07-25-2016, 08:54 PM
Hey guys if you know the answer please dont hesitate to comment.
23.
A 57-year-old man comes to the physician because of a 3-month history of five to six loose stools daily and a 7.3-kg (16-lb) weight loss. He notes that he had two to three bowel movements daily for 3 weeks following a 10-day course of tetracycline 2 months ago. He underwent antrectomy with Billroth II reconstruction for a perforated gastric ulcer 1 year ago. He has not had any changes in his diet. He has osteoarthritis of the hips treated with ibuprofen. He is 185 cm (6 ft 1 in) tall and weighs 72 kg (160 lb); BMI is 21 kg/m2. Examination shows excess skinfolds over the abdomen. The abdomen is scaphoid with a well-healed surgical scar. Which of the following is the most likely cause of this patient's diarrhea?
A
) Bacterial overgrowth
B
) Bile reflux
C
) COX-2 inhibition
D
) Dumping syndrome
E
) Efferent loop obstruction
30.
Eight hours after undergoing transurethral prostate resection, a 62-year-old man has a hemoglobin concentration of 7.5 g/dL. A transfusion of heterologous packed red blood cells is begun. Two hours later, he develops chills and fever. He has received 200 mL of the transfusion. His temperature is 39°C (102.2°F), pulse is 120/min, respirations are 18/min, and blood pressure is 120/70 mm Hg. Which of the following is the most likely explanation for these findings?
A
)
ABO incompatibility
B
)
Bacterial overgrowth in transfused blood
C
)
Intravenous catheter infection
D
)
Preformed antibodies to leukocyte antigens
E
)
Rh incompatibility
34.
A 52-year-old man is brought to the emergency department because of respiratory distress after hitting his chest on the steering wheel in a motor vehicle collision. On arrival, his pulse is 110/min, respirations are 32/min, and blood pressure is 110/80 mm Hg. There is tenderness to palpation over the 3rd, 4th, and 5th ribs. X-rays show fractures of these ribs both anteriorly and laterally and an infiltrate in an underlying area suggestive of alveolar and interstitial edema. Which of the following is the most likely diagnosis?
A
)
Cardiac tamponade
B
)
Hemothorax
C
)
Open pneumothorax
D
)
Pulmonary contusion
E
)
Tension pneumothorax
F
)
Traumatic diaphragmatic hernia
35.
An asymptomatic 26-year-old woman comes to the physician for a preemployment examination. Physical examination shows no abnormalities. An x-ray of the chest is shown. Which of the following is the most likely diagnosis?
A
)
Bronchogenic carcinoma
B
)
Sarcoidosis
C
)
Thymoma
D
)
Tuberculosis
E
)
Wegener granulomatosis
37.
A 52-year-old woman comes to the physician because of a 1-year history of progressive difficulty swallowing, intermittent vomiting of undigested food, and a cough that is more severe at night. During the past 6 months, she has had an 8-kg (17-lb) weight loss. She has not had pain with swallowing or difficulty speaking. She has no history of serious illness and takes no medications. She states that she has had some anxiety during the past 6 months because of fear of losing her job. She does not smoke cigarettes or drink alcohol. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 18/min, and blood pressure is 120/84 mm Hg. Examination shows no palpable neck masses. The trachea is midline, and there is no thyromegaly. Cardiopulmonary and abdominal examinations show no abnormalities. A chest x-ray shows an air-fluid level in the posterior mediastinum at the level of the cardiac silhouette. Manometry shows normal lower esophageal sphincter pressure and absent lower esophageal sphincter relaxation with swallowing. Which of the following is the most likely diagnosis?
A
)
Achalasia
B
)
Diffuse esophageal spasm
C
)
Globus hystericus
D
)
Hiatal hernia
E
)
Systemic sclerosis (scleroderma)
45.
A 19-year-old man comes to the emergency department because of severe generalized abdominal pain for 12 hours. He has had increasing episodes of diarrhea for 6 weeks and bloody diarrhea for 4 days. He has had no bowel movements since the onset of abdominal pain. He appears pale and ill. His temperature is 38.9°C (102°F), and pulse is 144/min. Abdominal examination shows diffuse tenderness with hypoactive bowel sounds. Rectal examination shows bloody stool. An x-ray of the abdomen shows a transverse colon 8 cm in diameter but no free air. Which of the following is the most likely diagnosis?
A
)
Angiodysplasia of the colon
B
)
Antibiotic-associated colitis
C
)
Arteriovenous malformation of the colon
D
)
Diverticulitis
E
)
Ischemic colitis
F
)
Pseudomembranous colitis
G
)
Rectal carcinoid
H
)
Ulcerative colitis
I
)
Volvulus of the colon
48.
A 42-year-old woman is brought to the emergency department 17 minutes after being involved in a motor vehicle collision. She has abdominal and left flank pain. She is hemodynamically stable. There is tenderness over the left flank but no external marks. Urinalysis shows gross blood. Which of the following is the most appropriate next step in management?
A
)
Renal blood flow scan
B
)
CT scan of the abdomen and kidneys
C
)
Arteriography
D
)
Peritoneal lavage
E
)
Exploratory operation
Thanks guys!!!
23.
A 57-year-old man comes to the physician because of a 3-month history of five to six loose stools daily and a 7.3-kg (16-lb) weight loss. He notes that he had two to three bowel movements daily for 3 weeks following a 10-day course of tetracycline 2 months ago. He underwent antrectomy with Billroth II reconstruction for a perforated gastric ulcer 1 year ago. He has not had any changes in his diet. He has osteoarthritis of the hips treated with ibuprofen. He is 185 cm (6 ft 1 in) tall and weighs 72 kg (160 lb); BMI is 21 kg/m2. Examination shows excess skinfolds over the abdomen. The abdomen is scaphoid with a well-healed surgical scar. Which of the following is the most likely cause of this patient's diarrhea?
A
) Bacterial overgrowth
B
) Bile reflux
C
) COX-2 inhibition
D
) Dumping syndrome
E
) Efferent loop obstruction
30.
Eight hours after undergoing transurethral prostate resection, a 62-year-old man has a hemoglobin concentration of 7.5 g/dL. A transfusion of heterologous packed red blood cells is begun. Two hours later, he develops chills and fever. He has received 200 mL of the transfusion. His temperature is 39°C (102.2°F), pulse is 120/min, respirations are 18/min, and blood pressure is 120/70 mm Hg. Which of the following is the most likely explanation for these findings?
A
)
ABO incompatibility
B
)
Bacterial overgrowth in transfused blood
C
)
Intravenous catheter infection
D
)
Preformed antibodies to leukocyte antigens
E
)
Rh incompatibility
34.
A 52-year-old man is brought to the emergency department because of respiratory distress after hitting his chest on the steering wheel in a motor vehicle collision. On arrival, his pulse is 110/min, respirations are 32/min, and blood pressure is 110/80 mm Hg. There is tenderness to palpation over the 3rd, 4th, and 5th ribs. X-rays show fractures of these ribs both anteriorly and laterally and an infiltrate in an underlying area suggestive of alveolar and interstitial edema. Which of the following is the most likely diagnosis?
A
)
Cardiac tamponade
B
)
Hemothorax
C
)
Open pneumothorax
D
)
Pulmonary contusion
E
)
Tension pneumothorax
F
)
Traumatic diaphragmatic hernia
35.
An asymptomatic 26-year-old woman comes to the physician for a preemployment examination. Physical examination shows no abnormalities. An x-ray of the chest is shown. Which of the following is the most likely diagnosis?
A
)
Bronchogenic carcinoma
B
)
Sarcoidosis
C
)
Thymoma
D
)
Tuberculosis
E
)
Wegener granulomatosis
37.
A 52-year-old woman comes to the physician because of a 1-year history of progressive difficulty swallowing, intermittent vomiting of undigested food, and a cough that is more severe at night. During the past 6 months, she has had an 8-kg (17-lb) weight loss. She has not had pain with swallowing or difficulty speaking. She has no history of serious illness and takes no medications. She states that she has had some anxiety during the past 6 months because of fear of losing her job. She does not smoke cigarettes or drink alcohol. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 18/min, and blood pressure is 120/84 mm Hg. Examination shows no palpable neck masses. The trachea is midline, and there is no thyromegaly. Cardiopulmonary and abdominal examinations show no abnormalities. A chest x-ray shows an air-fluid level in the posterior mediastinum at the level of the cardiac silhouette. Manometry shows normal lower esophageal sphincter pressure and absent lower esophageal sphincter relaxation with swallowing. Which of the following is the most likely diagnosis?
A
)
Achalasia
B
)
Diffuse esophageal spasm
C
)
Globus hystericus
D
)
Hiatal hernia
E
)
Systemic sclerosis (scleroderma)
45.
A 19-year-old man comes to the emergency department because of severe generalized abdominal pain for 12 hours. He has had increasing episodes of diarrhea for 6 weeks and bloody diarrhea for 4 days. He has had no bowel movements since the onset of abdominal pain. He appears pale and ill. His temperature is 38.9°C (102°F), and pulse is 144/min. Abdominal examination shows diffuse tenderness with hypoactive bowel sounds. Rectal examination shows bloody stool. An x-ray of the abdomen shows a transverse colon 8 cm in diameter but no free air. Which of the following is the most likely diagnosis?
A
)
Angiodysplasia of the colon
B
)
Antibiotic-associated colitis
C
)
Arteriovenous malformation of the colon
D
)
Diverticulitis
E
)
Ischemic colitis
F
)
Pseudomembranous colitis
G
)
Rectal carcinoid
H
)
Ulcerative colitis
I
)
Volvulus of the colon
48.
A 42-year-old woman is brought to the emergency department 17 minutes after being involved in a motor vehicle collision. She has abdominal and left flank pain. She is hemodynamically stable. There is tenderness over the left flank but no external marks. Urinalysis shows gross blood. Which of the following is the most appropriate next step in management?
A
)
Renal blood flow scan
B
)
CT scan of the abdomen and kidneys
C
)
Arteriography
D
)
Peritoneal lavage
E
)
Exploratory operation
Thanks guys!!!
