Correct Answer: B

Rationale: In respiratory distress, the skin between the ribs moves inward with inspiration, a phenomenon known as retractions. This is a sign of increased work of breathing as the body tries to pull in more air due to difficulty in breathing. The inward movement of the skin between the ribs indicates that the individual is not able to generate enough negative pressure in the chest cavity to inhale properly. This can be seen in conditions such as asthma, pneumonia, or other respiratory issues. Skin retractions are a concerning sign and may indicate a severe respiratory compromise that requires immediate medical attention. The other options listed do not specifically describe a characteristic of respiratory distress.

Correct Answer: D

Rationale: The patient's presentation is consistent with atrophic vaginitis, also known as vaginal atrophy. This condition typically occurs in postmenopausal women due to a decrease in estrogen levels, leading to thinning, drying, and inflammation of the vaginal walls. Symptoms of atrophic vaginitis include vaginal dryness, itching, discomfort with intercourse, and sometimes light bleeding after intercourse. The absence of vaginal discharge and the presence of vaginal dryness and bleeding easily upon examination suggest atrophic vaginitis as the most likely cause in this patient. Other causes of vaginitis such as Trichomonas vaginitis, Candida vaginitis, and bacterial vaginosis typically present with different symptoms and findings on examination.

Correct Answer: C

Rationale: The patient's history of frequent loose stools with cramping, occurring since high school and worsening during periods of nervousness, along with occasional constipation, is characteristic of irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder that presents with symptoms such as abdominal pain or discomfort, bloating, and altered bowel habits (diarrhea, constipation, or both) without any evidence of organic disease. The absence of systemic symptoms like fever, weight loss, or blood in the stool, as well as normal physical examination findings, also support the diagnosis of IBS in this case. This condition is often triggered or exacerbated by stress or anxiety. Monitoring stress levels, dietary modifications, and possibly prescription medications may help manage IBS symptoms in this patient.

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: Finding a bounding carotid pulse suggests a wide pulse pressure, which can be associated with aortic insufficiency. Aortic insufficiency (also known as aortic regurgitation) is characterized by the backflow of blood from the aorta into the left ventricle during diastole due to incomplete closure of the aortic valve. This results in increased stroke volume and left ventricular pressure, leading to widened pulse pressure and a bounding arterial pulse. Therefore, when a bounding carotid pulse is detected in a patient, it is important to search for signs and symptoms of aortic insufficiency, such as a diastolic murmur heard best at the left sternal border and radiating to the neck.