You are at your family reunion playing football when your uncle takes a hit to his right lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a very remote area. What would your next step be?

Correct Answer: D

Rationale: The correct answer is D: Examine him for tenderness over the injured area. Rationale: 1. Start with a physical examination to assess for tenderness directly over the injured area. 2. Rib fractures often present with localized tenderness upon palpation. 3. If tenderness is present, suspect a rib fracture and advise immobilization. 4. Advise against unnecessary movement to prevent further injury. Summary: - Choice A: Calling a medevac helicopter is premature without assessing the severity of the injury. - Choice B: Driving him 4 hours away could worsen his condition without proper assessment. - Choice C: Pressing on the sternum and spine simultaneously is not recommended as it can cause further harm.

Correct Answer: A

Rationale: The correct answer is A because a waist circumference of 38 inches for a male is a clinical identifier of metabolic syndrome. This measurement reflects abdominal obesity, a key component of metabolic syndrome. Excess abdominal fat is associated with insulin resistance, high blood pressure, and dyslipidemia, which are all features of metabolic syndrome. Choice B is incorrect because a waist circumference of 34 inches for a female is not the correct measurement for identifying metabolic syndrome in females. Choice C is incorrect because a blood pressure of 134/88 for a male, while elevated, is not a specific clinical identifier of metabolic syndrome. Choice D is incorrect because a blood pressure of 128/84 for a female, although slightly elevated, is not a specific clinical identifier of metabolic syndrome.

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: B

Rationale: The correct answer is B. Dividing the breast into quadrants and inspecting each systematically is the most effective pattern of palpation for breast cancer because it ensures thorough coverage of the entire breast, making it easier to detect any abnormalities. This method allows for a structured approach, reducing the likelihood of missing any potential signs of cancer. A: Beginning at the nipple and making an ever-enlarging spiral may not cover all areas of the breast equally, potentially leading to missed abnormalities. C: Examining in lines resembling mowing a lawn may also result in uneven coverage and potentially missing crucial areas. D: Beginning at the nipple and palpating outward in a stripe pattern may not provide comprehensive coverage of the entire breast, increasing the risk of overlooking abnormalities.

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.