Diminished radial pulses may be seen in patients with which of the following?

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Question 1 of 9

Diminished radial pulses may be seen in patients with which of the following?

Correct Answer: C

Rationale: Diminished radial pulses may be seen in patients with arterial emboli. Arterial emboli are blood clots that travel through the bloodstream and get lodged in a blood vessel, blocking blood flow to a certain area. When an embolus affects the arteries supplying the arm, it can lead to diminished pulses in the affected arm, such as the radial pulse in the wrist. This diminished pulse is due to decreased blood flow to the area beyond the blockage caused by the embolus. This distinguishes arterial emboli from the other options listed, as aortic insufficiency, hyperthyroidism, and early "warm" septic shock typically do not cause isolated diminished radial pulses.

Question 2 of 9

When you enter your patient's examination room, his wife is waiting there with him. Which of the following is most appropriate?

Correct Answer: A

Rationale: The most appropriate action in this situation is to ask the patient if it's okay to carry out the visit with both people in the room. This shows respect for the patient's autonomy and privacy. Some patients may feel more comfortable discussing personal information without a family member present, while others may prefer having their spouse or family member involved in the conversation. By asking for the patient's preference, you are ensuring that they have the opportunity to control who is present during the consultation and are upholding their right to confidentiality.

Question 3 of 9

A 68-year-old mechanic presents to the emergency room for shortness of breath. You are concerned about a cardiac cause and measure his jugular venous pressure (JVP). It is elevated. Which one of the following conditions is a potential cause of elevated JVP?

Correct Answer: C

Rationale: Constrictive pericarditis is a condition where the pericardium becomes thickened and rigid, impairing diastolic filling of the heart. This leads to an increase in venous pressure, including the jugular venous pressure (JVP). The elevated JVP in constrictive pericarditis is a result of impaired ventricular filling rather than forward failure seen in heart failure. Mitral stenosis can lead to an increased JVP due to elevated left atrial pressure, but constrictive pericarditis is a more common cause of elevated JVP in this scenario. Aortic aneurysm is not typically associated with elevated JVP.

Question 4 of 9

When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?

Correct Answer: A

Rationale: When crackles, wheezes, or rhonchi clear with a cough, it is suggestive of bronchitis. Bronchitis is inflammation of the bronchial tubes, often due to a viral infection, leading to the production of excess mucus. The characteristic sounds such as crackles, wheezes, or rhonchi can be heard on auscultation due to the presence of mucus in the airways. The act of coughing helps to clear the mucus from the airways, resulting in the temporary resolution of these abnormal sounds. In contrast, asthma, cystic fibrosis, and heart failure are not typically associated with crackles, wheezes, or rhonchi that clear with a cough.

Question 5 of 9

Very sensitive methods for detecting hearing loss include which of the following?

Correct Answer: D

Rationale: Audiometric testing is a very sensitive method for detecting hearing loss. It involves a series of tests that measure a person's ability to hear sounds at various frequencies and volumes. These tests can detect even subtle changes in hearing ability and provide detailed information on the type and degree of hearing loss. The whisper test and finger rub test are basic screening tests and are not as sensitive or comprehensive as audiometric testing. The tuning fork test is also used in evaluating hearing loss, but it is not as accurate or sensitive as audiometric testing. Overall, audiometric testing is considered the gold standard for diagnosing hearing loss due to its high sensitivity and ability to provide detailed information on the individual's hearing capabilities.

Question 6 of 9

With auscultation she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination the S and S are distant and an S is heard over the apex. 1 2 3 What disorder of the chest best describes her symptoms?

Correct Answer: D

Rationale: The given symptoms of distant air sounds, late inspiratory crackles in both lower lobes, distant S1 and S2 heart sounds, and an S3 heart sound heard over the apex are all characteristic findings of left-sided heart failure. Distant air sounds and late inspiratory crackles indicate pulmonary congestion due to fluid accumulation in the lungs as a result of left-sided heart failure. The distant heart sounds and presence of an S3 are signs of left ventricular dysfunction. In contrast, pneumonia would typically present with more localized abnormal breath sounds and other symptoms such as fever and productive cough. Chronic obstructive pulmonary disease (COPD) would manifest with prolonged expiratory phase and wheezing, not late inspiratory crackles. Pleural pain is typically associated with sharp chest pain exacerbated by breathing movements, and it does not explain the constellation of symptoms described in this case. Therefore, the most likely diagnosis based on the provided symptoms

Question 7 of 9

A 19-year-old college sophomore comes to the clinic for evaluation of joint pains. The student has been back from spring break for 2 weeks; during her holiday, she went camping. She notes that she had a red spot, shaped like a target, but then it started spreading, and then the joint pains started. She used insect repellant but was in an area known to have ticks. She has never been sick and takes no medications routinely; she has never been sexually active. What is the most likely cause of her joint pain?

Correct Answer: D

Rationale: The most likely cause of the 19-year-old college sophomore's joint pain is Lyme disease. The presentation of a red spot shaped like a target (erythema migrans) that spreads, along with joint pain, is classic for Lyme disease. Additionally, the history of camping in an area known to have ticks and the history of using insect repellent support the likelihood of a tick-borne illness like Lyme disease.

Question 8 of 9

On visualization of the penis he is circumcised and there are no lesions and no discharge from the meatus. His scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the patient begins to cry. His prostate examination is unremarkable. His cremasteric reflex is absent on the left but is normal on the right. By catheter you get a urine sample and the analysis is unremarkable. You send the boy with his mother to the emergency room for further workup. What is the most likely diagnosis for this young man's symptoms?

Correct Answer: C

Rationale: The presentation of severe testicular pain with a red, tense scrotum, and absent cremasteric reflex on one side is highly concerning for testicular torsion. Testicular torsion is a urologic emergency that occurs when the spermatic cord twists, leading to compromised blood flow to the testicle. The affected testicle can become ischemic and necrotic within hours, necessitating prompt diagnosis and intervention to avoid permanent damage or loss of the testicle.

Question 9 of 9

Diminished radial pulses may be seen in patients with which of the following?

Correct Answer: C

Rationale: Diminished radial pulses may be seen in patients with arterial emboli. Arterial emboli are blood clots that travel through the bloodstream and get lodged in a blood vessel, blocking blood flow to a certain area. When an embolus affects the arteries supplying the arm, it can lead to diminished pulses in the affected arm, such as the radial pulse in the wrist. This diminished pulse is due to decreased blood flow to the area beyond the blockage caused by the embolus. This distinguishes arterial emboli from the other options listed, as aortic insufficiency, hyperthyroidism, and early "warm" septic shock typically do not cause isolated diminished radial pulses.

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