Mr. Martin is a 72-year-old smoker who comes to you for his hypertension visit. You note that with deep palpation you feel a pulsatile mass which is about 4 centimeters in diameter. What should you do next?

Correct Answer: A

Rationale: The correct answer is A: Obtain an abdominal ultrasound. A pulsatile mass in an elderly smoker raises concern for an abdominal aortic aneurysm (AAA). An abdominal ultrasound is the best initial diagnostic test to confirm the presence of an AAA. If left untreated, AAA can lead to life-threatening complications such as rupture. Choice B (Reassess in 6 months) and C (Reassess in 3 months) are incorrect as immediate investigation is necessary due to the potential seriousness of an AAA. Choice D (Refer to a vascular surgeon) is premature without confirming the presence of an AAA through imaging. An ultrasound is needed first to guide further management.

Correct Answer: C

Rationale: Step-by-step rationale: 1. Increased ICP can lead to cerebral edema and worsen neurological outcomes. 2. Promoting carbon dioxide elimination helps reduce cerebral blood flow and intracranial pressure. 3. Hyperventilation decreases PaCO2, causing vasoconstriction and reducing ICP. 4. Preventing respiratory alkalosis (A) and lowering arterial pH (B) are incorrect as they can worsen cerebral vasoconstriction. 5. Maintaining PaO2 above 80 mm Hg (D) is important but not the primary goal in managing increased ICP.

Correct Answer: D

Rationale: The correct answer is D because a new onset of chest pain during a cardiovascular assessment could indicate a serious cardiac issue like a heart attack requiring immediate intervention. Chest pain can be a symptom of myocardial infarction, which is a medical emergency. Choices A, B, and C are not immediate concerns. A capillary refill of 3 seconds is within normal limits (2 seconds or less is normal). Blood pressure of 130/80 mmHg is within the normal range, and a heart rate of 110 beats per minute may be elevated but not necessarily an immediate concern without additional context.

Correct Answer: B

Rationale: The correct answer is B: Reflex hammer. This tool is specifically designed to assess deep tendon reflexes by eliciting a quick stretch reflex response. The pointed end of the reflex hammer is used to strike the tendon, causing a quick tap that triggers the reflex. The other choices are incorrect: A tuning fork is used for testing auditory sensations, a penlight is used for assessing pupillary responses and examining the eyes, and an otoscope is used for visualizing the ear canal and eardrum. Therefore, the reflex hammer is the most appropriate tool for assessing deep tendon reflexes due to its specific design and function.

Correct Answer: C

Rationale: The primary purpose of using the Snellen chart during a physical examination is to measure visual acuity, which refers to the sharpness of vision. The chart consists of letters or symbols of varying sizes that the individual is asked to read from a specific distance. By determining the smallest line of text that can be read accurately, the healthcare provider can assess the clarity of the individual's vision. Peripheral vision, depth perception, and color vision are not evaluated using the Snellen chart, making choices A, B, and D incorrect.