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: By telling the patient what to expect, giving her the option to stop or take a break, and checking in with her multiple times during the examination, you are accomplishing all of the above.

Correct Answer: C

Rationale: The information provided, specifically about the patient having three cesarean sections, is most appropriate to be placed under the Obstetrics/gynecology category. This category focuses on the healthcare of women, particularly during pregnancy, childbirth, and postpartum period, which includes details about cesarean sections. This information is not related to adult illnesses, surgeries in general, or psychiatric conditions.

Correct Answer: D

Rationale: The presence of a palpable pulsatile abdominal mass in a patient like Mr. Martin, who is a smoker and at risk for vascular diseases, is concerning for an abdominal aortic aneurysm (AAA). Immediate referral to a vascular surgeon is essential for further evaluation and management. AAA can be a life-threatening condition if left untreated, as it can lead to rupture and severe internal bleeding. Therefore, prompt specialist evaluation and monitoring are crucial in such cases. Waiting for 3 or 6 months for reevaluation could potentially lead to a delayed diagnosis and increase the risk of complications. Abdominal ultrasound is typically the diagnostic test of choice to confirm the presence and size of the aneurysm.

Correct Answer: C

Rationale: Venous insufficiency is the most likely etiology for the painful ulcerative lesion near the medial malleolus with accompanying hyperpigmentation. Venous insufficiency can lead to the development of venous stasis ulcers, which typically occur on the lower extremities, especially around the ankle area. These ulcers are often painful and associated with swelling, hyperpigmentation, and a weeping or moist wound bed. The location of the ulcer near the medial malleolus is also characteristic of venous insufficiency-related ulcers. Arterial insufficiency would typically present with different clinical findings, such as a pale, cool extremity, decreased pulses, and hair loss. Neuropathic ulcers are usually painless due to the loss of sensation, and trauma would have a different appearance than the described findings.