Which finding below would be unusual in a patient with diabetic retinopathy?

Correct Answer: A

Rationale: The correct answer is A: Papilledema. Diabetic retinopathy is a microvascular complication of diabetes that primarily affects the retina's blood vessels. Papilledema, which is optic disc swelling due to increased intracranial pressure, is not a typical finding in diabetic retinopathy. Dot and blot hemorrhages, microaneurysms, and cotton wool spots are commonly seen in diabetic retinopathy due to retinal vessel damage and ischemia. Papilledema is more associated with conditions like intracranial hypertension or optic neuritis.

Correct Answer: C

Rationale: Step 1: Identify the characteristics of the lesion described - dome-shaped, in dermis, benign, closed sac attached to epidermis. Step 2: A cutaneous cyst fits all these characteristics - it is a benign closed sac in the dermis with attachment to the epidermis. Step 3: Keloid (A) is an overgrowth of scar tissue, not a closed sac lesion. Tophi (B) are deposits of uric acid crystals, not a sac. Chondrodermatitis (D) is inflammation of cartilage and skin, not a closed sac lesion. Summary: A cutaneous cyst is the correct choice as it matches all the characteristics given, while the other options do not fit the description provided.

Correct Answer: C

Rationale: The correct answer is C: Stop aspirin and begin apixaban 5 mg twice a day. The rationale is that for stroke risk reduction in nonvalvular atrial fibrillation, anticoagulation therapy with direct oral anticoagulants (DOACs) like apixaban is preferred over antiplatelet therapy like aspirin. DOACs have been shown to be more effective in reducing stroke risk with a lower bleeding risk compared to warfarin. Choice A is incorrect as aspirin alone is not sufficient for stroke prevention in atrial fibrillation. Choice B is incorrect as warfarin has more monitoring requirements and potential drug interactions compared to DOACs like apixaban. Choice D is incorrect as aspirin and apixaban together are not recommended due to increased bleeding risk.

Correct Answer: B

Rationale: The correct answer is B: Hirsutism. Hirsutism is the presence of excessive hair growth in a male pattern distribution in women, which is a common sign of hyperandrogenism. Elevated androgen levels can lead to hirsutism in women, especially in conditions like polycystic ovary syndrome. High pitch voice (A) and obesity (D) are not direct indicators of hyperandrogenism. While polycystic ovaries (C) can be associated with hyperandrogenism, the presence of hirsutism is a more specific and direct finding in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Voluntary stopping of eating and drinking. This is legal throughout the United States because it is considered a patient's right to refuse food and water, even if it may lead to death. This decision is based on the principle of patient autonomy and respects the patient's wishes. Euthanasia (A) involves actively causing death, which is illegal in the United States. Palliative sedation (B) is providing medication to relieve suffering, but not with the intention of hastening death. Physician-assisted death (D) involves a physician providing medication for a patient to self-administer to end their life, which is not legal in all states.

Correct Answer: D

Rationale: The correct answer is D because asking the patient to describe what happened will provide crucial information about the onset, nature, and potential cause of the knee pain. This open-ended question allows the patient to share their experience freely, aiding in accurate diagnosis and appropriate treatment planning. Option A focuses solely on pain intensity, which is important but not as comprehensive as understanding the context of the pain (D). Options B and C are more specific to past injuries and onset time, respectively, which are relevant but not as immediate and all-encompassing as asking the patient to describe the current issue (D).

Correct Answer: B

Rationale: The correct answer is B: Migraines with aura. Estrogen in contraceptives can increase the risk of stroke in patients with migraines with aura due to its effect on blood clotting. Estrogen-progestin contraceptives should be avoided in these patients to reduce the risk of adverse cardiovascular events. Choices A, C, and D do not have a direct contraindication to estrogen-progestin contraceptives based on current guidelines.

Correct Answer: B

Rationale: The correct answer is B: A sebaceous cyst. A sebaceous cyst typically presents as a lump underneath the skin that can be squeezed to release a cheesy substance, consistent with Jacob's description. The formation of a prominent dimple when gently pinched is characteristic of a cyst, indicating it is filled with fluid or semi-solid material. Sebaceous cysts are usually benign and can grow slowly over time. Incorrect choices: A: An enlarged lymph node - Unlikely as lymph nodes are typically not associated with cheesy discharge or the formation of a dimple when pinched. C: An actinic keratosis - Unlikely as actinic keratosis is a precancerous skin condition caused by sun exposure, not presenting with cheesy discharge or a dimple. D: A malignant lesion - Unlikely as malignant lesions usually do not produce cheesy discharge and are more aggressive in growth compared to a sebaceous cyst.

Correct Answer: A

Rationale: The correct answer is A: The fovea. The fovea is the central focal point for incoming images because it contains a high concentration of cones, which are responsible for detailed central vision. Cones are essential for color vision and visual acuity. The macula, while important for central vision, refers to the area surrounding the fovea. The optic disk is where the optic nerve exits the eye, and it does not receive incoming images. The physiologic cup is a normal depression in the optic nerve head and is not involved in image reception. In conclusion, the fovea is the correct answer as it is the area with the highest visual acuity due to the dense concentration of cones.