Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?

Correct Answer: B

Rationale: Given the information provided about Jim's recent separation from his wife after a long marriage, coupled with the fact that he still experiences early morning erections, the likely cause for his sexual function difficulties is psychological issues. Separation, divorce, or relationship problems can have a significant impact on a person's sexual function due to emotional stress, anxiety, depression, or other mental health issues. In Jim's case, the presence of early morning erections suggests that there may not be a physiological issue like decreased testosterone levels, abnormal circulation, or impaired neural innervation. Instead, the situation seems more related to his emotional state and psychological well-being following the separation. It would be advisable for Jim to seek counseling or therapy to address these psychological factors affecting his sexual function.

Correct Answer: D

Rationale: The description provided indicates a presentation consistent with gonococcal arthritis. Gonococcal arthritis is an infectious arthritis caused by the bacteria Neisseria gonorrhoeae. Symptoms typically include red, swollen, and painful joints, especially affecting the distal joints of the limbs. The presence of papules, pustules, and vesicles on reddened bases at the distal extremities is characteristic of disseminated gonococcal infection. In women, the DIP joint involvement in the finger can be indicative of this condition. Prompt diagnosis and treatment with antibiotics are essential to prevent complications associated with gonococcal arthritis. It is important to consider a sexually transmitted infection like gonorrhea in young patients presenting with joint symptoms and cutaneous findings.

Correct Answer: C

Rationale: The symptoms described, including decreased air movement, high-pitched whistling (wheezing) on expiration in all lobes, and resonant lungs on percussion, are characteristic findings of asthma. Asthma is a chronic respiratory condition characterized by airway inflammation, bronchoconstriction, and increased mucus production, leading to symptoms like wheezing, shortness of breath, chest tightness, and cough. The presence of wheezing, particularly on expiration, is a classic sign of asthma. In contrast, spontaneous pneumothorax would typically present with sudden chest pain and shortness of breath, accompanied by hyperresonant percussion notes due to trapped air in the pleural space. COPD, a chronic lung condition characterized by progressive airflow limitation, would often present with symptoms such as chronic cough, sputum production, and dyspnea on exertion. Pneumonia is an infection of the lung tissue,

Correct Answer: B

Rationale: The patient described is most likely suffering from an external hemorrhoid. External hemorrhoids are swollen veins located near the opening of the anus, often resulting from increased pressure in the rectal area. The presence of a swollen bluish ovoid mass containing a blood clot is characteristic of an external hemorrhoid. The pain experienced during digital rectal examination further supports this diagnosis, as external hemorrhoids are typically painful when touched. In this case, there are no palpable masses within the anus or rectum, ruling out anorectal cancer or internal hemorrhoids. Anal fissures are small tears in the lining of the anus, which would present differently from the described swollen mass with a blood clot.

Correct Answer: D

Rationale: A subconjunctival hemorrhage is a common and benign condition characterized by blood in the space between the conjunctiva and sclera of the eye. The condition often presents as a painless, sharply demarcated area of redness on the white part of the eye, typically without associated discharge or visual disturbances. In this case, the absence of eye pain, discharge, visual disturbances, and clear cornea make subconjunctival hemorrhage the most likely diagnosis. The history of forceful coughing with a recent cold is also consistent with the increased intraocular pressure leading to a rupture of a small blood vessel, resulting in the hemorrhage. Treatment is not usually required as the condition is self-limiting and resolves on its own over time.

Correct Answer: B

Rationale: Even after a unilateral mastectomy, women should continue to self-examine and have regular clinical examinations for any signs of recurrence or new masses. It is important to closely monitor the surgical scar area for any changes or abnormalities, as breast cancer can still occur in the remaining breast tissue. Regular breast examinations remain important in the early detection of any potential issues, even after mastectomy.

Correct Answer: B

Rationale: The description of dark, granular material resembling coffee grounds in the vomitus suggests upper gastrointestinal bleeding. One common cause of upper GI bleeding is a peptic ulcer, which can present with symptoms such as vomiting blood or coffee ground material. Peptic ulcers can develop in the stomach or the upper part of the small intestine (duodenum). Risk factors for peptic ulcers include infection with Helicobacter pylori bacteria, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, and alcohol consumption. Prompt evaluation and management are necessary in cases of upper GI bleeding to address the underlying cause and prevent complications.

Correct Answer: C

Rationale: The young woman in this scenario is experiencing symptoms consistent with post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder that can develop after a person is exposed to a traumatic event, such as a life-threatening situation like a robbery with a gun involved. The symptoms she is experiencing, including difficulty sleeping, severe nightmares, irritability, hypervigilance, and avoidance of triggers such as driving at night, are all classic features of PTSD. These symptoms have persisted for at least 6 months since the traumatic event occurred, which is a key criterion for making a diagnosis of PTSD. Treatment for PTSD typically involves a combination of medication and therapy to help the individual process and cope with the traumatic experience.

Correct Answer: B

Rationale: Given the information provided about Jim's recent separation from his wife after a long marriage, coupled with the fact that he still experiences early morning erections, the likely cause for his sexual function difficulties is psychological issues. Separation, divorce, or relationship problems can have a significant impact on a person's sexual function due to emotional stress, anxiety, depression, or other mental health issues. In Jim's case, the presence of early morning erections suggests that there may not be a physiological issue like decreased testosterone levels, abnormal circulation, or impaired neural innervation. Instead, the situation seems more related to his emotional state and psychological well-being following the separation. It would be advisable for Jim to seek counseling or therapy to address these psychological factors affecting his sexual function.