You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process?

Correct Answer: D

Rationale: Nodules are a characteristic finding in an inflammatory joint condition such as rheumatoid arthritis. Nodules are small, firm lumps that can develop near the affected joint and are often indicative of an underlying inflammatory process. Tenderness, cool temperature, and ecchymosis can be seen in various musculoskeletal conditions, but nodules specifically point towards an inflammatory process in the joint.

Correct Answer: B

Rationale: Cheyne-Stokes respiration is characterized by a pattern of breathing with gradual increase and then decrease in depth of breaths, followed by a period of apnea. This cycle repeats itself. It is commonly seen in patients with heart failure and other conditions affecting the central nervous system. The patient in this scenario is not in distress, which is typical of Cheyne-Stokes respiration. Ataxic (Biot's) breathing is characterized by unpredictable irregular breaths with varying depths and irregular pauses; it is seen in patients with damage to the medulla. Kussmaul's respiration is deep, rapid, and labored breathing seen in metabolic acidosis. COPD with prolonged expiration is a characteristic finding in patients with chronic obstructive pulmonary disease, but in this case, the described breathing pattern is more consistent with Cheyne-Stokes respiration.

Correct Answer: B

Rationale: An ABI value less than 0.9 is indicative of mild peripheral arterial disease (PAD). In this case, an ABI of 0.85 falls below the 0.9 threshold, suggesting diminished blood flow to the lower extremities due to PAD. An ABI of 1.1 (Choice A) is actually elevated and not indicative of PAD. Values of 0.65 (Choice C) and 0.35 (Choice D) are significantly lower and would be consistent with moderate to severe PAD, rather than mild.

Correct Answer: B

Rationale: The most likely pathologic process based on the patient's symptoms and history would be an inflammatory process. The patient's joint pain, fever, and family history of rheumatoid arthritis suggest the possibility of an autoimmune inflammatory condition like rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disorder that primarily affects the joints, causing pain, swelling, and stiffness. The bilateral involvement of the wrists and fingers along with a family history of rheumatoid arthritis make this diagnosis more likely than an infectious, hematologic, or traumatic process in this case.

Correct Answer: A

Rationale: A splenic rub is a friction rub heard on auscultation in the left upper quadrant of the abdomen, typically in patients with an enlarged spleen. The rough grating noise heard during examination is due to the rubbing together of the inflamed or irritated peritoneal surfaces surrounding the spleen. This is a classic finding in patients with splenomegaly and is often associated with left upper quadrant pain. Bowel noises (borborygmi) are typically heard in the abdomen and are softer, gurgling, or rumbling in nature. Vascular noises are related to blood flow and are typically not associated with such sounds in the abdomen.

Correct Answer: C

Rationale: Lateral epicondylitis, commonly known as tennis elbow, is a condition characterized by pain and tenderness on the lateral (outside) aspect of the elbow. It is typically caused by overuse or repetitive strain of the extensor muscles in the forearm, leading to inflammation of the tendons attached to the lateral epicondyle of the humerus.

Correct Answer: C

Rationale: The described clinical presentation is consistent with internal hemorrhoids. The typical symptoms of internal hemorrhoids include painless rectal bleeding, protrusion from the anus during straining, and a feeling of incomplete evacuation. In this case, the protrusion is observed to be red, moist, and enlarges with bearing down, all indicative of internal hemorrhoids. The enlarged tender area felt on digital rectal examination supports the diagnosis. Additionally, the presence of blood on the glove after the examination is also suggestive of internal hemorrhoids causing bleeding. Anal fissures typically present with sharp pain during defecation and may have visible tears in the anal mucosa. External hemorrhoids are usually more painful and can be felt as a lump around the anus. Anorectal fistulas have different signs and symptoms, including discharge of pus and recurrent infections.

Correct Answer: B

Rationale: Peripheral arterial disease (PAD) is considered a coronary heart disease risk equivalent, meaning it confers a similar risk as having a history of coronary heart disease itself. Individuals with PAD have a significantly increased risk of cardiovascular events such as heart attack and stroke. Therefore, when assessing the 10-year coronary heart disease risk of the 40-year-old banker, having peripheral arterial disease would be a crucial factor to consider in addition to other risk factors like hypertension, exercise habits, and smoking history.

Correct Answer: B

Rationale: The information provided about Mr. M's shortness of breath being present for the past 10 days, worsening with activity, and relieved by rest are all objective findings. These are measurable and observable facts that can be documented by healthcare professionals through physical examination, assessment, and potentially diagnostic tests. Subjective information would involve Mr. M's personal feelings or descriptions of his symptoms, which are not included in the given information.