Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate?

Correct Answer: B

Rationale: Step 1: Dullness in the last intercostal space in the anterior axillary line on the left side suggests possible splenomegaly. Step 2: The dullness indicates an abnormality in that area and warrants further examination to confirm the presence of an enlarged spleen. Step 3: Option B is correct as it acknowledges the possibility of splenomegaly and emphasizes the need for close attention to further examination. Step 4: Options A and C are incorrect as they assert the presence of an enlarged spleen without confirming it, leading to unnecessary workup. Step 5: Option D is incorrect as it definitively states the spleen is normal, which contradicts the physical examination findings.

Correct Answer: B

Rationale: The correct answer is B: Firmness over the left upper quadrant. This finding is abnormal as the left upper quadrant should normally be soft on palpation. Firmness could indicate an underlying issue such as organ enlargement or inflammation. A: Soft, non-tender abdomen is normal. C: Generalized tympany on percussion is also normal as it indicates air-filled intestines. D: No palpable masses is a normal finding as well. Therefore, B is the correct answer as it deviates from the expected normal abdominal palpation findings.

Correct Answer: C

Rationale: The correct answer is C: Crackles in the lungs. Left-sided heart failure typically results in fluid buildup in the lungs, leading to crackles upon auscultation. This occurs due to the impaired ability of the left side of the heart to adequately pump blood, causing fluid to leak into the lungs. Peripheral edema (A) is more indicative of right-sided heart failure, where blood backs up in the systemic circulation. Jugular vein distension (B) is a sign of increased central venous pressure, often seen in right-sided heart failure. Ascites (D) is the accumulation of fluid in the abdominal cavity and is more commonly associated with liver or kidney disease rather than heart failure.

Correct Answer: B

Rationale: The correct answer is B: Transfer to radiology for a CT scan. This is the first collaborative intervention to implement because the patient's history of falling down the stairs a month ago with subsequent absence of visible injuries raises concern for possible head trauma. The acute lethargy, confusion, and incontinence could be indicative of a traumatic brain injury or intracranial bleeding. A CT scan is crucial to assess for any structural brain abnormalities that may require immediate intervention. Choice A: Placing on the hospital alcohol withdrawal protocol is not the first priority as the patient's symptoms are more suggestive of a potential head injury rather than alcohol withdrawal. Choice C: Inserting a retention catheter to straight drainage may be necessary for managing incontinence, but it does not address the primary concern of assessing for potential head trauma. Choice D: Giving phenytoin (Dilantin) 100 mg PO is not appropriate as the patient's symptoms are not necessarily indicative of seizures and administering ant

Correct Answer: A

Rationale: Step-by-step rationale for why option A is correct: 1. Optic nerve (CN II) is responsible for vision. 2. Testing visual acuity assesses the sharpness of vision. 3. Testing visual fields evaluates peripheral vision. 4. Both tests specifically assess the function of the optic nerve. 5. Assessing pupil response to light (B) tests CN III, CN IV, and CN VI. Eye movements (C) test CN III, IV, and VI. Testing hearing ability (D) involves CN VIII, the vestibulocochlear nerve.