Glaucoma is the leading cause of blindness in African Americans and the second leading cause of blindness overall. What features would be noted on funduscopic examination?

Correct Answer: A

Rationale: Glaucoma is a progressive optic neuropathy characterized by changes to the optic nerve head. One of the hallmark features seen on funduscopic examination in glaucoma is an increased cup-to-disc ratio. This refers to the ratio of the size of the optic cup (depression in the center of the optic nerve head) to the size of the optic disc (the pinkish-orange area around the cup). In glaucoma, there is typically an enlargement of the cup relative to the disc due to damage of the retinal ganglion cell axons. This change is often associated with thinning of the neuroretinal rim and loss of nerve fibers.

Correct Answer: D

Rationale: When assessing a patient for peripheral vascular disease in the arms, it is important to examine the pulses in the upper extremities. The pulses to be assessed in this context include the radial pulse (located on the wrist at the base of the thumb) and the brachial pulse (located in the upper arm near the elbow). These pulses provide important information about blood flow and circulation in the arms. Changes in the strength, regularity, or absence of these pulses can indicate potential issues related to peripheral vascular disease. While the femoral and popliteal pulses (Choice A) are important for assessing the lower extremities, and the dorsalis pedis and posterior tibial pulses (Choice B) are also crucial for evaluating peripheral vascular disease in the legs, the radial and brachial pulses are specifically relevant for assessing the arms. The carotid pulse (Choice C) is important for evaluating the vascular status of

Correct Answer: C

Rationale: The clinical presentation described in the case, including recurrent episodes of dizziness, nausea with vomiting, tinnitus, nystagmus, and normal gait, is suggestive of Menière's disease. Menière's disease is a disorder of the inner ear characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and aural fullness. The presence of tinnitus, episodic vertigo lasting for several hours, and nystagmus are key features that point towards Menière's disease. The Weber test result (localization to the right ear) can also be seen in Menière's disease due to sensorineural hearing loss in the affected ear. This set of symptoms and findings is more consistent with Menière's disease than the other options provided. Benign paroxysmal positional vertigo (BPPV) typically presents with brief episodes of vertigo triggered by changes in

Correct Answer: B

Rationale: The description provided, "It is accompanied by nausea and vomiting. It is located in the mid-epigastric area," indicates the current symptoms and location of the discomfort the patient is experiencing. This information is typically included in the Present Illness section of a medical history, which focuses on the patient's current health concerns, symptoms, and complaints. It helps the healthcare provider understand the nature of the problem and guide further evaluation and treatment. The Chief Complaint is usually a concise statement of the patient's main reason for seeking medical attention, the Personal and Social History includes information about the patient's lifestyle habits and social support, and the Review of Systems is a systematic inquiry about the patient's overall health.

Correct Answer: D

Rationale: In this patient with bilateral back pain that awakens him at night, the most reassuring finding is that the pain is bilateral. Bilateral symptoms are less likely to be associated with red flags such as malignancy or infection compared to unilateral symptoms. While back pain in individuals over the age of 50, pain at night, and pain lasting more than 1 month are concerning features, the fact that the pain in this patient is bilateral provides some reassurance. However, further evaluation is still warranted to determine the exact cause of the pain and appropriate management.

Correct Answer: D

Rationale: Inguinal hernias are common types of hernias that occur in the groin area. When a person strains, the hernia may become more noticeable as the abdominal contents push through a weak spot in the abdominal wall. The absence of symmetry of the inguinal areas with straining indicates that there is a hernia present, as the bulge or protrusion in the groin area becomes more prominent with straining. This makes a hernia more likely in this case. Therefore, option D is the correct choice in this scenario. The other options do not directly point to the presence of a hernia.

Correct Answer: A

Rationale: The carotid pulse is typically palpable, meaning that you can feel it when you place your fingers lightly on the carotid artery located in the neck. In contrast, jugular venous pulsation is not typically palpable. When examining jugular venous pulsation, it is important to differentiate it from the carotid pulse by considering factors such as the quality of pulsation, response to pressure, and changes with position.

Correct Answer: C

Rationale: The most likely pathologic process in this scenario is degenerative. The history provided includes chronic intermittent neck pain that worsened after a specific activity (wallpapering) but resolved with rest. The patient's age (47 years old) is also suggestive of degenerative changes in the spine. Additionally, the use of over-the-counter medications to manage the pain points towards a chronic condition such as degenerative changes in the cervical spine, possibly cervical spondylosis or osteoarthritis. There is no mention of any infectious symptoms, trauma, or neoplastic features in the presentation.

Correct Answer: D

Rationale: Blood pressure is not typically included in the initial assessment during the General Survey. The General Survey primarily focuses on obtaining an overall impression of the patient's health status and any noticeable cues such as level of consciousness, signs of distress, and appearance including dress, grooming, and personal hygiene. While blood pressure is an important vital sign to assess during a comprehensive examination, it is usually measured later in the assessment process and not part of the initial general observation.