Subtypes of elder mistreatment include:

Correct Answer: E

Rationale: Based on the given choices, none of them individually cover all subtypes of elder mistreatment. The correct answer should include all the mentioned subtypes: psychological mistreatment, physical mistreatment, sexual mistreatment, and financial exploitation. Therefore, the correct answer is not any of the provided options, as they are all individual subtypes and not a comprehensive list of all subtypes of elder mistreatment.

Correct Answer: C

Rationale: The correct answer is C: An intraductal papilloma. Bloody spontaneous discharge from the nipple in a perimenopausal woman is concerning for an intraductal papilloma, which is a benign growth in the milk ducts. Further evaluation with imaging studies and possibly a biopsy is necessary to rule out malignancy. Choice A: Fibroadenoma is a common benign breast tumor but does not typically present with bloody discharge. Choice B: Polycystic breast disease is not associated with bloody discharge and is characterized by multiple fluid-filled cysts in the breast tissue. Choice D: Pituitary prolactinoma is a benign tumor of the pituitary gland that can cause elevated prolactin levels leading to nipple discharge, but it is not typically bloody and would not present with spontaneous discharge from the nipple.

Correct Answer: D

Rationale: Rationale for correct answer D: Acne is NOT a typical finding of hyperprolactinemia in a 47-year-old premenopausal woman because hyperprolactinemia usually presents with symptoms related to hormonal imbalance, such as irregular menstrual cycles (oligomenorrhea), breast changes (gynecomastia), and excess body hair (hirsutism). Acne is not directly associated with elevated prolactin levels. Summary of incorrect choices: A: Hirsutism - Hirsutism is a common finding in hyperprolactinemia due to hormonal imbalances. B: Gynecomastia - Gynecomastia can occur in hyperprolactinemia due to the suppression of testosterone. C: Oligomenorrhea - Oligomenorrhea is a typical finding in hyperprolactinemia due to disruptions in the menstrual cycle.

Correct Answer: D

Rationale: The correct answer is D: Changes in behavior. This is the most common presenting sign of substance abuse in adolescents because substance use often leads to noticeable changes in behavior, such as irritability, mood swings, aggression, and withdrawal from family and friends. These behavioral changes are typically the first noticeable signs of substance abuse. A: Poor school performance may be a consequence of substance abuse, but it is not necessarily the most common presenting sign. B: Change in sleep habits can be a sign of substance abuse, but changes in behavior are more prominent and common. C: Increased blood pressure is a physical symptom of substance abuse, but changes in behavior are usually more readily apparent and commonly observed in adolescents with substance abuse issues.

Correct Answer: B

Rationale: The correct answer is B: Gastroesophageal reflux. Heartburn and regurgitation are classic symptoms of GERD, where stomach acid flows back into the esophagus. This causes a burning sensation in the chest and sour taste in the mouth. Hiatal hernia (A) can contribute to GERD but is not directly associated with these symptoms. Peptic ulcer disease (C) typically presents with stomach pain, not heartburn. Esophageal cancer (D) may present with difficulty swallowing and weight loss, not just heartburn and regurgitation. Therefore, choice B is the most appropriate answer.