Susanne is a 27-year-old who has had headaches, muscle aches, and fatigue for the last 2 months. You have completed a thorough history, examination, and laboratory workup but have not found a cause. What would your next action be?

Correct Answer: D

Rationale: The correct answer is D: To screen for depression. Susanne's symptoms of headaches, muscle aches, and fatigue for an extended period may indicate underlying depression. Screening for depression is important as it is a common cause of somatic symptoms. It is crucial to address mental health concerns that could be contributing to her physical symptoms. Referral to a neurologist (Choice A) or rheumatologist (Choice B) may not be necessary if there are no specific findings to suggest neurological or rheumatologic conditions. Telling the patient you can't find anything (Choice C) without exploring all possibilities is not appropriate. Screening for depression is the most appropriate next step to consider in this case.

Correct Answer: C

Rationale: The normal range of motion for plantar flexion of the ankle is approximately 50 degrees. This range allows for actions like pointing the toes downward. A: 20 degrees is too limited for normal function. B: 30 degrees is also insufficient for full plantar flexion. D: 90 degrees would be excessive and beyond the normal range of motion for plantar flexion. Therefore, C is the correct answer.

Correct Answer: B

Rationale: The correct answer is B: 60°. Scapulothoracic motion contributes to shoulder abduction by allowing the scapula to upwardly rotate and tilt posteriorly. Since shoulder abduction involves 180°, scapulothoracic motion accounts for half of this motion, which is 90°. Therefore, the correct answer is 60°, as it represents the scapulothoracic motion involved in shoulder abduction. Choices A, C, and D are incorrect because they do not accurately reflect the scapulothoracic motion required for shoulder abduction based on the given information.

Correct Answer: C

Rationale: The correct answer is C: The median nerve. The carpal tunnel is a narrow passageway in the wrist where the median nerve and nine flexor tendons pass through. The median nerve is responsible for providing sensory and motor functions to the thumb, index, and middle fingers. The ulnar nerve passes outside the carpal tunnel and innervates the ring and little fingers. The radial nerve also does not pass through the carpal tunnel, as it supplies motor function to the muscles of the forearm. The five finger flexor tendons pass through the carpal tunnel along with the median nerve, but the question specifically asks for structures passing through, making C the correct answer.

Correct Answer: C

Rationale: Heberden's nodes are bony swellings that develop at the distal interphalangeal joints of the fingers, characteristic of osteoarthritis. The nodes result from osteophyte formation and joint degeneration seen in OA, especially in older individuals. In rheumatoid arthritis (choice A), joint inflammation is more symmetrical and involves the proximal interphalangeal joints. Psoriatic arthritis (choice B) typically presents with dactylitis and nail changes. Gout (choice D) manifests as acute arthritis due to urate crystal deposition, not bony nodules.