Jarvis Physical Examination and Health Assessment Test Bank

Correct Answer: D

Rationale: The correct answer is D because asking the patient to describe what happened will provide crucial information about the onset, nature, and potential cause of the knee pain. This open-ended question allows the patient to share their experience freely, aiding in accurate diagnosis and appropriate treatment planning. Option A focuses solely on pain intensity, which is important but not as comprehensive as understanding the context of the pain (D). Options B and C are more specific to past injuries and onset time, respectively, which are relevant but not as immediate and all-encompassing as asking the patient to describe the current issue (D).

Correct Answer: B

Rationale: The correct answer is B: Small amplitude, weak. In congestive heart failure, the heart's ability to pump effectively is compromised, leading to decreased cardiac output. This results in a weakened pulse with reduced amplitude. Palpating a small, weak pulse in this patient is expected due to poor cardiac function. Choices A and C are incorrect because a large, forceful pulse is not expected in congestive heart failure, and a normal pulse may not reflect the compromised cardiac function. Choice D, bigeminal, refers to an abnormal rhythm characterized by every other heartbeat being premature and is not typically associated with congestive heart failure.

Correct Answer: D

Rationale: The correct answer is D: Repeat PSA in 6 months. In this case, the patient's PSA levels have decreased from 12 ng/mL to 10 ng/mL after treatment with tamsulosin and removal of the Foley catheter. Given the improvement in PSA levels, it is reasonable to monitor for further changes before considering invasive procedures like transrectal ultrasound and biopsy (choice A), which may not be necessary at this time. Empiric finasteride (choice B) is not indicated as the patient is already responding well to tamsulosin. A bone scan (choice C) is not necessary at this stage as there are no indications of metastasis. Therefore, repeating the PSA in 6 months allows for continued monitoring of the patient's prostate health without subjecting him to unnecessary procedures.

Correct Answer: B

Rationale: The correct answer is B: A sebaceous cyst. A sebaceous cyst typically presents as a lump underneath the skin that can be squeezed to release a cheesy substance, consistent with Jacob's description. The formation of a prominent dimple when gently pinched is characteristic of a cyst, indicating it is filled with fluid or semi-solid material. Sebaceous cysts are usually benign and can grow slowly over time. Incorrect choices: A: An enlarged lymph node - Unlikely as lymph nodes are typically not associated with cheesy discharge or the formation of a dimple when pinched. C: An actinic keratosis - Unlikely as actinic keratosis is a precancerous skin condition caused by sun exposure, not presenting with cheesy discharge or a dimple. D: A malignant lesion - Unlikely as malignant lesions usually do not produce cheesy discharge and are more aggressive in growth compared to a sebaceous cyst.

Correct Answer: D

Rationale: The correct answer is D: Exercise and weight loss. The American College of Rheumatology recommends this intervention as first-line therapy for osteoarthritis and rheumatoid arthritis due to its proven benefits in reducing pain, improving joint function, and overall quality of life. Exercise helps strengthen muscles around the joints, improve flexibility, and reduce stiffness. Weight loss can also alleviate pressure on the joints, especially in weight-bearing joints. A: Diagnostic workup to rule out rheumatoid arthritis - This is not the first-line therapy but rather a step in the diagnostic process. B: NSAID use at the lowest effective dose - While NSAIDs may help with pain management, they are not recommended as the first-line therapy due to potential side effects. C: Acetaminophen use up to 4 grams/day - Acetaminophen can be used for pain relief, but it is not as effective as exercise and weight loss in managing osteoarthritis or rheumatoid arthritis symptoms