On visual confrontation testing, a stroke patient is unable to see your fingers on his entire right side with either eye covered. Which of the following terms would describe this finding?

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: 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: Inspiratory splitting of S occurs due to the normal physiological delay in the closure of the aortic and pulmonic valves during inspiration. During inspiration, the negative intrathoracic pressure leads to increased venous return to the right side of the heart, causing a slight delay in the closure of the pulmonic valve. This results in the aortic valve closing first, followed by the closure of the pulmonic valve, leading to the splitting of S during inspiration.

Correct Answer: B

Rationale: Atrial flutter is a cardiac arrhythmia characterized by rapid, regular atrial contractions at a rate of around 250-350 beats per minute. This can lead to a ventricular response rate that is usually around 150 beats per minute, resulting in a fast heart rate. The ECG pattern in atrial flutter typically shows a sawtooth pattern of flutter waves, which distinguishes it from other arrhythmias. In contrast, second-degree A-V block, sinus arrhythmia, and atrial fibrillation would not typically present with the rapid regular atrial contractions seen in atrial flutter.

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.