Correct Answer: C

Rationale: To determine whether a murmur is systolic or diastolic, you should judge the relative length of systole and diastole by auscultation. Systolic murmurs occur during systole, which is the phase of the cardiac cycle when the heart is contracting and pushing blood out of the chambers. Diastolic murmurs occur during diastole, which is the phase when the heart is relaxing and filling with blood. By carefully listening to the timing of the murmur in relation to the cardiac cycle, you can determine if it is systolic or diastolic. Palpating the carotid pulse (Choice A) or radial pulse (Choice B) can help assess the pulse characteristics, but it does not directly determine whether a murmur is systolic or diastolic. Correlating the murmur with a bedside heart monitor (Choice D) may provide additional information about heart rate or rhythm, but it does not specifically indicate

Correct Answer: A

Rationale: A hyperresonant percussion note is a more intense and booming sound heard during percussion of the thorax. This can occur when there is an increased amount of air present in the chest cavity. In the case of a large pneumothorax, which is the presence of air in the pleural space causing partial or complete collapse of the lung, the percussion note would be hyperresonant due to the increased air content in the thoracic cavity. Lobar pneumonia, pleural effusion, and empyema would typically produce dull or flat percussion notes due to the presence of fluid or solid material in the pleural space.

Correct Answer: D

Rationale: The most likely cause of the woman's symptom of stool leakage despite normal bowel movements is an anorectal fistula. An anorectal fistula is an abnormal, tunnel-like connection between the anal canal or rectum and the skin around the anus. In this case, the small opening anterior to the anus with surrounding erythema on examination suggests the presence of a fistula.

Correct Answer: C

Rationale: Diplopia occurring when one eye is covered is a condition known as monocular diplopia. This symptom is typically not caused by problems within the eye itself, such as irregularities in the cornea or lens. Instead, monocular diplopia with one eye covered is more likely to be an indication of a neurological issue, often involving the brainstem. Lesions or damage in the brainstem can disrupt the normal coordination of eye movements, leading to the perception of double vision when one eye is closed. Weakness of CN III (oculomotor nerve) or CN IV (trochlear nerve) may cause diplopia when both eyes are open, but it would not typically manifest as monocular diplopia.

Correct Answer: C

Rationale: Splitting of the second heart sound is when the aortic and pulmonic valves close at slightly different times, resulting in two distinct components to the sound. This split is best heard over the apex of the heart, typically with the diaphragm of the stethoscope. The aortic component is heard first and represents closure of the aortic valve, followed by the pulmonic component, representing closure of the pulmonic valve. The split can narrow during inspiration and widen during expiration, which is important to keep in mind during assessment.