Which lesion is dark, raised, and asymmetric with an irregular border?

Correct Answer: D

Rationale: The correct answer is D, Melanoma. Melanoma is a type of skin cancer that typically presents as a dark, raised lesion with an irregular border and asymmetry. This is due to the abnormal growth of melanocytes, the pigment-producing cells in the skin. Nevus (A) is a common mole that is usually symmetrical and has a regular border. Actinic keratosis (B) is a precancerous lesion that is typically rough and scaly, not dark or raised. Keratoacanthoma (C) is a low-grade skin cancer that often appears as a dome-shaped lesion with a central crater, not necessarily dark or asymmetric.

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.

Correct Answer: A

Rationale: Rationale for correct answer (A): Amoxicillin does not significantly interact with warfarin. It is an antibiotic that works through a different mechanism than warfarin and is not known to affect its anticoagulant activity. Summary of incorrect choices: B (Trimethoprim/sulfamethoxazole): This drug combination can enhance the effects of warfarin, increasing the risk of bleeding. C (Ciprofloxacin): Ciprofloxacin can increase warfarin's effects, leading to a higher risk of bleeding. D (Clarithromycin): Clarithromycin can interact with warfarin, potentially increasing the risk of bleeding.