Which cranial nerve is being tested when the nurse asks the patient to stick out their tongue?

Correct Answer: D

Rationale: The correct answer is D, Cranial nerve XII (hypoglossal nerve). This nerve innervates the muscles responsible for tongue movement. When the nurse asks the patient to stick out their tongue, they are testing the function of the hypoglossal nerve. The hypoglossal nerve controls the intrinsic and extrinsic muscles of the tongue, allowing for movements such as protrusion, retraction, and side-to-side movements. Choices A, B, and C are incorrect because they do not directly relate to tongue movement. Cranial nerve IX (glossopharyngeal nerve) is involved in taste perception and swallowing, cranial nerve X (vagus nerve) is involved in various autonomic functions and cranial nerve XI (spinal accessory nerve) controls certain neck muscles.

Correct Answer: B

Rationale: The most likely diagnosis for the 40-year-old man with abdominal pain, vomiting, jaundice, ascites, elevated bilirubin, and elevated AST and ALT is cirrhosis. Cirrhosis is characterized by liver dysfunction due to chronic liver injury, which can be caused by alcohol use and liver disease. The presence of jaundice, ascites, and abnormal liver function tests are classic signs of advanced liver disease like cirrhosis. Chronic pancreatitis (A) typically presents with abdominal pain radiating to the back, and may not cause jaundice or ascites. Hepatitis (C) usually presents with symptoms like fatigue, nausea, and fever, and may or may not cause jaundice. Gallstones (D) can cause abdominal pain, but are less likely to present with jaundice, ascites, and liver function test abnormalities.

Correct Answer: A

Rationale: The correct answer is A: Mammography. Mammography is the initial investigation of choice for evaluating breast lumps in women over 40 years old. It helps to identify the characteristics of the mass and determine if it is suspicious for malignancy. Fine needle aspiration (B) may be used for further evaluation if mammography is inconclusive. Excisional biopsy (C) is typically reserved for definitive diagnosis after suspicious findings on mammography. Ultrasound (D) may be used as an adjunct to mammography but is not the first-line investigation in this scenario.

Correct Answer: B

Rationale: The most likely diagnosis for a 50-year-old man with a history of heavy alcohol use presenting with abdominal pain, jaundice, and ascites, along with elevated serum bilirubin, AST, and ALT, is cirrhosis. Cirrhosis is a chronic condition characterized by liver damage and scarring, commonly caused by long-term alcohol abuse. The elevated liver function tests and jaundice are indicative of liver dysfunction, while ascites is a common complication of cirrhosis due to portal hypertension. Chronic pancreatitis (choice A) typically presents with pancreatic enzyme abnormalities, not liver dysfunction. Hepatitis (choice C) may present with elevated liver enzymes but is less likely in a patient with a history of heavy alcohol use. Gallstones (choice D) can cause jaundice but are less likely to be the primary cause of liver dysfunction in this case.

Correct Answer: A

Rationale: The most likely diagnosis for the 60-year-old man with difficulty swallowing, weight loss, hoarse voice, smoking, and alcohol use is esophageal cancer. This is supported by the symptoms of dysphagia, weight loss, and hoarseness, which are common in esophageal cancer. Smoking and alcohol use are risk factors for developing esophageal cancer. Achalasia presents with dysphagia without weight loss or hoarseness. Gastroesophageal reflux disease typically presents with heartburn and regurgitation, not hoarseness or weight loss. Peptic ulcer disease usually presents with epigastric pain, not difficulty swallowing or hoarseness.