You ask a patient to draw a clock. He fills in all the numbers on the right half of the circle. What do you suspect?

Correct Answer: A

Rationale: Filling in all the numbers on just one side of the clock when asked to draw a clock suggests a visual field deficit, typically seen in hemianopsia. Hemianopsia is a visual impairment where half of the visual field is lost due to neurological damage or injury, such as a stroke. This causes the individual to have difficulty perceiving or attending to objects in the affected visual field. In this case, the patient's right visual field may be affected, leading to the specific pattern of filling numbers on the right half of the clock. It is essential to further assess and refer the patient for a complete visual field evaluation and neurological examination.

Correct Answer: C

Rationale: The appropriate counsel for the patient during the visit would be to give information about the reduction of fat, cholesterol, and calories because he is concerned about his weight. This option addresses the patient's concern and provides guidance on making healthier choices to manage weight. Referring the patient to a nutritionist because he is anorexic (Option A) is not appropriate based on the information provided. Reassuring the patient that he has a normal body weight (Option B) may not address his concerns about weight. Giving the patient information about reducing fat and cholesterol only because he is obese (Option D) does not cover all aspects of a healthy diet such as managing calorie intake.

Correct Answer: B

Rationale: The repeated scenario of finding a positive test result that does not correlate with the suspected disease indicates a lack of specificity for the test in question. In such cases, it is important to use the test when there is a higher suspicion for a specific condition that is known to correlate with the finding. By using the test selectively in situations where it is more likely to provide accurate information, its utility can be maximized and unnecessary further workup can be avoided. This approach allows for a more targeted and efficient use of resources in the diagnostic process.

Correct Answer: A

Rationale: The area of the arm that drains to the epitrochlear nodes includes the ulnar surface of the forearm and hand, little and ring fingers, and the ulnar side of the middle finger. The epitrochlear nodes are located in the medial aspect of the arm above the elbow, close to the insertion of the biceps brachii muscle. These nodes receive lymphatic drainage from the above-mentioned areas and play a role in the immune response against infections in these regions.

Correct Answer: B

Rationale: Orthopnea is a symptom characterized by difficulty breathing while lying flat that improves when sitting or standing upright. This symptom is specifically related to cardiovascular conditions, such as heart failure, in which fluid accumulates in the lungs when lying down. Considering the patient's complaint of breathlessness with activity and the need to assess for cardiovascular issues, asking about orthopnea would be most appropriate to gain insights into potential heart-related causes of the symptoms. Abdominal pain (A), hematochezia (C), and tenesmus (D) are not typically associated with cardiovascular conditions and are less relevant to the patient's presentation.

Correct Answer: A

Rationale: A sudden, painless unilateral vision loss may be caused by a retinal detachment. Retinal detachment occurs when the retina, which is the light-sensitive tissue lining the back of the eye, pulls away from its normal position. This can lead to visual disturbances, including sudden loss of vision in one eye. Retinal detachment can be a medical emergency and requires prompt evaluation and treatment to prevent permanent vision loss. Other conditions mentioned in the choices, such as corneal ulcer, acute glaucoma, and uveitis, may also cause vision problems but are less likely to present with a sudden and painless unilateral vision loss as a primary symptom.

Correct Answer: B

Rationale: The description of the headache as starting a few hours ago, associated with nausea, sensitivity to light, and being severe in intensity suggests a migraine headache. Migraine headaches are often accompanied by these symptoms, known as migraine features. The fact that the patient experiences headaches like this less than once a week and typically uses over-the-counter analgesics to relieve them is also suggestive of migraines. Tension headaches typically present as a more mild to moderate, band-like pressure around the head, without the associated symptoms of nausea and sensitivity to light. Cluster headaches are characterized by excruciating pain around one eye, often accompanied by other symptoms like redness or tearing in the eye. Analgesic rebound headaches occur due to overuse of pain medications and typically present as daily headaches that improve with the same medication that caused them in the first place.

Correct Answer: A

Rationale: Retinoblastoma typically presents with a white reflex, known as leukocoria or a cat's eye reflex, instead of the normal red reflex seen during ophthalmoscopy. The presence of red reflexes bilaterally in this case essentially rules out retinoblastoma as a differential diagnosis.

Correct Answer: A

Rationale: The symptom described - sharp, aching chest pain that increases with breathing - is typically associated with musculoskeletal issues. The pain worsening with breathing suggests a connection to the movements of the chest wall, which could involve the muscles, bones, or joints in that area. Conditions such as costochondritis (inflammation of the cartilage that connects a rib to the breastbone) or muscle strains in the chest wall are common causes of chest pain that worsens with breathing. This localization to the musculoskeletal system is based on the characteristics of the pain and how it is affected by breathing, helping to narrow down the differential diagnosis.