A 23-year-old man presents complaining of severe crampy abdominal pain and blood in his stool over the past 2 days. Asimilar episode occurred a few months ago and spontaneously resolved. No history of travel. Abdominal x-ray shows mild colonic dilatation. Which of the following is the most likely diagnosis?
Answer(s): A
Ulcerative colitis typically presents between the ages of 15 and 25 years with symptoms of diarrhea with blood and abdominal pain. Involvement begins in the rectum and is limited to the colon. The recurrent episodes and hematochezia make inflammatory bowel disease most likely.
A60-year-old man presents with a nonproductive cough for a week and generalized malaise. He also has noted some abdominal pain associated with diarrhea for the past few days. His temperature is 101.5°F a nd clinical examination is unremarkable. ACXR shows a left lower lobe infiltrate. His urinalysis shows 50 RBCs, and his BUN (30) and creatinine (1.6) are both mildly elevated. In light of the extrapulmonary symptoms and signs, which of the following is the most likely cause of his pneumonia?
Answer(s): E
The spectrum of infection with Legionella organisms ranges from asymptomatic seroconversion to Pontiac fever (a flu-like illness) to full-blown pneumonia. Cough is usually nonproductive initially. Malaise, myalgia, and headache are common. The diagnosis of Legionella infection is suggested by extrapulmonary signs and symptoms, including diarrhea, abdominal pain, azotemia, and hematuria.
A63-year-old man with chronic bronchitis presents to the emergency department with worsening shortness of breath. He is dyspneic, his respiratory rate is 32/min, and he has peripheral cyanosis. A chest examination reveals increased anteroposterior diameter and scattered rhonchi, but no wheezes or evidence of consolidation. His ABG determinations on room air are pH of 7.36, arterial oxygen pressure (PaO2) of 40 mmHg, and PaCO2 of 47 mmHg. He is given oxygen by face mask while awaiting a CXR. His respiratory rate falls to 12/min,but his ABGs on oxygen are now pH of 7.31, PaO2 of 62 mmHg, and PaCO2 of 58 mmHg. Which of the following is the most appropriate next step in the management of this patient?
Patients with advanced chronic obstructive pulmonary disease (COPD) are at risk for development of acute respiratory failure. Common precipitants are infections, increased secretions, and superimposed bronchospasm. Oxygen therapy is effective in reversing the hypoxemia associated with respiratory failure.Arisk of such therapy peculiar to patients withCOPD is worsening hypercapnia. Affected patients are thought to have lost their respiratory center's sensitivity to hypercapnia, so that their primary stimulus to breathe is hypoxemia. When the hypoxemia is corrected, they may lose their stimulus to breathe and develop carbon dioxide narcosis with worsening acidosis, confusion, stupor, and eventually coma. Because of this, the usual approach is to begin with a low fraction of inspired oxygen (FIO2) and increase gradually. Serial ABGs are obtained to ensure that as PaO2 improves,
A26-year-old man presents with a hard, painless testicular mass. At operation, frozen section reveals testicular cancer. Which of the following is a risk factor?
Answer(s): D
Testicular cancer is the most common cancer in men between the ages of 20 and 40. Predisposing factors include cryptorchidism, hernias, and testicular atrophy. Abdominal testes are at higher risk than inguinal cryptorchid testes. Family history of testicular or prostate cancer, radiation exposure, or maternal DES seems to play no role. Testicular cancers are divided into nonseminoma and seminoma subtypes.Seminoma represents about 50% of all tumors and generally follows a more indolent course. The primary tumor is treated by inguinal orchiectomy regardless of cell type. Pure seminomas do not require retroperitoneal lymph node dissection, because radiation is usually adequate therapy. Nonseminomatous testicular tumors (embryonal cell, teratocarcinoma, choriocarcinoma, endodermal sinus) are usually treated by retroperitoneal dissection. Serum alpha-fetoprotein (AFP) and hCG levels are markers that are important for diagnosis and as prognostic indicators and are used to monitor therapy. Serum LDH level is often elevated with bulky tumors but is not as specific as either AFP or hCG. CEA is a nonspecific marker elaborated by many adenocarcinomas. PSA is a marker associated with prostate cancer
A26-year-old man presents with a hard, painless testicular mass. At operation, frozen section reveals testicular cancer. Which of the following is a risk factor? What is the most common cell type in testicular cancer?
Answer(s): C
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