21-year-old woman is brought to the emergency department due to continuous vomiting, diarrhea, and high fever for a day The patient also has a severe headache unrelieved by acetaminophen; she has no hematemesis or hematochezia. She returned yesterday on an international flight after spending the last 3 months in Southeast Asia. She has no chronic medical conditions or previous surgeries. The patient is sexually active and uses oral contraceptive pills. She is currently on the third day of her menstrual
period The patient does not use tobacco or illicit drugs Temperature is 39.4 C (103 F), blood pressure is 80/40 mm Hg, and pulse is 124/min. Physical examination shows a diaphoretic woman with dry mucous membranes. There is no nuchal rigidity. An erythematous macular rash covers the entire body, including the palms and soles. Which of the following is the most likely microorganism responsible for these symptoms?
- QA Epstein-Barr virus
- 0 B. Herpes simplex virus type 2
- 0 C. Neisseria gonorrhoeae
- 0 D. Rotavirus
- 0 E. Shigel/a
- 0 F Staphylococcus aureus
- 0 G. Treponema pal/idum
0 voters
2.A 67 -year-old man comes to the hosprtal with acute-onset upper abdominal pain associated with nausea and vomiting. The patient was discharged 24 hours earlier after he underwent elective coronary angiography and stent placement due to lert circumflex artery stenosis. He has been taking his prescribed medications and reports no chest pain, shortness of breath, or flank pain His other medical problems include type 2 diabetes, hypertension, hypercholesterolemia, and peripheral vascular disease. The patient does not use tobacco, alcohol, or illicit drugs. His temperature is 37.7 C (99.9 F), blood pressure is 134/88 mm Hg, pulse is 92/min, and respirations are 18/min. The abdomen is tender to palpation in the epigastric area. Bowel sounds are decreased. The skin over the lower extremities and toes appears mottled, reddish-blue, and reticulated but blanches on pressure. Laboratory results are as follows:
Hemoglobin 13.1 g/dL
Platelets 206,000/mm’
Leukocytes 12,300/mm
Creatinine 1.5 mg/dL
Total bilirubin 1.0 mg/dL
Alkaline phOsphatase 125 U/L
Aspartate aminotransferase 30 U/l
Alanine aminotransferase 28 U/l
Lipase 1,841 U/l
CT scan of the abdomen reveals diffuse enlargement of the pancreas. Abdominal ullrasonogram reveals normal-sized gallbladder and common b ile duct without gallstones. The patient’s pain is improved with a dose of intravenous morphine. Which of the following is the best therapy for this patient?
- Q A. Elective cholecystectomy
- Q B . Endoscopic retrograde cholangiopancreatography
- Q C. Intravenous antibiotics
- Q 0 . Intravenous corticosteroids
- Q E. Intravenous fluids and supportive care only
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