Mark is a contractor who recently injured his back. He was told he had a "bulging disc" to account for the burning pain down his right leg and slight foot drop. The vertebral bodies of the spine involve which type of joint?

Correct Answer: B

Rationale: The vertebral bodies of the spine involve cartilaginous joints. Cartilaginous joints are connected by cartilage, which allows for slight movement and flexibility. In the spine, the cartilaginous joints between vertebral bodies are called intervertebral discs. These discs act as shock absorbers and provide cushioning between each vertebra, helping to prevent bone-on-bone contact. In Mark's case, the presence of a bulging disc suggests that there is an issue with the cartilaginous joint between his vertebral bodies, leading to the compression of a spinal nerve and causing the burning pain down his right leg and slight foot drop.

Correct Answer: C

Rationale: Diplopia occurring when one eye is covered is a condition known as monocular diplopia. This symptom is typically not caused by problems within the eye itself, such as irregularities in the cornea or lens. Instead, monocular diplopia with one eye covered is more likely to be an indication of a neurological issue, often involving the brainstem. Lesions or damage in the brainstem can disrupt the normal coordination of eye movements, leading to the perception of double vision when one eye is closed. Weakness of CN III (oculomotor nerve) or CN IV (trochlear nerve) may cause diplopia when both eyes are open, but it would not typically manifest as monocular diplopia.

Correct Answer: D

Rationale: Ischemic symptoms in the upper calf are indicative of peripheral artery disease affecting the tibial or peroneal arteries. These arteries are responsible for supplying blood to the lower leg and foot region, hence causing symptoms such as pain, cramping, or numbness in the upper calf area. Symptoms in the lower calf would typically be associated with more proximal arterial segments like femoral or iliac arteries. So, option D correctly matches the ischemic symptoms with the appropriate vascular supply.

Correct Answer: D

Rationale: The most important question to ask in this scenario would be if the patient has tried to lose weight. Given the patient's significant unintentional weight loss (from 140 to 110 pounds in a year), especially in the context of a chronic cough and a long history of smoking, lung cancer becomes a top concern. Unintentional weight loss is a common symptom seen in patients with lung cancer. Therefore, understanding if the weight loss was intentional or unintentional can provide crucial information in the diagnostic evaluation for possible lung cancer.

Correct Answer: A

Rationale: Scotomas refer to areas of partial alteration in the field of vision. These blind spots can be caused by various eye conditions such as glaucoma, retinal detachment, or optic nerve damage. Symptoms involving the eye like scotomas are important to recognize and address promptly to prevent potential vision loss or other complications. Tinnitus (choice B) refers to ringing in the ears, dysphagia (choice C) refers to difficulty swallowing, and rhinorrhea (choice D) refers to a runny nose, none of which are symptoms involving the eye.

Correct Answer: A

Rationale: A hyperresonant percussion note is a more intense and booming sound heard during percussion of the thorax. This can occur when there is an increased amount of air present in the chest cavity. In the case of a large pneumothorax, which is the presence of air in the pleural space causing partial or complete collapse of the lung, the percussion note would be hyperresonant due to the increased air content in the thoracic cavity. Lobar pneumonia, pleural effusion, and empyema would typically produce dull or flat percussion notes due to the presence of fluid or solid material in the pleural space.

Correct Answer: C

Rationale: It is important to show empathy and address Mrs. Donelan's feelings about missing her husband. By asking why Bill is not there, you are opening the door for her to talk about her emotions and potentially offer support or resources. This can help build a stronger patient-provider relationship and address any underlying emotional concerns she may have. It is important to prioritize the patient's emotional well-being along with their physical health during the visit.

Correct Answer: B

Rationale: Since the baby is exhibiting jaundice, which is a condition characterized by the yellowing of the skin, it is important to inquire about the family history of liver diseases. Jaundice can be a sign of liver dysfunction or disease, so understanding the family history of liver diseases can provide valuable insights into potential underlying causes for the baby's jaundice. In this case, it is crucial to explore this area further to determine if there may be any genetic predispositions or familial conditions that could be contributing to the baby's presentation of jaundice.

Correct Answer: B

Rationale: Coronary artery disease (CAD) is a significant risk factor for peripheral vascular disease (PVD). CAD is a condition where plaque builds up in the coronary arteries that supply blood to the heart muscle. This process is called atherosclerosis. Similarly, in PVD, atherosclerosis occurs in the peripheral arteries, affecting blood flow to the extremities, most commonly the legs. Individuals with CAD often have systemic atherosclerosis, which puts them at higher risk for developing PVD. Therefore, it is important for the 72-year-old teacher with CAD to be aware of this risk factor for PVD and consider appropriate screening and preventive measures.