Correct Answer: C

Rationale: The obturator sign is a physical examination maneuver used to assess for irritation of the obturator muscle due to an inflamed appendix that is in close proximity. This pain is typically felt in the right lower quadrant or hypogastric region. The sign is elicited by passively flexing the hip and knee of the patient, then internally rotating the hip. An alternative method is to position the patient on her left side and ask her to raise her right thigh against resistance while the examiner provides counterpressure. Pain experienced by the patient with these maneuvers is consistent with obturator sign, indicating possible appendicitis. Hence, option C is the correct answer.

Correct Answer: A

Rationale: Anisocoria refers to a condition where the pupils are of unequal size. Pathologic causes of anisocoria can include conditions such as Horner's syndrome. Horner's syndrome is a rare disorder caused by damage to the sympathetic nerves of the face and eye. Symptoms can include a constricted pupil (miosis), drooping of the upper eyelid (ptosis), and decreased sweating in the affected area. This results in anisocoria, where the affected pupil is smaller than the unaffected pupil. Other options listed (B-D) do not typically lead to pathologic anisocoria.

Correct Answer: D

Rationale: Weight loss can have a significant impact on the health problems associated with obesity. Even a modest weight loss of around 10% can lead to noticeable improvements in conditions such as diabetes, hypertension, osteoarthritis, and obstructive sleep apnea. Encouraging Mr. Curtiss to focus on achieving a meaningful but achievable goal, such as a 10% weight loss, can help him experience positive changes in his health and overall wellbeing, even if his ultimate goal weight seems far away. This approach can also help to boost his motivation and confidence in his ability to make progress towards better health.

Correct Answer: A

Rationale: The most significant risk factor for breast cancer in the patient's personal and family history is having a first-degree relative with premenopausal breast cancer. This is because the age at which a family member was diagnosed with breast cancer can be indicative of potential genetic predispositions that may increase the patient's own risk of developing the disease. Women with a first-degree relative who was diagnosed with breast cancer before menopause (premenopausal) are at a higher risk themselves compared to those with a family history of postmenopausal breast cancer. In this case, the patient's mother had unilateral breast cancer in her 70s, which suggests a higher risk compared to postmenopausal breast cancer. Other factors such as early age at menarche or age at first live birth are also important in assessing breast cancer risk, but having a first-degree relative with premenopausal breast cancer is the most significant

Correct Answer: A

Rationale: The presence of a firm and immobile mass felt against the bowel wall during a rectal examination is concerning for a potential malignancy, such as colon cancer. Other conditions such as hemorrhoids or anal fissures are typically not associated with a mass that is firm and immobile. The "Valve of Houston" is a term that does not pertain to this scenario and is not a recognized medical entity. Therefore, the most likely diagnosis based on the given information is colon cancer, and further evaluation such as a colonoscopy would be warranted for definitive diagnosis and management.