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: D

Rationale: The patient's symptoms point towards pneumonia. Pneumonia is characterized by infection and inflammation in the lung tissue, leading to symptoms such as decreased air movement, crackles on auscultation, dullness on percussion, increased fremitus on palpation, and abnormal breath sounds like egophony and whispered pectoriloquy. These findings are consistent with consolidation of the lung, which occurs in pneumonia as a result of fluid, inflammatory cells, and tissue debris filling the alveoli. The presence of nasal turbinates edema indicates a possible upper respiratory tract infection that may have preceded the development of pneumonia. Spontaneous pneumothorax would typically present with sudden-onset chest pain and dyspnea but would not typically cause findings of lung consolidation. Chronic obstructive pulmonary disease (COPD) and asthma are characterized by different patterns of lung damage and symptoms, such as chronic inflammation, airflow obstruction, and hyper

Correct Answer: B

Rationale: Ascites is the abnormal accumulation of fluid in the abdominal cavity. When ascites is present, dullness is typically heard on percussion due to the fluid in the abdomen. This dullness does not shift with changes in the patient's position. Therefore, the finding of dullness which remains despite a change in position would argue for the presence of ascites. The other choices (A, C, D) describe findings that are more consistent with gaseous distention rather than ascites.

Correct Answer: C

Rationale: Family history of osteoporosis is a significant risk factor, as genetics play a key role in determining a person's risk for developing osteoporosis. Having a close relative, such as an aunt, with severe osteoporosis increases this woman's risk as there is a strong genetic component to the disease. Factors such as obesity (choice A), late menopause (choice B), and delayed menarche (choice D) do not directly increase the risk of osteoporosis, unlike having a familial history of the condition.

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.