Ms. Whiting is a 68-year-old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn't mention them. They are tender when you examine them. What should you do?

Correct Answer: C

Rationale: The presence of new flat red and purple lesions that are tender on the ulnar aspect of Ms. Whiting's forearms raises concerns and warrants further investigation. Since she did not mention them, it is important to ask how she acquired them to gather more information. This will help determine the cause of the lesions and provide clues to potential underlying conditions or recent activities that could be related to their development. It is important not to dismiss these lesions as old without proper evaluation, as they could indicate a recent injury, infection, or other medical issues that may require attention.

Correct Answer: D

Rationale: The patient in this scenario presents with symptoms suggestive of an anorectal disorder. The presence of an irregular, firm mass on the posterior side of the rectum, along with frank blood seen on the glove after a digital rectal examination, raises suspicion for an underlying anorectal cancer. Anorectal cancer can present with symptoms such as rectal bleeding, changes in bowel habits, palpable masses, and weight loss. In this case, the findings of an irregular mass and rectal bleeding are concerning for a malignant process such as anorectal cancer. Further evaluation with imaging studies and biopsy would be warranted for confirmation and to guide appropriate management.

Correct Answer: B

Rationale: The information provided - "The patient had a stent placed in the left anterior descending artery (LAD)" - is related to a medical procedure, specifically a surgical intervention involving the placement of a stent in a coronary artery. This information falls under the category of surgeries because it describes a surgical treatment to address a cardiovascular issue. It does not pertain to adult illnesses, obstetrics/gynecology, or psychiatric conditions, making option B the most appropriate category for this information.

Correct Answer: B

Rationale: The clinical presentation described in the question is consistent with Candida vaginitis, also known as vaginal yeast infection. Candida vaginitis typically presents with a thick, white, curdy discharge that can be visualized on examination. The low pH of 1 is characteristic of Candida infection. The negative KOH whiff test and absence of an unusual smell help differentiate Candida vaginitis from other types of vaginitis.

Correct Answer: C

Rationale: Epistaxis, also known as a nosebleed, should be considered in a patient complaining of coughing up blood along with a history of smoking. Epistaxis can sometimes lead to blood trickling down the throat and being coughed up. It is important to consider this differential diagnosis, especially in patients with risk factors such as smoking. Intestinal bleeding (choice A) has a different presentation and cause compared to epistaxis. Hematoma of the nasal septum (choice B) is unlikely to cause coughing up blood. Bruising of the tongue (choice D) is also less likely to be the cause of hemoptysis in this case.

Correct Answer: A

Rationale: It is crucial to keep the patient's torso at a 45-degree angle when measuring the jugular venous pressure (JVP). This position allows the internal jugular vein to partially collapse, ensuring accurate observation of the pulsations. Keeping the patient at a 45-degree angle provides a standardized position for JVP measurement and helps avoid errors in assessment.

Correct Answer: B

Rationale: Paraphimosis is a condition where the foreskin is retracted behind the glans penis and cannot be returned to its original position. This can lead to swelling and constriction of the penis, causing pain and potential damage to the tissue due to decreased blood flow. Phimosis (Choice A) refers to a tight prepuce that cannot be retracted over the glans penis. Balanitis (Choice C) is inflammation of the glans penis, often associated with poor hygiene or infections. Balanoposthitis (Choice D) refers to inflammation of both the glans penis and the foreskin.

Correct Answer: C

Rationale: A right homonymous hemianopsia refers to a visual field defect in which the patient is unable to see objects in the right half of the visual field in both eyes. In the case described, the stroke patient is unable to see your fingers on his entire right side with either eye covered, which is consistent with a right homonymous hemianopsia. This type of visual field defect typically occurs as a result of damage to the optic tract or optic radiation on one side of the brain, which affects the processing of visual information from the opposite visual field. It is important to note that bitemporal hemianopsia, right temporal hemianopsia, and binasal hemianopsia involve different patterns of visual field loss and are not fitting descriptions for the presented scenario.

Correct Answer: D

Rationale: The described findings of a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea are characteristic of a pterygium. A pterygium is a benign growth of conjunctival tissue that extends onto the cornea. It is often associated with chronic exposure to ultraviolet light and typically occurs on the nasal side of the eye. Pterygiums are usually asymptomatic but can cause irritation, redness, and foreign body sensation in some cases. Surgical removal may be considered if the pterygium causes significant symptoms or affects vision.