scale is very accurate as mentioned, it is less likely that the weight gain is due to instrument inaccuracy. Therefore, the most plausible reason for the sudden weight gain is fluctuations in body fluid retention.

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: Ascites is the abnormal accumulation of fluid in the abdominal cavity. When ascites is present, dullness is typically heard on percussion due to the fluid in the abdomen. This dullness does not shift with changes in the patient's position. Therefore, the finding of dullness which remains despite a change in position would argue for the presence of ascites. The other choices (A, C, D) describe findings that are more consistent with gaseous distention rather than ascites.

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: C

Rationale: The young violinist is experiencing symptoms of anxiety specifically related to performing in front of others, which is characteristic of social phobia (also known as social anxiety disorder). The symptoms occur only during performances, indicating the anxiety is triggered by social situations where he is the center of attention. His ability to perform without symptoms during rehearsals or practice sessions further supports the diagnosis of social phobia, as the anxiety is specifically related to public performance. In contrast, panic disorder is characterized by recurrent, unexpected panic attacks that are not situation-specific, and specific phobia involves an intense fear of a specific object or situation, neither of which fully match this patient's presentation. Generalized anxiety disorder involves excessive worry and anxiety about various aspects of life, which is not the main feature of this case.

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 presence of new flat red and purple lesions that are tender on the ulnar aspect of Ms. Whiting's forearms raises concerns and warrants further investigation. Since she did not mention them, it is important to ask how she acquired them to gather more information. This will help determine the cause of the lesions and provide clues to potential underlying conditions or recent activities that could be related to their development. It is important not to dismiss these lesions as old without proper evaluation, as they could indicate a recent injury, infection, or other medical issues that may require attention.