You are working in a college health clinic and seeing a young woman with a red, painful, swollen DIP joint on the left index finger. There are also a few papules, pustules, and vesicles on reddened bases, located on the distal extremities. This would be consistent with which of the following?

Correct Answer: D

Rationale: The description provided indicates a presentation consistent with gonococcal arthritis. Gonococcal arthritis is an infectious arthritis caused by the bacteria Neisseria gonorrhoeae. Symptoms typically include red, swollen, and painful joints, especially affecting the distal joints of the limbs. The presence of papules, pustules, and vesicles on reddened bases at the distal extremities is characteristic of disseminated gonococcal infection. In women, the DIP joint involvement in the finger can be indicative of this condition. Prompt diagnosis and treatment with antibiotics are essential to prevent complications associated with gonococcal arthritis. It is important to consider a sexually transmitted infection like gonorrhea in young patients presenting with joint symptoms and cutaneous findings.

Correct Answer: B

Rationale: Leaning forward in the upright position increases venous return and systemic vascular resistance, which can help accentuate the intensity of aortic regurgitation murmur. This position helps to bring the heart closer to the chest wall, making the murmur easier to auscultate and potentially increasing its intensity.

Correct Answer: B

Rationale: The patient described is most likely suffering from an external hemorrhoid. External hemorrhoids are swollen veins located near the opening of the anus, often resulting from increased pressure in the rectal area. The presence of a swollen bluish ovoid mass containing a blood clot is characteristic of an external hemorrhoid. The pain experienced during digital rectal examination further supports this diagnosis, as external hemorrhoids are typically painful when touched. In this case, there are no palpable masses within the anus or rectum, ruling out anorectal cancer or internal hemorrhoids. Anal fissures are small tears in the lining of the anus, which would present differently from the described swollen mass with a blood clot.

Correct Answer: C

Rationale: In the context of visual acuity, the numbers in the ratio 20/100 represent a comparison between the patient's vision and normal vision. Specifically, a visual acuity of 20/100 means that the patient can see at 20 feet what a person with normal vision can see at 100 feet. This indicates that the patient's vision is reduced, as she needs to be closer to see the same level of detail compared to someone with normal vision.

Correct Answer: D

Rationale: By telling the patient what to expect, giving her the option to stop or take a break, and checking in with her multiple times during the examination, you are accomplishing all of the above.

Correct Answer: C

Rationale: The most likely cause of neck pain in this scenario is a cervical sprain. A cervical sprain is an injury to the ligaments in the neck as a result of sudden force or trauma, such as a motor vehicle collision. The symptoms of a cervical sprain typically include pain, stiffness in the neck, and muscle spasm. The fact that the patient has pain and spasm over the paraspinous muscles on one side of the neck, along with pain during active range of motion, is characteristic of a sprain. It is important to consider this diagnosis in individuals who have recently experienced trauma to the neck region. Treatment for a cervical sprain usually includes pain management, rest, and gentle stretching exercises to help with recovery.

Correct Answer: D

Rationale: The closed fist gesture over the sternum to describe chest pain is a typical characteristic of angina pectoris. Angina pectoris is chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. The gesture of clenching a fist over the sternum is often used to describe the tight, squeezing, or pressure-like discomfort experienced with angina. This type of chest pain is typically triggered by physical or emotional stress and is relieved by rest or medications like nitroglycerin. Considering the patient's age, smoking history, and the description of the chest pain gesture, angina pectoris should be a top consideration in this case.

Correct Answer: C

Rationale: The information provided, specifically about the patient having three cesarean sections, is most appropriate to be placed under the Obstetrics/gynecology category. This category focuses on the healthcare of women, particularly during pregnancy, childbirth, and postpartum period, which includes details about cesarean sections. This information is not related to adult illnesses, surgeries in general, or psychiatric conditions.

Correct Answer: C

Rationale: By connecting the patient's presenting symptoms (wheezing when exposed to cats) and family history of asthma, you have identified asthma as the most likely diagnosis for the 5-year-old girl. This initial conclusion, based on the available information, is known as a working diagnosis. Further evaluation and testing may be required to confirm the diagnosis, but at this stage, you have established a preliminary understanding of the likely condition affecting the patient.