You are palpating the apical impulse in a patient with heart disease and find that the amplitude is diffuse and increased. Which of the following conditions could be a potential cause of an increase in the amplitude of the impulse?

Correct Answer: D

Rationale: The correct answer is D, cardiomyopathy. Cardiomyopathy is a disease of the heart muscle that can lead to an increase in the size and strength of the heart muscle, resulting in an increased amplitude of the apical impulse. This is due to the heart working harder to pump blood effectively. Hypothyroidism (choice A) typically does not cause an increase in the amplitude of the apical impulse. Aortic stenosis (choice B) and mitral stenosis (choice C) both result in pressure or volume overload on specific chambers of the heart, but they do not directly lead to diffuse and increased amplitude of the apical impulse like cardiomyopathy does. In summary, an increase in the amplitude of the apical impulse is more likely to be caused by cardiomyopathy due to the increased workload on the heart muscle, compared to the other conditions provided in the choices.

Correct Answer: C

Rationale: Step 1: Identify the characteristics of the lesion described - dome-shaped, in dermis, benign, closed sac attached to epidermis. Step 2: A cutaneous cyst fits all these characteristics - it is a benign closed sac in the dermis with attachment to the epidermis. Step 3: Keloid (A) is an overgrowth of scar tissue, not a closed sac lesion. Tophi (B) are deposits of uric acid crystals, not a sac. Chondrodermatitis (D) is inflammation of cartilage and skin, not a closed sac lesion. Summary: A cutaneous cyst is the correct choice as it matches all the characteristics given, while the other options do not fit the description provided.

Correct Answer: B

Rationale: Correct Answer: B Rationale: 1. Adaptive questioning involves tailoring the questioning style to the patient's responses and needs to gather more detailed information. 2. Reassuring the patient that the symptoms are benign and not related to cancer is not a component of adaptive questioning as it can lead to bias and may hinder the patient from providing accurate information. 3. Directed questioning (A) helps to gather specific information systematically, offering choices (C) helps clarify symptoms, and asking for specific details (D) aids in understanding the patient's experiences. 4. By reassuring the patient prematurely, you may miss important details or dismiss potential concerns that could be relevant to the patient's condition.

Correct Answer: B

Rationale: The correct answer is B: Lung cancer. The patient's symptoms of chronic smoking, persistent cough, and weight loss are concerning for malignancy. Lung cancer is a common consequence of long-term smoking and can present with these symptoms. Chronic bronchitis (A) typically presents with cough and mucus production but not necessarily weight loss. Emphysema (C) is characterized by shortness of breath and is less likely to cause weight loss. Asthma (D) usually presents with wheezing and shortness of breath, not typically weight loss.

Correct Answer: B

Rationale: The correct answer is B: Spinal stenosis. The symptoms described suggest neurogenic claudication, which is a hallmark of spinal stenosis. Pain worsening with ambulation and improving with lumbar flexion is characteristic of spinal stenosis due to narrowing of the spinal canal leading to compression of nerves. Ankylosing spondylitis (A) presents with inflammatory back pain and stiffness, not neurogenic claudication. Bursitis (C) involves inflammation of bursae, not typically associated with leg pain and numbness. Cauda equina syndrome (D) presents with sudden-onset severe back pain, urinary retention, and saddle anesthesia, which are not consistent with the described symptoms.

Correct Answer: A

Rationale: The correct answer is A: Provide positive pressure ventilation with supplemental oxygen. This is the most appropriate action as the patient is cyanotic, responsive to painful stimuli, and exhibiting stridorous respirations, indicating potential airway compromise. Providing positive pressure ventilation with supplemental oxygen can help improve oxygenation and support the patient's breathing. Summary of other choices: B: Obtaining vital signs is important, but in this urgent situation, addressing the airway and breathing takes precedence. C: Contacting medical direction may delay essential treatment. Immediate intervention is crucial in this scenario. D: Applying a pulse oximeter can provide valuable information, but administering oxygen and ensuring adequate ventilation should be the priority in a patient with compromised breathing.

Correct Answer: A

Rationale: The correct answer is A because syphilis during pregnancy can lead to adverse outcomes for the fetus, such as spontaneous abortion or congenital syphilis. This is due to the ability of the Treponema pallidum bacterium to cross the placenta and infect the fetus. Testing pregnant women for syphilis helps identify and treat the infection early to prevent these complications. Choice B is incorrect because hormonal changes do not trigger activation of latent syphilis. Choice C is incorrect as syphilis can be transmitted to the fetus at any point during pregnancy, not just in the third trimester. Choice D is incorrect because while untreated syphilis can have various complications, neonatal respiratory distress is not a direct consequence of syphilis infection during pregnancy.

Correct Answer: A

Rationale: The correct answer is A because in an older adult with an indwelling urinary catheter, a fever >100°F can be a sign of urinary tract infection (UTI) or urosepsis. Given her acute decline in mental status and fever, empiric antibiotic therapy is warranted to treat a potential infection. Choice B is incorrect because older adults with indwelling catheters are at increased risk for UTIs and bloodstream infections. Choice C is incorrect as obtaining a urine culture is important to confirm the diagnosis and guide appropriate antibiotic therapy. Choice D is incorrect as the duration of antibiotic treatment for a UTI is typically longer than 3 days.

Correct Answer: B

Rationale: The correct answer is B because in Munchausen syndrome by proxy, the patient only exhibits symptoms under the direct care or supervision of the abuser. This is because the abuser intentionally causes or fabricates symptoms in the victim to gain attention or sympathy. In contrast, the other choices are incorrect. A is incorrect because the injury is inflicted by the abuser, not self-inflicted by the patient. C is incorrect as the caregiver is the one perpetrating the abuse. D is incorrect because the abuser is often overly involved and manipulative, rather than inattentive and uncaring.