You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate slightly. Both are noted to constrict briskly when the light is placed on the right eye. What is the most likely problem?

Correct Answer: C

Rationale: The correct answer is C: Efferent nerve damage on the right. When both pupils dilate but only the right pupil constricts briskly in response to light, it indicates a problem with the efferent pathway controlling the right eye's pupillary constriction. This suggests damage to the parasympathetic fibers of the oculomotor nerve (CN III) that innervate the pupillary sphincter muscle. Choices A and B (optic nerve damage) do not involve pupil constriction. Choice D (efferent nerve damage on the left) would not explain the brisk constriction in the right eye.

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: C

Rationale: The correct answer is C: Mitral valve defect. This is because the mitral valve is best heard in the left lateral decubitus position. In this position, the heart rotates, bringing the mitral valve closer to the chest wall, making it easier to auscultate any abnormalities such as murmurs. Aortic (A), pulmonic (B), and tricuspid (D) valve defects are not typically better heard in the left lateral decubitus position, so they are incorrect choices.

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.