In obtaining a history, you note that a patient uses the word "largely" repeatedly, to the point of being a distraction to your task. Which word best describes this speech pattern?

Correct Answer: D

Rationale: Perseveration is a speech pattern characterized by repeating a particular word, phrase, or topic excessively, even when it is no longer relevant to the conversation. In this scenario, the patient's repetitive use of the word "largely" to the point of distraction is indicative of perseveration. This can be a symptom of various neurological or psychiatric conditions, highlighting the importance of recognizing and addressing this speech pattern during the patient interview.

Correct Answer: D

Rationale: When a woman over the age of 40 presents with a breast mass, the risk of the mass being cancerous is around 40%. This risk is higher in older women compared to younger women. It is important for Mrs. Patton to undergo further evaluation, which may include imaging tests, a biopsy, and consultation with a specialist to confirm the diagnosis and determine the appropriate treatment. It is crucial to address breast masses promptly to ensure timely management and optimal outcomes.

Correct Answer: D

Rationale: The presence of late inspiratory crackles in the lower third of the chest that were not present previously is suggestive of pulmonary edema, a common finding in patients with heart failure. Heart failure can lead to fluid accumulation in the lungs, causing crackles on auscultation. These crackles are typically heard at the lung bases and can be more prominent during inspiration. Other clinical features of heart failure may include orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema, and fatigue. Therefore, in this case, the most likely explanation for the patient's shortness of breath with late inspiratory crackles is heart failure.

Correct Answer: B

Rationale: The description provided by Alexandra includes information about the location (right upper quadrant), intensity (3 to 8 on a scale), duration (2 to 3 hours), periodicity (coming and going, worse after eating), exacerbating factors (greasy foods), frequency (initially once a week, now every other day), and aggravating factors (nothing makes it better). However, there is no mention of any associated manifestations such as nausea, vomiting, fever, or other symptoms that may be occurring alongside the abdominal pain. Associated manifestations are important for a comprehensive assessment and differential diagnosis of the symptom.

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: 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: 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: 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: Option D, "Psychosocial reasons may cause this condition," is true. Vaginismus is a condition characterized by involuntary contractions of the muscles around the vaginal entrance, which can make sexual intercourse painful, difficult, or impossible. In many cases, this condition is linked with psychological factors such as anxiety, fear, past trauma, or relationship issues. These psychological factors can lead to the muscles tightening up in anticipation of pain or discomfort during intercourse, hence causing vaginismus. With appropriate psychological interventions like counseling, therapy, or relaxation techniques, individuals experiencing vaginismus can often overcome the condition and engage in pain-free intercourse.