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A 15-year-old high school sophomore comes to the clinic
for evaluation of a 3-week history
of sneezing; itchy, watery eyes; clear nasal discharge; ear
pain; and nonproductive cough. Which
is the most likely pathologic process?
A) Infection
B) Inflammation
C) Allergic
D) Vascular - Answer-C) Allergic
This description is most consistent with allergic rhinitis.
A 19-year old-college student presents to the emergency
room with fever, headache, and
neck pain/stiffness. She is concerned about the possibility
of meningococcal meningitis.
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Several of her dorm mates have been vaccinated, but she
hasn't been. Which of the following
physical examination descriptions is most consistent with
meningitis?
A) Head is normocephalic and atraumatic, fundi with sharp
discs, neck supple with full range
of motion
B) Head is normocephalic and atraumatic, fundi with sharp
discs, neck with paraspinous
muscle spasm and limited range of motion to the right
C) Head is normocephalic and atraumatic, fundi with
blurred disc margins, neck tender to
palpation, unable to perform range of motion
D) Head is normocephalic and atraumatic, fundi with
blurred disc margins, neck supple with
full range of motion - Answer-C) Head is normocephalic
and atraumatic, fundi with blurred disc margins, neck
tender to
palpation, unable to perform range of motion
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Blurred disc margins are consistent with papilledema, and
neck tenderness and lack of range of motion are
consistent with neck stiffness, which in this scenario is
likely to be caused
by meningeal inflammation. Kernig's and Brudzinski's
signs are also helpful in testing for meningeal irritation on
exam.
A 37-year-old nurse comes for evaluation of colicky right
upper quadrant abdominal pain. The pain is associated
with nausea and vomiting and occurs 1 to 2 hours after
eating greasy foods. Which one of the following physical
examination descriptions would be most consistent with
the diagnosis of cholecystitis?
A) Abdomen is soft, nontender, and nondistended, without
hepatosplenomegaly or masses.
B) Abdomen is soft and tender to palpation in the right
lower quadrant, without rebound or
guarding.
C) Abdomen is soft and tender to palpation in the right
upper quadrant with inspiration, to the
point of stopping inspiration, and there is no rebound or
guarding.
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D) Abdomen is soft and tender to palpation in the mid-
epigastric area, without rebound or
guarding. - Answer-C) Abdomen is soft and tender to
palpation in the right upper quadrant with inspiration, to
the
point of stopping inspiration, and there is no rebound or
guarding.
In cholecystitis, the pain, which originates from the
gallbladder, is located in the
right upper quadrant. Severity of pain with inspiration that
is sufficient to stop further inhalation
is also known as Murphy's sign, which, if present, is further
indicative of inflammation of the
gallbladder.
A patient presents for evaluation of a sharp, aching chest
pain which increases with breathing. Which anatomic area
would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary