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A 50-year-old man presents with progressive jaundice, dark urine, and pruritus. Imaging reveals a mass in the head of the pancreas. What is the most likely diagnosis?
- A. Pancreatic cancer
- B. Chronic pancreatitis
- C. Gallstones
- D. Primary sclerosing cholangitis
Correct Answer: A
Rationale: The most likely diagnosis for a 50-year-old man with jaundice, dark urine, pruritus, and a mass in the head of the pancreas is pancreatic cancer. Pancreatic cancer commonly presents with obstructive jaundice due to compression of the common bile duct by the tumor in the head of the pancreas. This leads to dark urine (due to increased bilirubin) and pruritus. Chronic pancreatitis typically presents with recurrent abdominal pain, not progressive jaundice. Gallstones can cause obstructive jaundice but are not associated with a mass in the pancreas. Primary sclerosing cholangitis presents with jaundice, but it typically involves intrahepatic and extrahepatic bile ducts, not the pancreas.
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Which of the following statements is true about ischemic colitis?
- A. Typically requires colonic resection
- B. Affects the watershed areas of the colon, namely, the splenic flexure, right colon, and rectum
- C. Is only seen in the elderly
- D. Requires colonoscopic intervention
Correct Answer: B
Rationale: The correct answer is B: Ischemic colitis affects the watershed areas of the colon, namely, the splenic flexure, right colon, and rectum. This is because these areas have relatively poor collateral blood supply, making them more susceptible to ischemia. Ischemic colitis typically presents with abdominal pain, bloody diarrhea, and tends to affect elderly patients with cardiovascular risk factors. Choice A is incorrect as most cases of ischemic colitis can be managed conservatively without the need for colonic resection. Choice C is incorrect as ischemic colitis can occur in individuals of any age group, although it is more common in the elderly. Choice D is incorrect because colonoscopic intervention is not always necessary for the diagnosis and management of ischemic colitis.
What is the most likely diagnosis in a 30-year-old woman with right upper quadrant pain, fever, and jaundice, along with elevated white blood cell count and bilirubin levels?
- A. Acute hepatitis
- B. Acute cholecystitis
- C. Acute cholangitis
- D. Pancreatic cancer
Correct Answer: C
Rationale: The correct answer is C: Acute cholangitis. In a 30-year-old woman with right upper quadrant pain, fever, jaundice, elevated white blood cell count, and bilirubin levels, acute cholangitis is the most likely diagnosis. This condition is characterized by inflammation of the bile ducts, often due to obstruction, leading to symptoms such as pain, fever, and jaundice. The combination of right upper quadrant pain, fever, jaundice, and elevated white blood cell count and bilirubin levels suggests an infection in the biliary system, which is typical of acute cholangitis. Acute hepatitis (choice A) typically presents with elevated liver enzymes but may not have the same degree of biliary obstruction symptoms. Acute cholecystitis (choice B) usually presents with gallbladder inflammation and may not cause jaundice. Pancreatic cancer (choice D) typically presents with different symptoms and is less common in a
A 40-year-old woman presents with a history of chronic constipation, bloating, and abdominal pain. She notes that the pain is relieved with defecation. She denies any weight loss, blood in her stools, or nocturnal symptoms. Physical examination and routine blood tests are normal. What is the most likely diagnosis?
- A. Inflammatory bowel disease
- B. Irritable bowel syndrome
- C. Celiac disease
- D. Lactose intolerance
Correct Answer: B
Rationale: The correct answer is B: Irritable bowel syndrome (IBS). The key clues in the question are chronic constipation, bloating, abdominal pain relieved with defecation, and absence of alarming symptoms. These symptoms align with the Rome IV criteria for IBS. Inflammatory bowel disease (A) typically presents with more severe symptoms, including weight loss and blood in stools. Celiac disease (C) is associated with malabsorption symptoms and autoimmune features, not typically seen in this case. Lactose intolerance (D) presents with symptoms after consuming dairy, which is not mentioned in the patient's history. Therefore, based on the clinical presentation and exclusion of other conditions, the most likely diagnosis is IBS.
A 45-year-old woman with occasional indigestion has had episodes of chest pain and dysphagia to both solids and liquids. An upper GI series and EGD fail to disclose any structural abnormalities. What is the most appropriate initial therapy?
- A. Sucralfate
- B. Proton pump inhibitor
- C. Prokinetic agent
- D. Benzodiazepine
Correct Answer: B
Rationale: The correct answer is B: Proton pump inhibitor. In this case, the patient's symptoms of chest pain, dysphagia to solids and liquids, and indigestion suggest possible gastroesophageal reflux disease (GERD). A proton pump inhibitor helps reduce gastric acid production, alleviating symptoms and potentially healing any esophageal damage caused by reflux. This is the most appropriate initial therapy as it targets the underlying cause.
A: Sucralfate is a cytoprotective agent that may help with mucosal protection but does not address acid suppression, which is crucial in GERD.
C: Prokinetic agents enhance gastrointestinal motility and are not the first-line treatment for GERD.
D: Benzodiazepines are not indicated for the treatment of GERD and do not address the underlying acid reflux issue.
A 56-year-old white male complains of intermittent dysphagia for the past three months, particularly with the ingestion of meat. He has no difficulties swallowing liquids. He has no history of smoking, uses no medications, and has had no weight loss. What test would be best to evaluate him?
- A. Upper endoscopy
- B. Chest/abdominal CT scan
- C. Barium swallow
- D. Esophageal manometry
Correct Answer: C
Rationale: The correct answer is C: Barium swallow. In this case, the patient's symptoms suggest a possible esophageal disorder affecting solid food ingestion. Barium swallow is a non-invasive test that can detect structural abnormalities in the esophagus, such as strictures or tumors, that may be causing dysphagia. It is the best initial test to evaluate the patient's symptoms as it provides a detailed visualization of the esophagus and can identify the cause of dysphagia. Upper endoscopy (choice A) would be appropriate if structural abnormalities are suspected. Chest/abdominal CT scan (choice B) may not provide as detailed information about esophageal function. Esophageal manometry (choice D) is more useful for evaluating motor function of the esophagus, which is not the primary concern in this case.