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127 questions
A40-year-old man with a history of alcohol abuse presents after an episode of binge drinking. He is complaining of epigastric pain, radiating to the back, associated with nausea and vomiting. On examination, he has marked tenderness in the epigastrium, with guarding, decreased bowel sounds, and moderate abdominal distention. Laboratory findings include leukocytosis and increased serum amylase and lipase. Abdominal roentgenograms demonstrate several dilated bowel loops in the upper abdomen. For the above patient with abdominal pain, select the most likely diagnosis. gastroenteritis regional enteritis acute appendicitis perforated peptic ulcer sigmoid diverticulitis acute pancreatitis
Which of the following patients is most likely to progress to develop cirrhosis?
A 40-year-old woman presents to the emergency room with a 3-day history of worsening abdominal pain, with nausea and vomiting. Examination reveals a low-grade fever and abdominal tenderness in the right upper quadrant with guarding, especially during inspiration. Laboratory findings include a mild leukocytosis and a slightly elevated bilirubin. For the above patient with abdominal pain, select the most likely diagnosis. gastroenteritis regional enteritis acute appendicitis perforated peptic ulcer sigmoid diverticulitis acute pancreatitis
A 50-year-old male with a history of alcohol abuse presents with acute pancreatitis. Which of the following facts about the patient is included in Ranson's criteria?
A42-year-old male with a history of ulcerative colitis has been to the ER three times over the past 6 months complaining of right upper quadrant pain, fever, and jaundice. His total bilirubin has fluctuated from 0.5 to 4.2 over this time. Workup has included an endoscopic retrograde cholangiopancreatography (ERCP) with the findings as shown in Figure. Of which of the following should the patient be informed?
A 48-year-old female with a history of mild congestive heart failure (CHF) treated with furosemide presents to the emergency room (ER) for evaluation of 24 hours of epigastric pain, nausea, and vomiting after eating a large meal in a restaurant. Previously, the patient had experienced intermittent right upper quadrant pain after eating. On examination, the patient has a temperature of 98.5°F and a pulse of 100. Her examinat ion is remarkable for epigastric tenderness to palpation, normal bowel sounds, and no rebound tenderness or guarding. Laboratory studies are as follows: Leukocyte count 4800/mm3 Alanine aminotransferase (ALT) 258 U/L Aspartate aminotransferase (AST) 287 U/L Alkaline phosphatase, serum 350 U/L Bilirubin (total) 2.0 mg/dL Bilirubin (indirect) 0.4 mg/dL Amylase 2865 U/L Lipase 3453 U/L Which of the following is the most likely diagnosis?
Which of the following is characteristic of Hirschsprung's disease?
An 85-year-old man presents to the emergency room with an acute onset of midepigastric pain, nausea, vomiting, and hiccups starting 2 days ago. He is unable to keep any food down. Past history is pertinent for a long-standing hiatal hernia, hypertension, and diet-controlled diabetes. Examination reveals vital signs of pulse rate 82/min, BP 100/52 mmHg, respiratory rate 16/min, and temperature 97.2°F. The patient is in no acu te distress, but has epigastric tenderness without guarding. Laboratory analysis revealed a hematocrit of 46 and a normal white blood cell (WBC) count. A chest x-ray is shown in Figure. A fluoroscopically guided NG tube was placed using contrast, and his stomach was decompressed.After adequate fluid and electrolyte resuscitation, an upper gastrointestinal (UGI) contrast study was obtained and is shown in Figure. Which of the following is the most likely diagnosis?
An 85-year-old man presents to the emergency room with an acute onset of midepigastric pain, nausea, vomiting, and hiccups starting 2 days ago. He is unable to keep any food down. Past history is pertinent for a long-standing hiatal hernia, hypertension, and diet-controlled diabetes. Examination reveals vital signs of pulse rate 82/min, BP 100/52 mmHg, respiratory rate 16/min, and temperature 97.2°F. The patient is in no acu te distress, but has epigastric tenderness without guarding. Laboratory analysis revealed a hematocrit of 46 and a normal white blood cell (WBC) count. A chest x-ray is shown in Figure. A fluoroscopically guided NG tube was placed using contrast, and his stomach was decompressed.After adequate fluid and electrolyte resuscitation, an upper gastrointestinal (UGI) contrast study was obtained and is shown in Figure. Which of the following is the most appropriate next step in management?
From the below clinical indications, choose an option for use of immune globulin (IG) in Rubella prophylaxis
In your internal medicine clinic you are caring for a 42-year-old woman with hereditary nonpolyposis colon cancer (HNPCC), Lynch syndrome II, which is a hereditary, autosomal dominant, cancer syndrome that results from a mutation in a mismatch deoxyribonucleic acid (DNA) repair gene. These patients have a lifetime risk of colon cancer nearly 6080%, but are also at risk for several other malignancies. For which gynecologic malignancy is this woman most at risk?
From the below the clinical indications, choose an option for use of immune globulin (IG) in Hepatitis C prophylaxis indicated
From the below the clinical indications, choose an option for use of immune globulin (IG) in Measles prophylaxis
Which of the following conditions usually causes hypoglycemia at birth?
A 16-year-old girl with a history of ulcerative colitis managed with steroid therapy presents to the emergency department with a 36-hour history of nausea, crampy abdominal pain, and severe bloody diarrhea. On examination, the patient is febrile and pale, with a blood pressure of 90/60 mmHg and heart rate of 130 beats/min. Her abdomen is distended and diffusely tender. Acomplete blood count (CBC) demonstrates a leukocytosis with a left shift. The patient receives IV fluid resuscitation and nasogastric (NG) tube decompression. Further therapeutic interventions should include which one of the following?
For the screening tests listed below, select the screening schedule that is appropriate for women (as per the U.S. Preventive Services Task Force [USPSTF], The Guide to Clinical Preventive Services, 2006) Screening for hepatitis B do not routinely screen yearly over age 50
From the below the clinical indications, choose an option for use of immune globulin (IG) in Hepatitis A prophylaxis
For each of the diseases listed, select the arthropod vector responsible for its transmission. Yellow fever
From the below the clinical indications, choose an option for use of immune globulin (IG) in Hepatitis B prophylaxis
A2-year-old child presents with a 2-day history of painless rectal bleeding. On examination, the child is pale with tachycardia. The abdomen is nondistended and nontender. There is dark blood on rectal examination. The child has the following imaging study. Which of the following is the most appropriate management?