Nokea
57 y/o male is admitted with acute cholecystitis due to cholelithiasis and undergoes an uneventful laparoscopic cholecystectomy. He is discharged the next day but returns to the ER 2 days later due to abdominal pain, distension, and fever. Abdominal CT is only positive for moderate ascites. Paracentesis reveals 50 PMNs and bilious fluid. What is the most likely diagnosis?
- A. Cirrhosis of the liver
- B. Secondary bacterial peritonitis
- C. Bile leak
- D. Retained common bile duct stone
Correct Answer: C
Rationale: Bile leak is a known complication of cholecystectomy, leading to bilious ascites and peritonitis symptoms like pain and fever.
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The common iliac artery is in which blood circuit?
- A. pulmonary
- B. coronary
- C. systemic
- D. pelvic
Correct Answer: C
Rationale: The common iliac artery is part of the systemic circuit, delivering blood to the lower body.
Regarding treatment of hypertension of a 53 years-old woman already prescribed ramipril 10 mg daily but has a blood pressure of 150/95 mmHg, which ONE of the following prescriptions is TRUE
- A. Ramipril dose should be increased to 15 mg daily
- B. Ramipril dose should be split into 5 mg twice daily
- C. Candesartan 2 mg daily should be added to ramipril 10 mg daily
- D. Amlodipine 5 mg should be added to ramipril 10 mg daily
Correct Answer: D
Rationale: Ramipril 10 mg is the maximum dose. If BP remains uncontrolled, adding a calcium channel blocker like amlodipine is recommended as per guidelines (e.g., NICE), making D the correct choice.
A patient with alpha 1-antitrypsin deficiency is warned by his physician that his increasing dyspnea may be worsened by his continued cigarette smoking. Which of the following factors, released by both neutrophils and alveolar macrophages, is responsible for the patient's condition?
- A. Major Basic Protein
- B. Antibodies against alpha-3 segment of collagen IV
- C. Mucus
- D. Elastase
Correct Answer: D
Rationale: Elastase, unchecked due to alpha-1-antitrypsin deficiency, destroys alveolar walls, worsened by smoking, causing emphysema and dyspnea.
Which is correct regarding HDL?
- A. It is the biggest lipoprotein
- B. Its lipid content is higher than its protein content
- C. Removes cholesterol from the periphery and delivers to liver for metabolism
- D. Has an insignificant role in cholesterol transportation
Correct Answer: C
Rationale: HDL removes cholesterol from tissues and delivers it to the liver, aiding reverse cholesterol transport.
Frank Starling's law states that if more blood enters the heart,
- A. the weaker the contraction.
- B. the stronger the contraction.
- C. the faster the heart rate.
- D. blood volume does not affect the strength of the heart contraction.
Correct Answer: B
Rationale: Frank-Starling's law states that an increase in end-diastolic volume stretches cardiac muscle fibers, resulting in a stronger contraction and greater stroke volume.