Guidelines for the primary prevention of stroke recommend that aspirin be used in which one of the following?

Correct Answer: A

Rationale: The correct answer is A because guidelines for primary stroke prevention recommend using aspirin in individuals whose risk of stroke is high enough for the benefits to outweigh the risks. This is based on assessing individual risk factors such as age, hypertension, diabetes, smoking, and history of cardiovascular diseases to determine if the potential benefits of aspirin therapy in reducing the risk of stroke outweigh the potential risks such as gastrointestinal bleeding. Choices B, C, and D are incorrect because aspirin should not be used regardless of risk level, based on gender, or in specific populations without considering individual risk factors to ensure the benefits outweigh the risks.

Correct Answer: B

Rationale: The correct answer is B: Dopamine agonist. In early PD, dopamine agonists are preferred due to their lower risk of motor complications compared to levodopa. Dopamine agonists help improve motor symptoms by directly stimulating dopamine receptors. COMT inhibitors are usually used in combination with levodopa to prolong its effects. Levodopa is effective but can lead to motor complications with long-term use. Careful observation is not a treatment strategy and delays symptom management. Therefore, starting with a dopamine agonist is the most suitable option for early PD to manage symptoms effectively with minimal risk of motor complications.

Correct Answer: B

Rationale: The correct answer is B: 3+. Bounding pulses indicate a 3+ strength on a scale of 0 to 3. This reflects increased blood flow or pressure in the arteries, which can be a sign of conditions like peripheral vascular disease. A strength of 0 indicates no palpable pulse, 1+ is weak and thready, 2+ is normal, and 3+ is bounding. In this case, the patient's history of coronary artery disease and diabetes may contribute to the increased blood flow, leading to bounding pulses. Choices A, C, and D are incorrect as they do not accurately reflect the strength of the pulses based on the given assessment findings.

Correct Answer: C

Rationale: The correct answer is C because clinical diagnosis of anxiety or depression can indeed have an effect on frailty rates. Anxiety and depression can contribute to the development and progression of frailty through various mechanisms such as decreased physical activity, poor nutrition, and social isolation. This can lead to a higher risk of frailty in individuals with mental health issues. Choices A, B, and D are incorrect because both prominent frailty models (e.g., Fried's phenotype model and Rockwood's accumulation of deficits model) do consider age as a component for defining frailty, individuals who are prefrail are at a higher risk of progressing to frailty rather than becoming robust, and frailty diagnosis has been shown to be valuable in preoperative assessment as it helps identify patients who may not do well with surgical interventions.

Correct Answer: B

Rationale: The correct answer is B: Small amplitude, weak. In congestive heart failure, the heart's ability to pump effectively is compromised, leading to decreased cardiac output. This results in a weakened pulse with reduced amplitude. Palpating a small, weak pulse in this patient is expected due to poor cardiac function. Choices A and C are incorrect because a large, forceful pulse is not expected in congestive heart failure, and a normal pulse may not reflect the compromised cardiac function. Choice D, bigeminal, refers to an abnormal rhythm characterized by every other heartbeat being premature and is not typically associated with congestive heart failure.

Correct Answer: D

Rationale: The correct answer is D: It can protect against anogenital lesions. The HPV vaccine can protect against several types of HPV that are known to cause anogenital warts and lesions. This is based on scientific evidence from clinical trials. A: Ideally it should be administered within 3 years of first intercourse - This statement is not accurate. The HPV vaccine is recommended for both males and females between the ages of 9 and 26, regardless of sexual activity. B: It covers against almost every HPV type - This statement is incorrect. While the HPV vaccine covers the most common high-risk HPV types that cause cervical cancer, it does not cover against every HPV type. C: It can be used as adjuvant therapy in cervical cancer - This statement is incorrect. The HPV vaccine is primarily used as a preventive measure to reduce the risk of HPV infection and related health issues, not as a treatment for existing cervical cancer.

Correct Answer: B

Rationale: The correct answer is B: A sebaceous cyst. A sebaceous cyst typically presents as a lump underneath the skin that can be squeezed to release a cheesy substance, consistent with Jacob's description. The formation of a prominent dimple when gently pinched is characteristic of a cyst, indicating it is filled with fluid or semi-solid material. Sebaceous cysts are usually benign and can grow slowly over time. Incorrect choices: A: An enlarged lymph node - Unlikely as lymph nodes are typically not associated with cheesy discharge or the formation of a dimple when pinched. C: An actinic keratosis - Unlikely as actinic keratosis is a precancerous skin condition caused by sun exposure, not presenting with cheesy discharge or a dimple. D: A malignant lesion - Unlikely as malignant lesions usually do not produce cheesy discharge and are more aggressive in growth compared to a sebaceous cyst.

Correct Answer: C

Rationale: The correct answer is C. During the secondary stage of syphilis, a rash marked by red or reddish-brown, penny-sized lesions over the palms and soles is a common clinical manifestation. This rash, known as a syphilitic rash, is a hallmark symptom of secondary syphilis. The rash can also appear on other parts of the body. It is important to note that syphilis progresses through distinct stages, and the secondary stage typically occurs a few weeks to a few months after the initial infection. Now, let's analyze why the other choices are incorrect: A: Absence of symptoms - This is incorrect as syphilis does present symptoms, especially during the secondary stage. B: Single painless lesion, chancre on the genital area - This is characteristic of the primary stage of syphilis, not the secondary stage. D: Poor muscle coordination - This symptom is associated with the late or tertiary stage of syphilis, not the secondary stage

Correct Answer: A

Rationale: The correct answer is A because dopamine, serotonin, and norepinephrine are neurotransmitters commonly associated with mood regulation. Medications that affect these neurotransmitters can lead to symptoms of depression as a side effect. B: Gabapentin is not primarily associated with mood regulation. C: Milnacipran is an SNRI used to treat depression, not cause it. D: Cortisol is a stress hormone, not a neurotransmitter directly linked to depression symptoms.