You are examining an elderly man and notice the following: Decreased vibration sense in the feet and ankles, diminished gag reflex, right patellar reflex
... [Show More] less than the left, and diminished abdominal reflexes. Which of these is abnormal?
• Decreased vibration sense
• Diminished gag reflex
• Diminished right patellar reflex compared to the left
• Diminished abdominal reflexes
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A 68-year-old retired farmer presents to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?
• Actinic keratosis
• Seborrheic keratosis
• Basal cell carcinoma
• Squamous cell carcinoma
• A 14-year-old junior high school student is brought in by his mother and father because he seems to be developing breasts. The mother is upset because she read on the Internet that smoking marijuana leads to breast enlargement in males. The young man adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is unremarkable. His parents are both in good health. He has two older brothers who never had this problem. On examination, you see a mildly overweight teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise his examination is normal. He is agreeable to taking a drug test.
What is the most likely cause of his gynecomastia?
• Breast cancer
• Imbalance of hormones of puberty
• Drug use
• Alcohol use
• A 17-year-old female presents to your office, complaining of a clear discharge
from her right breast for 2 months. She states that she noticed it when she and her boyfriend were “messing around” and he squeezed her nipple. She continues to have this discharge anytime she squeezes that nipple. She denies any trauma to her breasts. Her past medical history is unremarkable. She denies any pregnancies. Both of her parents are healthy. She denies using tobacco or illegal drugs and drinks three to four beers a week. On examination, her breasts are symmetric with no skin changes. You are able to express clear discharge from her right nipple. You feel no discrete masses and her axillae are normal. The remainder of her heart, lung, abdominal, and pelvic examinations are unremarkable. A urine pregnancy test is negative.
What cause of nipple discharge is the most likely in her circumstance?
• Benign breast abnormality
• Breast cancer
• Nonpuerperal galactorrhea
• Pagets disease
• A 26-year-old flight attendant presents in for a third trimester prenatal visit. She has had prenatal care since her sixth week of pregnancy. She has no complaints today and her prenatal course has been unremarkable. Today her blood pressure and weight gain are appropriate, and her urine is unremarkable. You have a first-year medical student shadowing you, so you ask the student to get Doptones and measure the patient's uterus in centimeters. The nurse practitioner student promptly reports fetal heart tones of 140, but he is having difficulty obtaining the correct measurement. He knows one end of the tape goes over the uterine fundus.
From what inferior anatomic position should the tape be placed?
• Vagina
• Clitoris
• Pubic symphysis
• Umbilicus
• A 58-year-old gardener presents to your office for evaluation of a new lesion on her upper chest. The lesion appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a rough, wart like texture on palpation. Based on this description, what is your most likely diagnosis?
• Actinic keratosis
• Seborrheic keratosis
• Basal cell carcinoma
• Squamous cell carcinoma
• Which of the following represents age-related changes in the lungs?
• Decrease in chest wall compliance
• Speed of expiration increases
• Increase in respiratory muscle strength
• Increased elastic recoil of lung tissue
• A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and
fussiness. The ear examination is as follows: external ear, normal appearance and no tenderness with manipulation; canal, normal diameter without evidence of inflammation; tympanic membrane, bulging, erythematous, and opaque. Insufflation is deferred due to pain. What is the most likely condition here?
• Otitis externa
• Cholesteatoma
• Ruptured tympanic membrane
• Otitis media
• A 28-year-old musician presents to your clinic, complaining of a “spot” on his penis. He states his partner noticed it 2 days ago and it hasn't gone away. He says it doesn't hurt. He has had no burning with urination and no pain during
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