Which physical assessment finding is most indicative of chronic hypoxia?

Correct Answer: B

Rationale: The correct answer is B: Clubbing of the fingers. Clubbing is a sign of chronic hypoxia due to prolonged oxygen deprivation, leading to changes in the nails and fingertips. This occurs in conditions like chronic lung disease. Barrel chest (choice A) is typically seen in emphysema due to lung hyperinflation. Use of accessory muscles (choice C) and intercostal retractions (choice D) are signs of acute respiratory distress, not chronic hypoxia.

Correct Answer: A

Rationale: The most likely diagnosis is bronchitis because it presents with a persistent cough lasting more than 2-3 weeks without fever, chest pain, or chills. Shortness of breath can be seen in bronchitis due to airway inflammation. Asthma would typically present with wheezing and can have triggers like allergies. Pneumonia is accompanied by fever, chest pain, and productive cough with yellow or green sputum. Chronic obstructive pulmonary disease (COPD) usually occurs in older patients with a history of smoking and presents with a chronic cough and progressive shortness of breath.

Correct Answer: C

Rationale: The most likely diagnosis is breast cancer recurrence (Choice C) due to the patient's history of breast cancer and the characteristics of the mass (firm, non-tender, fixed). Recurrence is common in breast cancer survivors. Fibrocystic changes (Choice A) typically present with lumpy or tender breasts and are not usually fixed. Breast abscess (Choice B) would present with more acute symptoms like redness, warmth, and fever. Fat necrosis (Choice D) may mimic a cancerous mass but is usually not fixed to underlying tissue. In this case, the history and characteristics of the mass strongly suggest breast cancer recurrence.

Correct Answer: B

Rationale: The correct answer is B: Hypertensive crisis. The patient's symptoms of headache, blurred vision, and nausea, along with severely elevated blood pressure (200/120 mm Hg), suggest a hypertensive emergency. In this situation, the elevated blood pressure is causing end-organ damage, leading to symptoms. Treatment is urgent to prevent further complications. Choice A: Primary hypertension is unlikely as the sudden onset of severe symptoms and extremely high blood pressure indicate an acute issue rather than chronic primary hypertension. Choice C: Migraine typically presents with specific symptoms like throbbing head pain, sensitivity to light or sound, and may have an aura. The lack of these symptoms and the presence of severely elevated blood pressure make migraine less likely. Choice D: Cluster headaches are characterized by severe, unilateral head pain with associated symptoms like eye redness or tearing. The lack of these specific symptoms and the presence of markedly elevated blood pressure make cluster headache less likely.

Correct Answer: B

Rationale: The correct answer is B: Cool, pale skin. Arterial insufficiency results in decreased blood flow to the extremities, leading to reduced skin temperature and pallor. Cool skin indicates diminished blood supply, while pale skin suggests vasoconstriction. Pitting edema (choice A) is a sign of venous insufficiency, not arterial. Brown discoloration (choice C) is characteristic of chronic venous insufficiency due to hemosiderin deposition. Warm, erythematous skin (choice D) is a sign of inflammation or infection, not arterial insufficiency.