Nokea
A 28-year-old woman at 34 weeks of gestation presents with elevated liver enzymes and pruritus. Labs reveal total bilirubin to be 4.2 mg/dL, AST 480 U/L, ALT 640 U/L, and alkaline phosphatase 232 U/L. Viral hepatitis serologies and ANA are negative. On physical examination, she is jaundiced, but has a normal blood pressure, no edema, and a soft abdomen. The fetus is in no distress. Which of the following is true?
- A. The baby should be delivered immediately
- B. Symptoms will resolve promptly after delivery
- C. There is little risk of recurrence with subsequent pregnancies
- D. The mother should be screened for long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency
Correct Answer: B
Rationale: The correct answer is B: Symptoms will resolve promptly after delivery. The presentation of elevated liver enzymes, pruritus, and jaundice in a pregnant woman at 34 weeks with no signs of severe preeclampsia suggests cholestasis of pregnancy. This condition typically resolves after delivery. The absence of fetal distress and normal maternal blood pressure indicate that immediate delivery is not necessary. There is a risk of recurrence in subsequent pregnancies, so choice C is incorrect. Screening for LCHAD deficiency is not indicated in this scenario, as the presentation is more consistent with cholestasis of pregnancy.
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A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be
- A. Liver biopsy
- B. Magnetic resonance cholangiopancreatography
- C. Hepatitis B surface antigen and hepatitis C RNA assay
- D. Colonoscopy with biopsies
Correct Answer: B
Rationale: The correct answer is B: Magnetic resonance cholangiopancreatography (MRCP). Given the patient's clinical presentation of right upper quadrant pain, fever, jaundice, and abnormal liver function tests, MRCP is the next diagnostic test of choice to evaluate the biliary tree and pancreatic ducts for possible obstruction or structural abnormalities. This would help identify the cause of the patient's symptoms, such as biliary obstruction or choledocholithiasis.
Choice A: Liver biopsy is not the next step in this scenario as the patient's symptoms are suggestive of a biliary or pancreatic etiology rather than a primary liver pathology.
Choice C: Hepatitis B surface antigen and hepatitis C RNA assay may be relevant for evaluating viral hepatitis, but in this case, the patient's symptoms and lab results are more indicative of a biliary or pancreatic issue.
Choice D: Colonoscopy with biopsies is not the next appropriate step as the patient's symptoms and lab results are not
A 35-year-old man presents with difficulty swallowing, weight loss, and regurgitation of undigested food. A barium swallow shows a 'bird beak' appearance of the lower esophagus. What is the most likely diagnosis?
- A. Esophageal cancer
- B. Achalasia
- C. Peptic stricture
- D. Gastroesophageal reflux disease
Correct Answer: B
Rationale: The correct answer is B: Achalasia. The presentation of difficulty swallowing, weight loss, regurgitation of undigested food, and 'bird beak' appearance on barium swallow are classic for achalasia. In achalasia, there is impaired relaxation of the lower esophageal sphincter and absent peristalsis in the esophagus. This leads to functional obstruction and dilation of the esophagus, causing the characteristic 'bird beak' appearance.
Incorrect Choices:
A: Esophageal cancer typically presents with progressive dysphagia, weight loss, and may show a mass or stricture on imaging.
C: Peptic stricture is usually seen in patients with long-standing gastroesophageal reflux disease or esophagitis. Symptoms are often related to acid reflux.
D: Gastroesophageal reflux disease commonly presents with heartburn, regurgitation, and chest pain. It does not typically cause weight loss or the 'bird
The healthcare provider is preparing to administer a blood transfusion. Which action is most important to ensure client safety?
- A. Check the client's vital signs before starting the transfusion.
- B. Verify the client's identity and blood compatibility.
- C. Administer the blood with normal saline.
- D. Monitor the client for the first 15 minutes of the transfusion.
Correct Answer: B
Rationale: The correct answer is B: Verify the client's identity and blood compatibility. This step is crucial to prevent transfusion reactions due to compatibility issues. By confirming the client's identity and ensuring that the blood type matches, the healthcare provider minimizes the risk of adverse reactions such as hemolytic transfusion reactions. Checking vital signs (A) is important but ensuring blood compatibility takes precedence. Administering blood with normal saline (C) is incorrect as blood should be infused with the appropriate blood administration set. Monitoring the client for the first 15 minutes (D) is essential but verification of identity and blood compatibility is the primary step to prioritize safety.
A 28-year-old woman presents with abdominal pain, diarrhea, and rectal bleeding. She has a history of similar episodes in the past. What is the most likely diagnosis?
- A. Ulcerative colitis
- B. Irritable bowel syndrome
- C. Celiac disease
- D. Diverticulitis
Correct Answer: A
Rationale: The correct answer is A: Ulcerative colitis. This chronic inflammatory condition affects the colon and rectum, leading to symptoms like abdominal pain, diarrhea, and rectal bleeding. The patient's recurrent episodes and history of similar symptoms point towards ulcerative colitis. Irritable bowel syndrome (choice B) typically presents with abdominal pain, bloating, and changes in bowel habits but not rectal bleeding. Celiac disease (choice C) presents with gastrointestinal symptoms after consuming gluten. Diverticulitis (choice D) presents with localized abdominal pain and fever due to inflammation or infection of the diverticula, not typically with rectal bleeding.
A 65-year-old woman presents with difficulty swallowing, weight loss, and a history of long-standing heartburn. She has been on proton-pump inhibitors for years, but her symptoms have worsened. What is the most likely diagnosis?
- A. Peptic stricture
- B. Esophageal cancer
- C. Achalasia
- D. Esophageal spasm
Correct Answer: B
Rationale: The correct answer is B: Esophageal cancer. Given the patient's age, symptoms of difficulty swallowing and weight loss, along with a history of chronic heartburn not responding to proton-pump inhibitors, esophageal cancer is the most likely diagnosis. Esophageal cancer commonly presents with dysphagia, weight loss, and a history of chronic reflux. Peptic stricture (A) typically presents with dysphagia but is less likely given the worsening symptoms despite treatment. Achalasia (C) presents with dysphagia and regurgitation, but not typically with weight loss. Esophageal spasm (D) presents with chest pain and dysphagia, but not typically with weight loss or chronic heartburn.