Which of the following conditions would produce a hyperresonant percussion note?

Correct Answer: A

Rationale: A hyperresonant percussion note is a more intense and booming sound heard during percussion of the thorax. This can occur when there is an increased amount of air present in the chest cavity. In the case of a large pneumothorax, which is the presence of air in the pleural space causing partial or complete collapse of the lung, the percussion note would be hyperresonant due to the increased air content in the thoracic cavity. Lobar pneumonia, pleural effusion, and empyema would typically produce dull or flat percussion notes due to the presence of fluid or solid material in the pleural space.

Correct Answer: A

Rationale: Mr. Kelly's scenario is consistent with the phenomenon called "white coat hypertension," where an individual's blood pressure readings are elevated in a medical setting due to anxiety or stress, but are normal when measured at home. This discrepancy between office and home readings is a key indicator of white coat hypertension. Additionally, the fact that Mr. Kelly has been consistently monitoring his blood pressure at home and has kept a log supports the likelihood that his elevated readings in the office are primarily due to the stress of being in that environment. It is important to acknowledge white coat hypertension as a common occurrence and not necessarily a reflection of true high blood pressure that requires immediate medical intervention.

Correct Answer: C

Rationale: Diplopia occurring when one eye is covered is a condition known as monocular diplopia. This symptom is typically not caused by problems within the eye itself, such as irregularities in the cornea or lens. Instead, monocular diplopia with one eye covered is more likely to be an indication of a neurological issue, often involving the brainstem. Lesions or damage in the brainstem can disrupt the normal coordination of eye movements, leading to the perception of double vision when one eye is closed. Weakness of CN III (oculomotor nerve) or CN IV (trochlear nerve) may cause diplopia when both eyes are open, but it would not typically manifest as monocular diplopia.

Correct Answer: D

Rationale: Metrorrhagia refers to abnormal bleeding between menstrual periods. This can manifest as spotting or heavier bleeding outside of the regular menstrual cycle. It is important to differentiate metrorrhagia from other types of abnormal bleeding such as menorrhagia (excessive flow), oligomenorrhea (infrequent bleeding), and polymenorrhea (fewer than 21 days between menses) in order to address and diagnose the underlying cause accurately.

Correct Answer: A

Rationale: Ethnicity is one of the factors used to estimate the 10-year risk of developing coronary heart disease. Different ethnic groups may have varying risks for heart disease based on genetic predisposition, lifestyle factors, and cultural practices. For example, individuals of South Asian descent have been found to have a higher risk of heart disease compared to other ethnic groups. Therefore, considering ethnicity is essential when assessing the overall risk of developing heart disease in an individual.

Correct Answer: C

Rationale: A cough can be attributed to various anatomic regions. Cardiac conditions, such as heart failure or fluid overload, can lead to congestion in the lungs and irritation of the airway, resulting in a cough. Ophthalmologic, auditory, and endocrine regions are less commonly associated with causing a cough.

Correct Answer: C

Rationale: Splitting of the second heart sound is when the aortic and pulmonic valves close at slightly different times, resulting in two distinct components to the sound. This split is best heard over the apex of the heart, typically with the diaphragm of the stethoscope. The aortic component is heard first and represents closure of the aortic valve, followed by the pulmonic component, representing closure of the pulmonic valve. The split can narrow during inspiration and widen during expiration, which is important to keep in mind during assessment.

Correct Answer: D

Rationale: It is important to maintain a calm demeanor when walking into the examination room to speak with your first clinic patient, especially in a busy and high-pressure situation. Demonstrating calmness will help to build rapport with the patient, create a sense of trust, and promote effective communication. This demeanor will also convey professionalism and confidence, which are essential qualities for a healthcare provider. Displaying irritability, impatience, or boredom can negatively impact the patient-provider relationship and hinder effective communication, potentially compromising the quality of care provided.

Correct Answer: A

Rationale: Scotomas refer to areas of partial alteration in the field of vision. These blind spots can be caused by various eye conditions such as glaucoma, retinal detachment, or optic nerve damage. Symptoms involving the eye like scotomas are important to recognize and address promptly to prevent potential vision loss or other complications. Tinnitus (choice B) refers to ringing in the ears, dysphagia (choice C) refers to difficulty swallowing, and rhinorrhea (choice D) refers to a runny nose, none of which are symptoms involving the eye.