Physical Examination and Health Assessment 8th Edition Test Bank

Correct Answer: D

Rationale: The presence of a palpable pulsatile abdominal mass in a patient like Mr. Martin, who is a smoker and at risk for vascular diseases, is concerning for an abdominal aortic aneurysm (AAA). Immediate referral to a vascular surgeon is essential for further evaluation and management. AAA can be a life-threatening condition if left untreated, as it can lead to rupture and severe internal bleeding. Therefore, prompt specialist evaluation and monitoring are crucial in such cases. Waiting for 3 or 6 months for reevaluation could potentially lead to a delayed diagnosis and increase the risk of complications. Abdominal ultrasound is typically the diagnostic test of choice to confirm the presence and size of the aneurysm.

Correct Answer: B

Rationale: Urticaria, commonly known as hives, typically presents as raised, red, and itchy welts or wheals that can appear and disappear in various locations on the skin. Each lesion tends to last for many minutes before resolving and may be associated with itching or a burning sensation. Urticaria is often triggered by an allergic reaction to food, medications, insect bites, or other substances. The clinical presentation described in the question, involving an itchy rash that appears and disappears in different areas, is consistent with urticaria.

Correct Answer: C

Rationale: Pain in the calf is a common symptom of atherosclerosis in the lower extremities, also known as peripheral artery disease (PAD). Atherosclerosis is the buildup of plaque in the arteries, leading to reduced blood flow. The calf pain associated with PAD is often described as cramping, aching, or fatigue that occurs during walking and is relieved with rest. This is called intermittent claudication. Thigh, knee, and ankle pain could have other causes, but calf pain specifically raises concerns for atherosclerosis in the lower extremities.

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: D

Rationale: A subconjunctival hemorrhage is a common and benign condition characterized by blood in the space between the conjunctiva and sclera of the eye. The condition often presents as a painless, sharply demarcated area of redness on the white part of the eye, typically without associated discharge or visual disturbances. In this case, the absence of eye pain, discharge, visual disturbances, and clear cornea make subconjunctival hemorrhage the most likely diagnosis. The history of forceful coughing with a recent cold is also consistent with the increased intraocular pressure leading to a rupture of a small blood vessel, resulting in the hemorrhage. Treatment is not usually required as the condition is self-limiting and resolves on its own over time.