59-year-old woman with renal cell carcinoma presents to the emergency department with severe right upper quadrant (RUQ) pain


#1

59-year-old woman with renal cell carcinoma

presents to the emergency department with severe

right upper quadrant (RUQ) pain. She is

afebrile, acutely tender in the RUQ, and has

shifting dullness and a palpable liver edge.

Murphy’s sign is negative. Laboratory studies

show:

Na+: 138 mEq/L

K+: 3.6 mEq/L

Glucose: 80 mg/dL

Aspartate aminotransferase: 50 U/L

Alanine aminotransferase: 43 U/L

Alkaline phosphatase: 138 U/L

Total protein: 6.4 g/dL

Albumin: 3.8 g/dL

Total bilirubin: 1.1 mg/dL

Imaging demonstrates a spider web of collateral

veins in the liver. Although extensive measures

are taken, the patient dies 6 hours after

arriving. Which of the following was the most

likely initial treatment?

  • (A) β-Blocker followed by lactulose
  • (B) Cholecystectomy
  • © Endoscopic retrograde cholangiopancreatography with dilation of the common bile duct
  • (D) Exploratory laparotomy
  • (E) Tissue plasminogen activator followed by anticoagulation

0 voters

35-year-old man comes to the office for follow up or ulcerative colitis. He was diagnosed 8 years ago, and had involvement of the

colon from the hepatic flexure to the rectum at that time. The patient is maintained on daily 5 -aminosalicyl ic acid and reels well;

however, he had an exacerbati on of colitis 6 months ago that required a brief course of treatment with antibiotics and oral

glucocorticoids. He has no nausea, vomiting, blood in his stool, or weight loss. Medical history is otherwise unremarkable. The

patient smokes a pack of cigarettes daily and does not use alcohol or illicit drugs. Family history is negative for inflammatory bowel

disease and cancer. Physical examination is normal. Which of the following is the most appropriate management at this time?

  • O A. Offer col onoscopy now and every 1 - 2 years thereafter
  • O B. Offer col onoscopy now and every 5 years thereafter
  • Q C. Recommend prophylactic colectomy with ilea! pouch
  • O 0. Recommend surveillance colonoscopy starting at age 45
  • O E. Surveillance colonoscopy is not needed as his disease is well controlled

0 voters

83-year-old woman who lives alone is admitted

because of confusion. She is accompanied

to the hospital by her neighbor, who states

that as recently as 3 months ago the patient was

able to perform basic and independent activities

of daily living, and enjoyed gardening in

her yard. However, after her husband’s death 6

weeks ago the patient has not been seen outside

her home. When the neighbor went to

check on the patient today, she found her to be

awake and alert but confused. Her house was

uncharacteristically unkempt, and a few empty

TV dinners were strewn around the living

room. Her blood pressure is 106/66 mm Hg,

heart rate is 68/min, and temperature is 37.3°C

(98.1°F). The remainder of her examination is

unremarkable, except for marked temporal

wasting. Laboratory tests show:

Na+: 137 mEq/L

K+: 3.5 mEq/L

Ca2+: 6.9 mg/dL

Mg2+: 1.5 mEq/L

BUN: 8 mg/dL

Creatinine: 0.5 mg/dL

Inorganic phosphate: 3.1 mg/dL

Albumin: 1.5 g/dL

What is the best next step in managing this patient’s

low calcium levels?

(A) This patient has low BUN levels; therefore,

her hypocalcemia likely does not represent

a decrease in active calcium. She

does not need calcium repletion at this

time

(B) This patient has low creatinine levels;

therefore, her hypocalcemia is likely more

severe than measured. She needs aggressive

calcium repletion

© This patient has low creatinine levels;

therefore, her hypocalcemia likely does not represent a decrease in active calcium. She does not need calcium repletion at this time

(D) This patient is hypoalbuminemic; therefore,her hypocalcemia is likely more severethan measured. She needs aggressive calcium repletion

(E) This patient is hypoalbuminemic; therefore,her hypocalcemia likely does not represent a decrease in active calcium. She does not need calcium repletion at this time.