Why would a combined hormonal contraceptive be contraindicated in a 36-year-old patient with a past medical history of type 2 diabetes, obesity, chronic smoking, and a sedentary lifestyle?

Correct Answer: C

Rationale: The correct answer is C. The patient's age (36 years) and chronic smoking are the main reasons why a combined hormonal contraceptive would be contraindicated. Age over 35 and tobacco use increase the risk of cardiovascular complications with hormonal contraceptives. Obesity (choice A), type 2 diabetes (choice B), and a sedentary lifestyle (choice D) are also risk factors, but they are not the primary reasons for contraindicating combined hormonal contraceptives in this case.

Correct Answer: C

Rationale: The pectinate or dentate line is the border between the anal canal and the rectum. This is true because it represents the transition between the endoderm-derived upper anal canal and the ectoderm-derived lower anal canal. It is an important anatomical landmark in colorectal surgery and in distinguishing different pathologies in the anal region. Choice A is incorrect because the pectinate or dentate line is not typically palpable. Choice B is incorrect as it does not demarcate areas supplied by different nervous systems. Choice D is incorrect as the pectinate or dentate line is visible on proctoscopic examination due to its distinct appearance.

Correct Answer: C

Rationale: The correct answer is C: Regularly irregular rhythm. This is the appropriate documentation for Ms. Wright's presentation as her pulse demonstrates a pattern of irregularity with every fourth beat sounding different. This indicates a regularly irregular rhythm, where there is a discernible pattern to the irregularity. Rationale: 1. Regular rate and rhythm (Choice A) is incorrect as Ms. Wright's palpitations and the irregularity in her pulse indicate an irregular rhythm. 2. Irregularly irregular rhythm (Choice B) is incorrect as this term is used to describe arrhythmias like atrial fibrillation, which do not have a discernible pattern of irregularity. 3. Bradycardia (Choice D) is incorrect as it refers to a slow heart rate, which is not the primary concern in this scenario where the focus is on the irregular rhythm. In summary, the correct choice (C) accurately describes the specific irregular pattern observed in Ms. Wright's pulse, distinguishing it from

Correct Answer: B

Rationale: The correct answer is B: Straight-leg raise. This test is used to assess for herniated disc by stretching the sciatic nerve. A positive test is indicated by reproduction of leg pain when the leg is raised between 30 to 70 degrees. This suggests nerve root irritation, common in herniated disc. A: Leg-length test - This test is used to assess for leg length discrepancy, not herniated disc. C: Tinel's test - This test is used to assess for nerve compression, typically in carpal tunnel syndrome, not specifically for herniated disc. D: Phalen's test - This test is used to assess for carpal tunnel syndrome, not herniated disc.

Correct Answer: B

Rationale: The correct answer is B: A dull pain or cramp. In peripheral artery disease, calf pain is typically described as a dull ache or cramp due to inadequate blood flow to the muscles during exercise. This pain is known as claudication. Choice A is incorrect as sharp, stabbing pain is not typically associated with peripheral artery disease. Choice C, an electric shock, is more indicative of nerve-related conditions. Choice D, a pulsating pain, is more characteristic of an aneurysm rather than peripheral artery disease.

Correct Answer: A

Rationale: The correct answer is A: A palpable "notch" along its edge. This supports an enlarged kidney over the spleen because the kidney has a concave shape with a notch where the renal vessels enter. This notch is palpable in an enlarged kidney. Choice B is incorrect because the inability to push fingers between the mass and the costal margin is indicative of a spleen, which is a solid organ located close to the ribs. Choice C is incorrect as normal tympany over the area suggests gas-filled structures like the stomach or intestines, not a solid organ like the kidney or spleen. Choice D is incorrect as the ability to push fingers medial and deep to the mass would be more typical of an enlarged spleen, which can displace other organs medially due to its size.

Correct Answer: A

Rationale: The correct answer is A: It is moderately loud. A grade 4-intensity murmur indicates a moderately loud murmur that is readily heard with the stethoscope lightly on the chest. This intensity suggests a significant level of turbulence in blood flow, typically indicating a more pronounced cardiac abnormality. Explanation for why other choices are incorrect: B: It can be heard with the stethoscope off the chest - This is incorrect because a murmur would not be audible without the stethoscope. C: It can be heard with the stethoscope partially off the chest - This is incorrect as a murmur would still require direct contact with the chest for auscultation. D: It is associated with a "thrill" - This is incorrect as a thrill is a palpable vibration indicating turbulent blood flow and is not directly related to murmur intensity.

Correct Answer: B

Rationale: The correct answer is B: Provide thickened liquids and soft foods. This intervention helps prevent aspiration by reducing the risk of food or liquids entering the airway. Thickened liquids are easier to control while swallowing, decreasing the chance of aspiration. Soft foods are also easier to chew and swallow, further reducing the risk. Choice A is incorrect because eating quickly can increase the risk of choking and aspiration. Choice C is incorrect as lying down after meals can actually increase the risk of aspiration. Choice D is incorrect as large meals can increase the likelihood of swallowing difficulties and aspiration.

Correct Answer: A

Rationale: Rationale: 1. Cefuroxime and nitrofurantoin are safe for use in pregnancy and effective against UTIs. 2. Cefuroxime is a cephalosporin antibiotic, considered safe in pregnancy. 3. Nitrofurantoin is a first-line agent for UTIs in pregnancy due to its safety profile. 4. Ciprofloxacin and tetracycline are contraindicated in pregnancy due to potential harm to the fetus. 5. Amoxicillin is considered safe in pregnancy but not as effective as nitrofurantoin for UTIs.