You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a history of hypertension, which is well-controlled on his current medications. He does not smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his 10- year coronary heart disease risk. Which of the following conditions is considered to be a coronary heart disease risk equivalent?

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: D

Rationale: In this situation, it is important to prioritize active listening over taking detailed notes. By pushing away from the keyboard or putting down your pen, you are signaling to the patient that you are fully present and engaged in listening to their story. This will help foster trust and encourage the patient to continue sharing their personal history. Taking notes can be done later, but the immediate focus should be on providing a supportive and attentive environment for the patient to share their experiences.

Correct Answer: C

Rationale: The characteristics described - being louder and higher in pitch, with a short silence between inspiration and expiration, and expiration being longer than inspiration - are indicative of the bronchial lung sound. The bronchial sound is typically heard over the trachea area and can be louder and higher-pitched than other lung sounds due to conduction of sounds through the bronchial tree. The short silence between inspiration and expiration is due to the short expiratory phase during which air rushes out quickly, whereas expiration is longer than inspiration in this sound due to the increased airflow velocity during expiration.

Correct Answer: B

Rationale: When a person's thought process is characterized by speaking rapidly, jumping from topic to topic, and making loose or tangential connections between ideas, it is referred to as a "flight of ideas." This type of thought process is commonly seen in conditions such as mania, where there is a marked increase in goal-directed activity, energy, and racing thoughts. In contrast, derailment refers to a disorganized thought process where the individual is unable to maintain a logical progression in their speech. Circumstantiality involves providing excessive and unnecessary detail before eventually reaching the main point. Incoherence is used to describe speech that is incomprehensible and disjointed, lacking any logical connection between ideas.

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: 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: A

Rationale: In hyperthyroidism, there is an increased metabolic rate and sympathetic activity. This can lead to increased cardiac output and left ventricular mass, causing the heart to work harder. As a result, the left ventricle becomes hypertrophied, leading to a sustained, high-amplitude Point of Maximum Impulse (PMI) that is displaced laterally and downward. This can be felt during a physical examination as a strong and forceful PMI. In contrast, conditions like anemia, fever, and hypertension are not typically associated with a sustained, high-amplitude PMI.

Correct Answer: C

Rationale: The ankle-brachial index (ABI) is the appropriate test to initially evaluate for peripheral vascular disease in this case. ABI is a simple, non-invasive test that compares the blood pressure in the arms to the blood pressure in the legs. A lower ABI value indicates a higher likelihood of peripheral arterial disease (PAD). Given the patient's presentation of leg swelling and risk factors like smoking and hypertension, ABI can help determine the presence and severity of PAD, guiding further management and treatment decisions.

Correct Answer: B

Rationale: Secondary amenorrhea refers to the absence of menstruation for 3-6 months in a woman who previously had regular menstrual cycles. In this case, Jean's lack of menstruation after giving birth and while breastfeeding her child for 6 months likely indicates secondary amenorrhea. This temporary suppression of ovulation and menstruation commonly occurs during breastfeeding due to the high levels of the hormone prolactin, which is responsible for milk production and can inhibit ovulation and menstruation. It is a natural phenomenon known as lactational amenorrhea. Once breastfeeding decreases or stops, menstruation usually resumes within a few months.