Which valve lesion typically produces a murmur of equal intensity throughout systole?

Correct Answer: C

Rationale: The correct answer is C: Pulmonic stenosis. This valve lesion typically produces a murmur of equal intensity throughout systole due to the obstruction of blood flow during both systole and diastole. Pulmonic stenosis results in turbulent blood flow across the pulmonary valve, creating a consistent murmur throughout the cardiac cycle. Rationale for incorrect choices: A: Aortic stenosis - Produces a crescendo-decrescendo murmur that peaks in mid-systole. B: Mitral insufficiency - Causes a holosystolic murmur that is loudest at the apex. D: Aortic insufficiency - Results in a diastolic murmur heard best at the left sternal border. In summary, pulmonic stenosis is the correct answer as it uniquely presents with a murmur of equal intensity throughout systole, distinguishing it from the other valve lesions.

Correct Answer: D

Rationale: The correct answer is D: Irritable bowel syndrome (IBS). Monique's symptoms of lower abdominal pain relieved by defecation, change in bowel movements' form and frequency, and absence of menses-related pain align with IBS criteria. IBS is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It is a diagnosis of exclusion, meaning other conditions must be ruled out. Choice A: Colon cancer is less likely due to Monique's age, absence of alarming symptoms like weight loss or blood in stool, and the intermittent nature of her symptoms. Choice B: Cholecystitis typically presents with right upper quadrant pain, nausea, and vomiting, which do not match Monique's symptoms. Choice C: Inflammatory bowel disease (IBD) usually presents with persistent symptoms, blood in stool, and systemic signs, which are not seen in Monique's case.

Correct Answer: D

Rationale: Rationale for D (Enlarged bladder): The presentation of a smooth lower abdominal mass that is minimally tender and associated with dullness to percussion above the symphysis pubis suggests an enlarged bladder. This is a common finding in elderly individuals due to various reasons such as urinary retention or bladder outlet obstruction. The location and characteristics of the mass align with an enlarged bladder. Summary of other choices: A: Sigmoid mass - Unlikely as sigmoid mass typically presents with different characteristics such as irregular shape and may not cause dullness to percussion above the symphysis pubis. B: Tumor in the abdominal wall - Less likely as tumors in the abdominal wall would have a different presentation and wouldn't be associated with urinary symptoms. C: Hernia - Less likely as hernias typically manifest with a bulge that can be reduced and may not cause dullness to percussion above the symphysis pubis.

Correct Answer: C

Rationale: The Allen test assesses collateral circulation by checking for patency of the ulnar artery. This is important before obtaining an arterial blood gas from the radial artery to ensure adequate blood flow and prevent ischemia. If the ulnar artery is not patent, using the radial artery could lead to arterial insufficiency. Checking the radial artery's patency (Choice A) is not the purpose of the Allen test. Checking the patency of the brachial artery (Choice B) or the femoral artery (Choice D) is not relevant in this context. The correct answer is C because ensuring ulnar artery patency is crucial for arterial blood gas sampling from the radial artery.

Correct Answer: A

Rationale: The correct answer is A. Pallor of the foot when raised to 60 degrees for one minute is consistent with chronic arterial insufficiency. When the foot is raised, blood flow decreases, leading to decreased oxygenation and pallor in the presence of arterial insufficiency. This is known as the dependent rubor test, and the delayed return of color is indicative of impaired blood flow. Choice B is incorrect because a quick return of color within 5 seconds suggests normal vascular perfusion. Choice C is incorrect as filling of veins within 10 seconds indicates venous insufficiency rather than arterial insufficiency. Choice D, hyperpigmentation of the skin, is not a typical finding in chronic arterial insufficiency.