The ‘cold viruses’ are spread rapidly from person to person. Children are the major reservoir of cold viruses, often acquiring a new virus from another child in school or day care. In class, we talked about the greatest source of spread, and the most common portals for entry of the virus. What is the greatest source of spread?

Choice A reason: Yellowing of the sclera (icterus) is expected with high bilirubin in cirrhosis, as impaired liver function causes bilirubin accumulation. Conjugated bilirubin deposits in the sclera, visible early due to its vascularity, making this a correct clinical finding.

Choice B reason: Dark brown urine results from excess conjugated bilirubin excreted by the kidneys in cirrhosis. High bilirubin levels overwhelm liver clearance, leading to bilirubinuria, which darkens urine, making this a correct and common finding in this condition.

Choice C reason: Frothy light-colored urine is not associated with high bilirubin. Light urine suggests dilute urine or low bilirubin excretion, opposite to the dark urine seen in cirrhosis, making this an incorrect finding for this patient’s condition.

Choice D reason: Jaundice of the skin occurs with elevated bilirubin in cirrhosis, as bilirubin deposits in tissues. This yellowish discoloration is a hallmark of liver dysfunction, reflecting impaired bilirubin metabolism, making this a correct clinical manifestation.

Choice E reason: Bluish mucous membranes suggest cyanosis from hypoxemia, not related to high bilirubin. Cirrhosis causes jaundice, not oxygenation issues, unless complicated by other conditions, making this an incorrect finding for this patient.

Choice A reason: A fracture is a bone break, not a joint surface misalignment. Subluxation describes partial joint displacement, matching John’s injury with pain and limited motion, so this is incorrect for the shoulder injury.

Choice B reason: A sprain involves ligament stretching or tearing, not joint surface displacement. Subluxation is partial joint misalignment, fitting the described trauma, so this is incorrect for John’s specific shoulder injury.

Choice C reason: Subluxation is the partial loss of contact between joint surfaces, causing pain and limited motion, as seen in John’s shoulder after trauma. This matches the imaging findings, making it the correct term.

Choice D reason: Dislocation is complete joint displacement, not partial. John’s injury involves partial contact loss, aligning with subluxation, not full dislocation, so this is incorrect for the described shoulder injury.