Mrs. Fletcher comes to your office with unilateral pain during chewing, which is chronic. She does not have facial tenderness or tenderness of the scalp. Which of the following is the most likely cause of her pain?

Correct Answer: B

Rationale: Mrs. Fletcher's symptoms of unilateral pain during chewing, which is chronic, without facial tenderness or tenderness of the scalp are more suggestive of temporomandibular joint (TMJ) syndrome rather than other conditions listed. TMJ syndrome is characterized by pain and dysfunction of the jaw muscles and the joints that connect the jaw to the skull. The pain is often worsened by chewing or opening the mouth widely. In this case, the absence of facial tenderness or signs of temporal arteritis makes these conditions less likely. Trigeminal neuralgia typically presents with sudden, severe facial pain in the distribution of the trigeminal nerve. Tumor of the mandible would likely present with other symptoms such as swelling, bone destruction, or difficulty with mouth opening and chewing. Temporal arteritis usually presents with symptoms such as headache, scalp tenderness, and visual disturbances. Given Mrs. Fletcher's presentation,

Correct Answer: A

Rationale: A sudden, painless unilateral vision loss may be caused by a retinal detachment. Retinal detachment occurs when the retina, which is the light-sensitive tissue lining the back of the eye, pulls away from its normal position. This can lead to visual disturbances, including sudden loss of vision in one eye. Retinal detachment can be a medical emergency and requires prompt evaluation and treatment to prevent permanent vision loss. Other conditions mentioned in the choices, such as corneal ulcer, acute glaucoma, and uveitis, may also cause vision problems but are less likely to present with a sudden and painless unilateral vision loss as a primary symptom.

Correct Answer: B

Rationale: At the start of diastole, the ventricles relax and begin to fill with blood from the atria. As this relaxation phase begins, the pulmonic valve opens to allow blood to flow from the right ventricle to the pulmonary artery and then to the lungs for oxygenation. This marks the beginning of diastole, the period of the cardiac cycle when the heart is filling with blood. The closure of the tricuspid valve, closure of the aortic valve, and production of the first heart sound (S1) occur during systole, the phase of the cardiac cycle when the heart is contracting to pump blood out to the body.

Correct Answer: B

Rationale: Orthopnea is a symptom characterized by difficulty breathing while lying flat that improves when sitting or standing upright. This symptom is specifically related to cardiovascular conditions, such as heart failure, in which fluid accumulates in the lungs when lying down. Considering the patient's complaint of breathlessness with activity and the need to assess for cardiovascular issues, asking about orthopnea would be most appropriate to gain insights into potential heart-related causes of the symptoms. Abdominal pain (A), hematochezia (C), and tenesmus (D) are not typically associated with cardiovascular conditions and are less relevant to the patient's presentation.

Correct Answer: B

Rationale: Urge incontinence, also known as overactive bladder, is characterized by a sudden and strong urge to urinate which is difficult to control. In this case, Mrs. LaFarge is unable to get to the bathroom quickly enough when she senses the need to urinate, which indicates a lack of control over the urge to urinate. This is typically caused by involuntary contractions of the bladder muscle. Stress incontinence, on the other hand, is leakage of urine during activities that increase intra-abdominal pressure, such as coughing or exercising. Overflow incontinence is characterized by urinary retention and constant dribbling of urine due to the bladder being unable to empty properly. Functional incontinence occurs when a person has normal bladder control but is unable to reach the bathroom in time due to physical or cognitive impairments. Since Mrs. LaFarge is experiencing a sudden and strong urge to urinate that she cannot

Correct Answer: C

Rationale: Leaving the plexor finger on the pleximeter after each strike is consistent with good percussion technique. This helps to maintain stability and precision during percussion by providing a consistent point of contact for accurate assessment of the underlying structures. This technique also helps to control the force and angle of the percussive strike, ensuring accurate interpretation of the resulting sounds produced. Maintaining this contact can enhance the effectiveness of percussion as a diagnostic tool in physical examinations.

Correct Answer: C

Rationale: The appropriate counsel for the patient during the visit would be to give information about the reduction of fat, cholesterol, and calories because he is concerned about his weight. This option addresses the patient's concern and provides guidance on making healthier choices to manage weight. Referring the patient to a nutritionist because he is anorexic (Option A) is not appropriate based on the information provided. Reassuring the patient that he has a normal body weight (Option B) may not address his concerns about weight. Giving the patient information about reducing fat and cholesterol only because he is obese (Option D) does not cover all aspects of a healthy diet such as managing calorie intake.

Correct Answer: B

Rationale: Prostatitis is the most likely disorder based on the symptoms described. The warm, boggy, tender prostate upon digital rectal examination, along with the presence of moderate white blood cells and bacteria in the urinalysis, suggests an inflammatory condition of the prostate. In this case, there are no signs of masses or blood in the rectal examination, which would be more indicative of prostate cancer. Epididymitis typically presents with symptoms involving the scrotum and may be associated with testicular pain and swelling, which are not described in this scenario. Benign prostatic hyperplasia (BPH) is a nonmalignant enlargement of the prostate gland that typically presents with symptoms of urinary urgency, frequency, and nocturia, rather than the inflammatory signs seen in this case.

Correct Answer: B

Rationale: Mrs. Fletcher's symptoms of unilateral pain during chewing, which is chronic, without facial tenderness or tenderness of the scalp are more suggestive of temporomandibular joint (TMJ) syndrome rather than other conditions listed. TMJ syndrome is characterized by pain and dysfunction of the jaw muscles and the joints that connect the jaw to the skull. The pain is often worsened by chewing or opening the mouth widely. In this case, the absence of facial tenderness or signs of temporal arteritis makes these conditions less likely. Trigeminal neuralgia typically presents with sudden, severe facial pain in the distribution of the trigeminal nerve. Tumor of the mandible would likely present with other symptoms such as swelling, bone destruction, or difficulty with mouth opening and chewing. Temporal arteritis usually presents with symptoms such as headache, scalp tenderness, and visual disturbances. Given Mrs. Fletcher's presentation,