Which of the following conditions could be responsible for this heart rate?

Correct Answer: B

Rationale: Atrial flutter is a cardiac arrhythmia characterized by rapid, regular atrial contractions at a rate of around 250-350 beats per minute. This can lead to a ventricular response rate that is usually around 150 beats per minute, resulting in a fast heart rate. The ECG pattern in atrial flutter typically shows a sawtooth pattern of flutter waves, which distinguishes it from other arrhythmias. In contrast, second-degree A-V block, sinus arrhythmia, and atrial fibrillation would not typically present with the rapid regular atrial contractions seen in atrial flutter.

Correct Answer: C

Rationale: The presence of new flat red and purple lesions that are tender on the ulnar aspect of Ms. Whiting's forearms raises concerns and warrants further investigation. Since she did not mention them, it is important to ask how she acquired them to gather more information. This will help determine the cause of the lesions and provide clues to potential underlying conditions or recent activities that could be related to their development. It is important not to dismiss these lesions as old without proper evaluation, as they could indicate a recent injury, infection, or other medical issues that may require attention.

Correct Answer: B

Rationale: Among the options presented, Hepatitis B (HBV) is most likely in this scenario. HBV can be transmitted through mucous membrane exposure to infectious blood or body fluids, including sexual contact. The daycare worker's history of not being sexually active for the past 10 months would not completely rule out the possibility of acquiring HBV through a past sexual encounter. Also, HBV can persist in the blood for prolonged periods, making it a likely cause of jaundice in this case. The other types of hepatitis (A, C, D) are less likely based on the information provided concerning the daycare worker's history and risk factors.

Correct Answer: B

Rationale: The clinical presentation described in the question is consistent with Candida vaginitis, also known as vaginal yeast infection. Candida vaginitis typically presents with a thick, white, curdy discharge that can be visualized on examination. The low pH of 1 is characteristic of Candida infection. The negative KOH whiff test and absence of an unusual smell help differentiate Candida vaginitis from other types of vaginitis.

Correct Answer: D

Rationale: The described findings of a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea are characteristic of a pterygium. A pterygium is a benign growth of conjunctival tissue that extends onto the cornea. It is often associated with chronic exposure to ultraviolet light and typically occurs on the nasal side of the eye. Pterygiums are usually asymptomatic but can cause irritation, redness, and foreign body sensation in some cases. Surgical removal may be considered if the pterygium causes significant symptoms or affects vision.

Correct Answer: C

Rationale: Epistaxis, also known as a nosebleed, should be considered in a patient complaining of coughing up blood along with a history of smoking. Epistaxis can sometimes lead to blood trickling down the throat and being coughed up. It is important to consider this differential diagnosis, especially in patients with risk factors such as smoking. Intestinal bleeding (choice A) has a different presentation and cause compared to epistaxis. Hematoma of the nasal septum (choice B) is unlikely to cause coughing up blood. Bruising of the tongue (choice D) is also less likely to be the cause of hemoptysis in this case.

Correct Answer: B

Rationale: Paraphimosis is a condition where the foreskin is retracted behind the glans penis and cannot be returned to its original position. This can lead to swelling and constriction of the penis, causing pain and potential damage to the tissue due to decreased blood flow. Phimosis (Choice A) refers to a tight prepuce that cannot be retracted over the glans penis. Balanitis (Choice C) is inflammation of the glans penis, often associated with poor hygiene or infections. Balanoposthitis (Choice D) refers to inflammation of both the glans penis and the foreskin.

Correct Answer: C

Rationale: The next step would be to discuss the physical therapy plan with Mr. Larson. It is important to communicate openly with him, explain the recommendation for physical therapy, and ensure that he understands and agrees with the plan before proceeding further. This allows for any questions or concerns to be addressed, and ensures that the treatment plan is tailored to his needs and preferences. By discussing the plan with Mr. Larson first, you can also provide him with the opportunity to ask any questions and actively involve him in his own care, which can lead to better compliance and outcomes.

Correct Answer: D

Rationale: Chronic arterial insufficiency results in poor blood flow to the lower extremities. This leads to inadequate oxygen and nutrient supply to the tissues, causing damage and changes in the skin. A common physical examination finding in chronic arterial insufficiency is thin, shiny, atrophic skin. The skin may appear pale, cool to the touch, and may have decreased hair growth. It is important to note that other findings such as diminished or absent pulses and reduced temperatures may also be present with chronic arterial insufficiency.