Jason is a 41-year-old electrician who presents to the clinic for evaluation of shortness of breath. The shortness of breath occurs with exertion and improves with rest. It has been going on for several months and initially occurred only a couple of times a day with strenuous exertion; however, it has started to occur with minimal exertion and is happening more than a dozen times per day. The shortness of breath lasts for less than 5 minutes at a time. He has no cough, chest pressure, chest pain, swelling in his feet, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. Which of the following symptom attributes was not addressed in this description?

Correct Answer: A

Rationale: While the description provides information about the duration, frequency, onset, and relieving factors of Jason's shortness of breath, it does not mention the severity of the symptom. Severity refers to the intensity or degree of the symptom, such as mild, moderate, or severe. In this case, we do not have information about how Jason would rate the severity of his shortness of breath. It can be an important attribute to consider when assessing the impact of the symptom on the individual's quality of life and the potential urgency of intervention.

Correct Answer: A

Rationale: The raised, dark red rash that does not blanch when pressed on, typically known as erythema nodosum, is a common skin manifestation of systemic lupus erythematosus (SLE). Given Mrs. Hill's history of SLE, it is likely that her rash is related to her autoimmune condition rather than an exposure to a chemical or an allergic reaction. It is important for her to discuss this new symptom with her healthcare provider to ensure appropriate management and monitoring of her lupus.

Correct Answer: D

Rationale: HPV (human papillomavirus) infection is a very common sexually transmitted infection (STI) that can affect both men and women. It is the most common STI in the United States. While most cases of HPV infection are asymptomatic and resolve on their own, certain high-risk strains of HPV can lead to the development of various cancers, including cervical cancer. Therefore, HPV infections do cause a small but important number of cervical cancers, making option D the correct choice. Regular screening, such as Pap smears and HPV testing, are crucial for early detection and effective management of HPV-related abnormalities that could progress to cervical cancer.

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.

Correct Answer: A

Rationale: According to American Cancer Society recommendations, a woman should undergo a screening breast examination by a skilled clinician every year. Regular breast exams help in early detection of breast cancer, which can significantly improve outcomes and treatment options. Annual screenings are crucial in monitoring changes in breast health and detecting any abnormalities at the earliest stage possible. Therefore, it is advised that women follow this guideline to prioritize their breast health and well-being.

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.

Correct Answer: D

Rationale: The group of lymph nodes that lie just behind the sternocleidomastoid muscles bilaterally are known as the posterior cervical lymph nodes. These lymph nodes are part of the superficial cervical lymph node chain, which is involved in draining lymph from the head and neck region. In the case described, the presence of sore throat, fever, and enlarged tonsils with exudates suggests a likely upper respiratory tract infection or tonsillitis, leading to the enlargement of the nearby lymph nodes. The posterior cervical lymph nodes are commonly examined in cases of upper respiratory infections and tonsillitis due to their proximity to the area of infection and inflammation.

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.

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.