Bill, a 55-year-old man, presents with pain in his epigastrium which lasts for 30 minutes or more at a time and has started recently. Which of the following should be considered?

Correct Answer: D

Rationale: The correct answer is D: All of the above. 1. Epigastric pain lasting 30+ minutes suggests a serious condition. 2. Peptic ulcer: Common cause of epigastric pain, especially if worsened by food. 3. Pancreatitis: Presents with severe epigastric pain that may radiate to the back. 4. Myocardial ischemia: Can manifest as epigastric discomfort, especially in older individuals. Summary: All choices are valid considerations due to the severity and location of the pain, making D the correct answer.

Correct Answer: C

Rationale: The correct answer is C: Obesity. Obesity is a significant risk factor for cerebrovascular accidents (CVAs) due to its association with hypertension, diabetes, and dyslipidemia, all of which increase the risk of stroke. Excess weight can lead to inflammation, endothelial dysfunction, and atherosclerosis, contributing to the development of CVAs. The other choices are incorrect because: A: Caucasian race is not a direct risk factor for CVA. Risk factors are based on individual health conditions rather than race. B: Female sex alone is not a risk factor for CVA. However, certain conditions more prevalent in females, such as migraine headaches or hormonal factors, could contribute to CVA risk. D: While bronchial asthma may lead to decreased oxygen supply and potentially increase stroke risk, it is not considered a major risk factor compared to obesity.

Correct Answer: B

Rationale: The correct answer is B: Affect is flat, with periods of emotional lability. This is because the limbic system is responsible for regulating emotions and behavior. A deficit in this area can lead to flat affect (lack of emotional expression) and emotional lability (rapid changes in emotions). A: Disorientation to person, place, and time is more indicative of a deficit in cognitive function, commonly associated with the temporal lobe rather than the limbic system. C: Difficulty recalling recent events like what was eaten for breakfast is related to memory impairment, typically associated with the hippocampus rather than the limbic system. D: Inability to perform tasks like adding and subtracting or knowing the current president is more related to executive functioning and memory, associated with the frontal lobe rather than the limbic system. In summary, the correct answer is B because it directly relates to the emotional and behavioral aspects affected by deficits in the limbic system, while the other choices are more

Correct Answer: A

Rationale: The correct answer is A: Serum albumin. Serum albumin is the most reliable indicator of long-term nutritional status because it has a longer half-life compared to other lab values, reflecting protein intake over a longer period. Low serum albumin levels indicate chronic malnutrition. B: Serum potassium is not a reliable indicator of long-term nutritional status. C: Hematocrit reflects hydration status and can be influenced by factors other than nutrition. D: Blood glucose levels can fluctuate throughout the day and are not specific to long-term nutritional status.

Correct Answer: A

Rationale: The correct answer is A. A mole with an asymmetrical shape is concerning for melanoma, a potentially deadly skin cancer. Asymmetry is a key characteristic of melanoma, warranting immediate attention for further evaluation and possible biopsy. B is incorrect as dry skin on the elbows is a common benign condition. C is incorrect as a small, round, and brown lesion is likely a benign mole or freckle. D is incorrect as faint, white striae are typically stretch marks and not urgent. In summary, the asymmetrical shape of a mole is alarming due to its association with melanoma, making it the finding requiring immediate attention.