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: B

Rationale: The correct answer is B: Potential congenital deformity. This observation suggests a condition called "low-set ears," which can be a sign of certain congenital anomalies affecting the development of the head and neck structures during fetal growth. It is important to investigate further to rule out any associated syndromes or genetic disorders. Choice A: Normal anatomical variation is incorrect because this positioning is not commonly considered a normal variation in the general population. Choice C: Increased risk of hearing loss is incorrect as the position of the ears alone does not directly correlate with hearing loss. Choice D: No clinical significance is incorrect because this observation warrants further evaluation to assess for potential underlying issues.

Correct Answer: C

Rationale: The correct answer is C. Meningitis typically presents with neck stiffness due to meningeal irritation. In choice C, the patient has a tender neck to palpation and is unable to perform range of motion, indicating meningeal inflammation. Choices A, B, and D all describe a normal head and fundi exam, which is not consistent with meningitis. Choice B mentions muscle spasm and limited range of motion to the right, but this is more suggestive of a musculoskeletal issue rather than meningitis. Choice D describes a normal neck exam, which is not in line with the presentation of meningitis.

Correct Answer: D

Rationale: The correct answer is D: Obtain an ultrasound of the liver. This is the most appropriate next step to assess the patient's enlarged liver in the context of COPD. Ultrasound can provide detailed images of the liver to identify potential causes of enlargement, such as fatty liver disease or liver cirrhosis. Percussing the lower border (Choice A) or measuring the span of the liver (Choice B) may provide some information but are less specific and may not identify the underlying cause. Ordering a hepatitis panel (Choice C) would focus only on viral hepatitis as a potential cause, while an ultrasound can provide a broader evaluation of liver structure and function.

Correct Answer: B

Rationale: The correct answer is B: Lymph node. A mobile mass that is palpable and moves in multiple directions is characteristic of a lymph node. Lymph nodes are small, bean-shaped structures that are part of the immune system and can move freely when touched. Incorrect choices: A: Cancer - A cancerous mass would typically be fixed and not mobile. C: Deep scar - Scars are usually fixed and do not move when touched. D: Muscle - Muscles are usually deeper in the body and not typically palpable as a mobile mass.