- Joined
- Jul 7, 2014
- Messages
- 13
- Reaction score
- 1
1. previously healthy 47yo man comes to physician because of 2wk history of fatigue and progressive abdominal swelling. P/E abdominal distension and shifting dullness. Bowel sounds normal. No tenderness, mass, or organomegaly. Diagnostic paracentesis yields 50ml milky chylous fluid. Cause of findings?
choose between lymphoma or portal vein thrombosis? Both can cause chylous ascites. The latter one is a rare cause of chylous ascites but given this pt history (previously healthy, no mass, no other symptoms of lymphoma), is idiopathic portal vein thrombosis more likely?
2. 18YO man to ED because of pain in right hip and flank after MVA. He’s alert and stable. P/E abrasions, ecchymoses, tenderness over right iliac crest, and abrasions on right flank. U/A show gross blood. X-ray of cervical spine normal. Next step?
a) CT abdomen w/ contrast
b) MRI pelvis
c) radionuclide renal scan
d) selective renal angiography
3) cystoscopy
3. A 52-year-old woman with well-controlled type 2 diabetes mellitus is brought to the emergency department 24 hours after the onset of abdominal pain. She has vomited three times in the emergency department. She appears toxic. She is 157 cm (5 ft 2 in) tall and weighs 95 kg (210 lb); BMI is 38 kg/m2. Her temperature is 39.5°C (103.1°F), pulse is 120/min, respirations are 28/min, and blood pressure is 160/90 mm Hg. Examination shows scleral icterus. Breath sounds are decreased over the lower lung fields bilaterally. The abdomen is mildly tender; bowel sounds are normal. Rectal examination shows no abnormalities. Laboratory studies show:
Hemoglobin 12.6 g/dL
Leukocyte count 16,000/mm3
Segmented neutrophils 70%
Bands 10%
Lymphocytes 20%
Serum
Na+ 130 mEq/L
Cl− 90 mEq/L
K+ 5.0 mEq/L
HCO3− 14 mEq/L
Glucose 600 mg/dL
Bilirubin
Total 5.2 mg/dL
Direct 2.0 mg/dL
Alkaline phosphatase 350 U/L
AST 300 U/L
Amylase 100 U/L
Which of the following is the most likely diagnosis?
A) Acute pancreatitis
B) Amebic liver abscess
C) Biliary cirrhosis
D) Cholangitis, ascending
E) Chronic cholecystitis
F) Hepatitis
G) Pancreatic cancer
4. following diagnosis of ectopic pregnancy in a married 25yo woman, an abdominal operation is performed. However, examination of abdomen shows normal uterine pregnancy but an acutely inflamed appendix. An appendectomy is performed despite the fact that operative permit authorized only a surgical procedure for ectopic pregnancy.
a)appropriate in view of medical necessity to remove inflamed appendix
b)appropriate only if consent was obtained from spouse
c)inappropriate, because it constituted an unauthorized extension of field of surgery
d)inappropriate, because the pt had not previously been informed of risks associated with an appendectomy
choose C?
5. 80yo woman atherosclerosis and chornic atrial fibrillation has had severe midabdominal pain for 4 hours. P/E mild abdominal tenderness and absent bowel sounds; no masses or signs of peritoneal irritation. Stool occult blood positive. Wbc 28,340 w/ 65% segmented neutrophils, 20% bands, 15% lymphocytes. PH 7.18, Pco2 35, Po2 62. X-ray of abdomen show nonspecific gas pattern . next step?
a)colonoscopy
b)exploratory celiotomy
c)gastroscopy
d)laparoscopy (wrong)
e) peritoneal lavage
choose between lymphoma or portal vein thrombosis? Both can cause chylous ascites. The latter one is a rare cause of chylous ascites but given this pt history (previously healthy, no mass, no other symptoms of lymphoma), is idiopathic portal vein thrombosis more likely?
2. 18YO man to ED because of pain in right hip and flank after MVA. He’s alert and stable. P/E abrasions, ecchymoses, tenderness over right iliac crest, and abrasions on right flank. U/A show gross blood. X-ray of cervical spine normal. Next step?
a) CT abdomen w/ contrast
b) MRI pelvis
c) radionuclide renal scan
d) selective renal angiography
3) cystoscopy
3. A 52-year-old woman with well-controlled type 2 diabetes mellitus is brought to the emergency department 24 hours after the onset of abdominal pain. She has vomited three times in the emergency department. She appears toxic. She is 157 cm (5 ft 2 in) tall and weighs 95 kg (210 lb); BMI is 38 kg/m2. Her temperature is 39.5°C (103.1°F), pulse is 120/min, respirations are 28/min, and blood pressure is 160/90 mm Hg. Examination shows scleral icterus. Breath sounds are decreased over the lower lung fields bilaterally. The abdomen is mildly tender; bowel sounds are normal. Rectal examination shows no abnormalities. Laboratory studies show:
Hemoglobin 12.6 g/dL
Leukocyte count 16,000/mm3
Segmented neutrophils 70%
Bands 10%
Lymphocytes 20%
Serum
Na+ 130 mEq/L
Cl− 90 mEq/L
K+ 5.0 mEq/L
HCO3− 14 mEq/L
Glucose 600 mg/dL
Bilirubin
Total 5.2 mg/dL
Direct 2.0 mg/dL
Alkaline phosphatase 350 U/L
AST 300 U/L
Amylase 100 U/L
Which of the following is the most likely diagnosis?
A) Acute pancreatitis
B) Amebic liver abscess
C) Biliary cirrhosis
D) Cholangitis, ascending
E) Chronic cholecystitis
F) Hepatitis
G) Pancreatic cancer
4. following diagnosis of ectopic pregnancy in a married 25yo woman, an abdominal operation is performed. However, examination of abdomen shows normal uterine pregnancy but an acutely inflamed appendix. An appendectomy is performed despite the fact that operative permit authorized only a surgical procedure for ectopic pregnancy.
a)appropriate in view of medical necessity to remove inflamed appendix
b)appropriate only if consent was obtained from spouse
c)inappropriate, because it constituted an unauthorized extension of field of surgery
d)inappropriate, because the pt had not previously been informed of risks associated with an appendectomy
choose C?
5. 80yo woman atherosclerosis and chornic atrial fibrillation has had severe midabdominal pain for 4 hours. P/E mild abdominal tenderness and absent bowel sounds; no masses or signs of peritoneal irritation. Stool occult blood positive. Wbc 28,340 w/ 65% segmented neutrophils, 20% bands, 15% lymphocytes. PH 7.18, Pco2 35, Po2 62. X-ray of abdomen show nonspecific gas pattern . next step?
a)colonoscopy
b)exploratory celiotomy
c)gastroscopy
d)laparoscopy (wrong)
e) peritoneal lavage
