Which of the following is true of jugular venous pressure (JVP) measurement?

Correct Answer: B

Rationale: Jugular venous pressure (JVP) is measured as the vertical height of the blood column in centimeters above the sternal angle (Angle of Louis). To measure the JVP accurately, the patient should be positioned at a 30-45 degree angle (not 45-degree angle as in choice A). The value obtained by measuring the JVP in centimeters is then added to 5 cm, which represents the distance from the sternal angle to the right atrium. Therefore, the formula for calculating JVP is the vertical height of the blood column in cm + 5 cm. A JVP below 9 cm (not 9 cm or choice C) is generally considered normal, while a JVP above that level is considered elevated. It is important to measure the JVP correctly and interpret the findings in the context of the patient's

Correct Answer: A

Rationale: The presentation of decreased bowel sounds, rebound tenderness, and involuntary guarding in the right lower quadrant is highly suggestive of acute appendicitis. These signs indicate inflammation and potential perforation of the appendix, leading to the classic symptoms of appendicitis. The pain in this case is likely due to the inflammatory process involving the appendix. The absence of abnormal findings in the rectal, inguinal, prostate, penile, and testicular examinations further supports the diagnosis of acute appendicitis as the most likely cause of the patient's pain.

Correct Answer: B

Rationale: A condylar joint is a type of synovial joint that allows movement in two planes, typically flexion/extension and abduction/adduction. The interphalangeal joints of the hand, which are the joints between the phalanges (finger bones), exhibit this type of movement, making them an example of a condylar joint. The hip joint (choice A) is a ball-and-socket joint, the temporomandibular joint (choice C) is a hinge joint, and the intervertebral joint (choice D) is a cartilaginous joint, none of which are examples of condylar joints.

Correct Answer: B

Rationale: Peripheral arterial disease (PAD) is considered a coronary heart disease risk equivalent, meaning it confers a similar risk as having a history of coronary heart disease itself. Individuals with PAD have a significantly increased risk of cardiovascular events such as heart attack and stroke. Therefore, when assessing the 10-year coronary heart disease risk of the 40-year-old banker, having peripheral arterial disease would be a crucial factor to consider in addition to other risk factors like hypertension, exercise habits, and smoking history.

Correct Answer: C

Rationale: The ankle-brachial index (ABI) is the appropriate test to initially evaluate for peripheral vascular disease in this case. ABI is a simple, non-invasive test that compares the blood pressure in the arms to the blood pressure in the legs. A lower ABI value indicates a higher likelihood of peripheral arterial disease (PAD). Given the patient's presentation of leg swelling and risk factors like smoking and hypertension, ABI can help determine the presence and severity of PAD, guiding further management and treatment decisions.

Correct Answer: B

Rationale: The most likely pathologic process based on the patient's symptoms and history would be an inflammatory process. The patient's joint pain, fever, and family history of rheumatoid arthritis suggest the possibility of an autoimmune inflammatory condition like rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disorder that primarily affects the joints, causing pain, swelling, and stiffness. The bilateral involvement of the wrists and fingers along with a family history of rheumatoid arthritis make this diagnosis more likely than an infectious, hematologic, or traumatic process in this case.

Correct Answer: A

Rationale: When a patient presents with epistaxis (nosebleed), other causes such as intracranial hemorrhage should be considered. Intracranial hemorrhage refers to bleeding within the skull, which can sometimes manifest as epistaxis. Common symptoms of intracranial hemorrhage include severe headache, altered mental status, focal neurological deficits, and sometimes, epistaxis. It is essential to assess for signs of increased intracranial pressure or neurological deficits if a patient with epistaxis has a history of trauma or other risk factors for intracranial bleeding. Immediate medical evaluation and imaging studies may be necessary to rule out intracranial hemorrhage in such cases to prevent serious consequences.

Correct Answer: C

Rationale: It is recommended for women to conduct breast self-examination immediately prior to their menses. This is because the breasts are less likely to be tender, lumpy, or swollen during this time of the menstrual cycle, making it easier to detect any abnormalities such as lumps or changes in the breast tissue. Conducting breast self-examination around this time each month can help women become familiar with the normal look and feel of their breasts, making it easier to detect any changes that may indicate a potential issue.

Correct Answer: C

Rationale: Changes in weight, fatigue and weakness, fever and chills are common symptoms that can provide valuable information about a person's overall health. These symptoms may indicate underlying medical conditions and merit further investigation. However, a cough, while it can be a symptom of various respiratory or systemic illnesses, is not typically part of the General Survey and vital signs assessment. It is usually addressed in a more focused respiratory assessment.