Internal 2 Exam 2 (after quizzes 1 and 2) Logan U

What disorder is consistent with the following clinical features? Affects men aged 20-40 years and men 70 years Symptoms vary including sudden-onset malaise and moderate/severe genitourinary pain (retro-pubic/perineal); lower urinary tract symptoms (dysuria, increased frequency urinate, urgency, cloudy urine), rarely: dyschezia, painful ejaculation Physical exam: fever; on digital rectal palpation, the prostate is diffusely enlarged, warm, boggy, and tender. Definition/cause: infection of the prostate with Chlamydia or Gonococci (younger men) or E. coli (older men) a.Acute bacterial prostatitis (ABP) b.Chronic bacterial prostatitis (CBP) c.Benign prostatic hyperplasia (BPH

a. Acute bacterial prostatitis (ABP)

Mutation of the adenomatous polyposis coli gene (APC gene), without mutations of any other tumor suppressor genes, is the cause of what very common neoplastic disorder? a. Adenomatous polyps b. Inflammatory polyps c. Hyperplastic polyps

a. Adenomatous polyps

What disorder is consistent with the following clinical features? Affects primarily men between 40 and 60 years of age. Symptoms: no malaise or fever; persistent, diffuse, and moderate to severe genitourinary pain involving lower abdomen, lower back, groin, perineum, scrotum, and/or penis. Commonly erectile dysfunction, painful ejaculation, and bloody semen. Physical exam: no fever or malaise; on digital rectal palpation, the prostate usually has normal size and consistency and might be mildly tender. Cause: Idiopathic. Most cases are noninfectious. a. Chronic pelvic floor pain syndrome (CPFS) b.Benign prostatic hyperplasia (BPH) c. Acute bacterial prostatitis (ABP)

a. Chronic pelvic floor pain syndrome (CPFS)

Which IBD has the following unique clinical features? Watery, non-bloddy diarrhea +/- steatorrhea Smoking is a risk factor Appendectomy increases the risk for the disease a. Crohn disease b. Ulcerative colitis c. Neither Crohn's or UC. d. Both diseases have the same clinical features

a. Crohn disease

A 37-year-old woman comes to the physician because of right-sided inguinal pain for the past 8 weeks. During this period, the patient has had increased pain during activities such as walking and standing. She has no nausea, vomiting, or fever. Her temperature is 36.8°C (98.2°F), pulse is 73/min, and blood pressure is 132/80 mm Hg. The abdomen is soft and nontender. There is a visible and palpable groin protrusion above the inguinal ligament on the right side. Bulging is felt during Valsalva maneuver. Which of the following is the most likely diagnosis? a. Indirect inguinal hernia b. Direct inguinal hernia c. Femoral hernia

a. Indirect inguinal hernia

The most common type of groin hernia in males and females is... a. Indirect inguinal hernia b. direct inguinal hernia

a. Indirect inguinal hernia

A 79-year-old man is brought to the emergency department because of a 1-hour history of severe groin pain, nausea, and vomiting. He reports that he has had a groin swelling that worsens with standing, coughing, and straining for the past 3 months, but he has not sought medical attention for it. Examination shows a nonreducible bulging mass of the left groin that is severely tender to palpation; the overlying skin is erythematous. Abdominal ultrasound shows protrusion of abdominal contents through a defect medial to the inferior epigastric vessels. Which of the following is the most likely site of protrusion of the patient's groin mass? a. Inguinal triangle (Hesselbach triangle) b. rectus abdominus muscle c. Femoral ring

a. Inguinal triangle (Hesselbach triangle)

What condition is described below? A condition that presents with signs and symptoms classically associated with appendicitis (e.g., RLQ pain, muscle guarding, fever, vomiting, leukocytosis). It often is associated with a recent or coexisting viral infection of the upper respiratory tract or GI tract. The condition mimics appendicitis, except the pain is more diffuse, signs of peritonitis often are absent, and generalized lymphadenopathy may be present. a. Mesenteric adenitis b. Midgut volulus c. Meckel diverticulitis d. Necrotizing enterocolitis

a. Mesenteric adenitis

A 54-year-old man comes to the emergency department because of a 2-day history of increasingly severe, colicky abdominal pain, nausea, and bilious vomiting. His last bowel movement was yesterday and he has not passed flatus since then. No long-term change in bowel habits, until the acute onset of abdominal pain. Negates weight loss, history of anemia, or blood in stool. PMH: He underwent appendectomy at the age of 39. Vitals: BMI 35.4 kg/m2. Temp 36.8°C (98.4°F); RR 15/min; HR 90/min, regular rhythm; B/L BP 112/67 mmHg. Abdominal examination shows three well-healed laparoscopic scars. The abdomen is distended. Hyperresonant percussion note. Absence of bowel sounds, except for occational, metallic high-pitched bowel sounds on auscultation. Digital rectal examination shows an empty rectum. Laboratory studies show: Abdominal ultrasound shows nonpropulsive peristalsis of the small bowel. What is the top differential diagnosis and clinical features? Select 2 answers. a. Small bowel obstruction (SBO) b. Obstructive Ileus - Mechanical bowel obstruction c. Extrinsic bowel obstruction d. Paralytic ileus - Functional bowel obstruction

a. Small bowel obstruction (SBO) c. Extrinsic bowel obstruction

A patient with IBD has the following extra-intestinal disorders: Erythema Nodusum Pyoderma Gangrenosum Acrodermatitis enteropathica What is the best clinical assessment? a. The patient either has Ulcerative Colitis or Crohn Disease b. The patient has Crohn Disease, but not Ulcerative Colitis c. The patient has Ulcerative Colitis, but not Crohn Disease

a. The patient either has Ulcerative Colitis or Crohn Disease

A 19-year-old woman comes to the physician because of a 1-year history of severe abdominal pain, bloating, and episodic diarrhea. She has also had a 10-kg (22-lb) weight loss over the past 10 months. Physical examination shows a mildly distended abdomen, diffuse abdominal tenderness, and multiple erythematous, tender nodules on the anterior aspect of both legs. There is a small draining lesion in the perianal region. Further evaluation of this patient's gastrointestinal tract is most likely to show which of the following findings? a. Transmural inflammation b. No structural abnormalities c. Neuroendocrine tumor cells

a. Transmural inflammation

Absence of bowel sounds + Abdominal distention + Absence of flatus + Absent BM are features consistent with a. acute bowel obstruction b. septic shock

a. acute bowel obstruction

Psoas sign in indicative of: a. rectocecal location of appendix b. Pelvic location of appendix c. peritonitis

a. rectocecal location of appendix

Crohn disease a. voluminous, watery, non-bloody diarrhea, often including steatorrhea b. presents with tenesmus and frequent, watery and bloody diarrhea

a. voluminous, watery, non-bloody diarrhea, often including steatorrhea

A 6-week-old male infant is brought to the physician by his mother because of a 2-day history of recurrent nonbilious vomiting. Vomiting occurs almost immediately after most feeds. Each time, he becomes irritable while feeding and refuses to finish the bottle. He was born at 37 weeks' gestation and weighed 3300 g (7 lb 4 oz); he currently weighs 4000 g (8 lb 13 oz). He has Down syndrome. His vaccinations are up-to-date. He appears agitated and cries during the examination. His temperature is 37.2°C (99°F), pulse is 156/min, respirations are 32/min, and blood pressure is 100/49 mm Hg. Examination shows upward slanting of the eyelids, a broad and flat nasal bridge, and a single transverse palmar crease on both hands. The abdomen is soft and nontender. A 2.5-cm (1-inch) epigastric mass is palpated. Cardiac examination shows no abnormalities. What is the top differential diagnosis? a. Meckel diverticulitis b. Congenital pyloric stenosis c. Acute appendicitis d. Mesenteric adenitis e. Midgut volvulus

b. Congenital pyloric stenosis

A 54-year-old man comes to the emergency department because of a 2-day history of increasingly severe, colicky abdominal pain, nausea, and bilious vomiting. His last bowel movement was yesterday and he has not passed flatus since then. PMH: He underwent appendectomy at the age of 39. Vitals: BMI 35.4 kg/m2. Temp 36.8°C (98.4°F); RR 15/min; HR 90/min, regular rhythm; B/L BP 112/67 mmHg. Abdominal examination shows three well-healed laparoscopic scars. The abdomen is distended. Hyperresonant percussion note. Absence of bowel sounds, except for occational, metallic high-pitched bowel sounds on auscultation. Digital rectal examination shows an empty rectum. Laboratory studies show: Abdominal ultrasound shows nonpropulsive peristalsis of the small bowel. What is the most probable cause of the patient's current acute abdominal disorder? a. Obesity b. History of abdominal surgery c. IBD

b. History of abdominal surgery

A 63-year-old man comes to the emergency department because of pain in his left groin for the past hour. The pain began soon after he returned from a walk. He describes it as 8 out of 10 in intensity and vomited once on the way to the hospital. He has had a swelling of the left groin for the past 2 months. He has chronic obstructive pulmonary disease and hypertension. Current medications include amlodipine, albuterol inhaler, and a salmeterol-fluticasone inhaler. He appears uncomfortable. His temperature is 37.4°C (99.3°F), pulse is 101/min, and blood pressure is 126/84 mm Hg. Examination shows a tender bulge on the left side above the inguinal ligament that extends into the left scrotum; lying down or applying external force does not reduce the swelling. Coughing does not make the swelling bulge further. There is no erythema. The abdomen is distended. Bowel sounds are hyperactive. Scattered rhonchi are heard throughout both lung fields. Which of the following is the most appropriate next step in management? What is the correct clinical assessment? Select two (2) answers. a. Femoral hernia b. Incarcerated inguinal hernia c. Direct inguinal hernia d. Indirect inguinal hernia

b. Incarcerated inguinal hernia d. Indirect inguinal hernia

A 19-year-old woman, gravida 1, para 0, at 21 weeks' gestation comes to the physician for a follow-up prenatal visit. At her previous appointment, her serum α-fetoprotein concentration was elevated. She had smoked 1 pack of cigarettes daily for 3 years but quit at 6 weeks' gestation. Examination shows a uterus consistent in size with a 21-week gestation. Ultrasonography shows fetal viscera suspended freely into the amniotic cavity. Which of the following is the most likely diagnosis? a. Omphalocele b. Femoral hernia c. Gastroschisis d. Diastasis recti

c. Gastroschisis

A 54-year-old woman comes to the emergency department because of a 5-hour history of diffuse, severe abdominal pain, nausea, and vomiting. She reports that there is no blood or bile in the vomitus. Two weeks ago, she started having mild aching epigastric pain, which improved with eating. Since then, she has gained 1.4 kg (3 lb). PMH: She has a 2-year history of osteoarthritis of both knees, for which she takes ibuprofen (NSAID). She drinks 1-2 glasses of wine daily. Physical exam: patient is lying supine with her knees drawn up and avoids any movement. Her temperature is 38.5°C (101.3°F), pulse is 112/min, respirations are 20/min, and blood pressure is 115/70 mm Hg. Abdominal examination reveals RUQ and epigastric abdominal tenderness (TTP), involuntary muscle guarding and rebound tenderness in the epigastric region and the RUQ; absent bowel sounds. a. Acute appendicitis with perforation b. Perforatated peptic ulcer c. Gastric cancer

b. Perforatated peptic ulcer

A patient with peritonitis due to ruptured appendicitis. Develops fever, tachycardia, tachypnea, hypotension, and ↑ WBC. Treated with vasopressors => persistent hypotension and after adequate fluid resuscitation, there is persistent lactic acidosis. Given the clinical data, what is the best assessment? a. Paralytic ileus b. Septic shock and risk for Multiple organ dysfunction syndrome c. Obstructive ileus

b. Septic shock and risk for Multiple organ dysfunction syndrome

A 26-year-old white man comes to the physician because of increasing generalized fatigue for 6 months. He has been unable to work out at the gym during this period. He has also had cramping lower abdominal pain and diarrhea for the past 5 weeks that is occasionally bloody. His father was diagnosed with colon cancer at the age of 65. He has smoked half a pack of cigarettes daily for the past 10 years. He drinks 1-2 beers on social occasions. His temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 116/74 mm Hg. Physical examination shows dry mucous membranes. The abdomen is soft and nondistended with slight tenderness to palpation over the lower quadrants bilaterally. Rectal examination shows stool mixed with blood. His hemoglobin concentration is 13.5 g/dL, leukocyte count is 7,500/mm3, and platelet count is 480,000/mm3. Urinalysis is within normal limits. Given the clinical data, what is the most likely differential diagnosis? a. Crohn's disease b. Ulcerative Colitis c. diverticulitis

b. Ulcerative Colitis

Which IBD is most likely when the HPI includes the following clinical features? (Reminder HPI = history of present illness) Severe hematochezia Toxic megacolon with risk for perforation and peritonitis High risk for CRC The disease can potentially be cured surgically 90% of individuals with primary sclerosing cholangitis (PSC) has this IBD disease a. IBS-M b. Ulcerative Colitis c. Crohn Disease

b. Ulcerative Colitis

A. A 19-year-old female presents with acute onsset of... Low grade fever Umbilical => RLQ pain TTP at RLQ Based only on the clinical data before further examination, what is the best clinical assessment? a. peritonitis b. appendicitis c. viscus rupture

b. appendicitis

A 26-year-old white man comes to the physician because of increasing generalized fatigue for 6 months. He has been unable to work out at the gym during this period. He has also had cramping lower abdominal pain and diarrhea for the past 5 weeks that is occasionally bloody. His father was diagnosed with colon cancer at the age of 65. He has smoked half a pack of cigarettes daily for the past 10 years. He drinks 1-2 beers on social occasions. His temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 116/74 mm Hg. Physical examination shows dry mucous membranes. The abdomen is soft and nondistended with slight tenderness to palpation over the lower quadrants bilaterally. Rectal examination shows stool mixed with blood. His hemoglobin concentration is 13.5 g/dL, leukocyte count is 7,500/mm3, and platelet count is 480,000/mm3. Urinalysis is within normal limits. Which of the following is the most appropriate next step in management? a. CT scan of the abdomen and pelvis with contrast b. colonoscopy c. Wireless capsule endoscopy

b. colonoscopy

A 55-year-old woman comes to the emergency department because of a 24-hour history of severe lower abdominal pain. She has had two episodes of nonbloody vomiting today and has been unable to keep down food or fluids. She has not had a bowel movement since the day before. PMH: She has hyperlipidemia and rheumatoid arthritis treated with NSAIDS and periodically with glucocorticoids. Cholecystectomy 5 years ago due to acute cholecystitis. Drugs: 20 pack-years of cigarettes (i.e., patienet has been smoking one pack of cigarettes/day for the past 20 years). Currently smoking. Current medications include atorvastatin (for high cholesterol), and naproxen (NSAID) & sporadically high-doese glucocorticoids (Prednisone) RA. Vital statistics: temp 38.8°C (101.8°F); HR 102/min, regular rhythm; RR 20/min; BP 118/78 mm Hg. BMI is 33.4 kg/m2. Given the clinical dta, what is the most probable differential diagnosis? a. appendicitis b. Constipation c. Diverticulitis

c. Diverticulitis

Ulcerative colitis: a. voluminous, watery, non-bloody diarrhea, often including steatorrhea b. presents with tenesmus and frequent, watery and bloody diarrhea

b. presents with tenesmus and frequent, watery and bloody diarrhea

A 55-year-old woman comes to the emergency department because of a 24-hour history of severe lower abdominal pain. She has had two episodes of nonbloody vomiting today and has been unable to keep down food or fluids. She has not had a bowel movement since the day before. PMH: She has hyperlipidemia and rheumatoid arthritis treated with NSAIDS and periodically with glucocorticoids. Cholecystectomy 5 years ago due to acute cholecystitis. Drugs: 20 pack-years of cigarettes (i.e., patienet has been smoking one pack of cigarettes/day for the past 20 years). Currently smoking. Current medications include atorvastatin (for high cholesterol), and naproxen (NSAID) & sporadically high-doese glucocorticoids (Prednisone) RA. Vital statistics: temp 38.8°C (101.8°F); HR 102/min, regular rhythm; RR 20/min; BP 118/78 mm Hg. BMI is 33.4 kg/m2. Which of the following is most appropriate to confirm the diagnosis, its extent, and detecting potential complications? a. Abdominal ultrasound b. Colonoscopy c. CT scan of the abdomen with contrast

c. CT scan of the abdomen with contrast

What disorder is consistent with the following clinical features? Affects men age 20-40 years and men over 70 years Symptoms: no malaise; only mild genitourinary pain (retro-pubic/perineal); persistent/recurrent lower urinary tract symptoms (dysuria, increased frequency urinate, urgency); commonly erectile dysfunction and possibly bloody semen. Physical exam: low-grade fever; on digital rectal palpation, the prostate either has normal size and consistency or is mildly enlarged and tender. Cause: long-lasting prostate infection with Chlamydia or Gonococci (younger men) or E.coli (older men). a. Benign prostatic hyperplasia (BPH) b.Chronic pelvic floor pain syndrome (CPFS) c. Chronic bacterial prostatitis (CBP)

c. Chronic bacterial prostatitis (CBP)

A 33-year-old woman comes to the physician because of a 4-month history of intermittent lower abdominal cramps associated with diarrhea, bloating, and mild nausea. During this period, she has had a 5-kg (11-lb) weight loss. She feels like she cannot fully empty her bowels. She has no history of serious illness. She has a high-fiber diet. Her father is of Ashkenazi Jewish descent. She has smoked 2 packs of cigarettes daily for 15 years. She appears well. Her temperature is 36.9°C (98.5°F), pulse is 90/min, and blood pressure is 130/90 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. Abdominal examination shows mild tenderness to palpation in the right lower quadrant without guarding or rebound. Bowel sounds are normal. Test of the stool for occult blood is negative. Her hemoglobin concentration is 10.5 g/dL, leukocyte count is 12,000/mm3, platelet count is 480,000/mm3, and erythrocyte sedimentation rate is 129 mm/h. A barium enema shows ulceration and narrowing of the right colon. Which of the following is the most likely diagnosis? a. Celiac disease b. IBS c. Crohn's disease

c. Crohn's disease

A 19-year-old woman, gravida 1, para 0, at 21 weeks' gestation comes to the physician for a follow-up prenatal visit. At her previous appointment, her serum α-fetoprotein concentration was elevated. She had smoked 1 pack of cigarettes daily for 3 years but quit at 6 weeks' gestation. Examination shows a uterus consistent in size with a 21-week gestation. Ultrasonography shows fetal viscera suspended freely into the amniotic cavity. Which of the following is the most likely diagnosis? a. Diastasis recti b. Omphalocele c. Gastroschisis

c. Gastroschisis

A 15-year-old girl is brought to the physician by her mother for a 2-day history of abdominal pain, nausea, vomiting, diarrhea, and decreased appetite. Her last menstrual period was 3 weeks ago. Her temperature is 37.6°C (99.7°F). Abdominal examination shows tenderness to palpation with guarding in the right lower quadrant. Laboratory studies show a leukocyte count of 12,600/mm3. What is the most likely underlying cause of this patient's condition? a. Mesenteric adenitis b. Colonic diverticular inflammation c. Intraluminal obstruction, infection, and ischemia

c. Intraluminal obstruction, infection, and ischemia

A 26-year-old white man comes to the physician because of increasing generalized fatigue for 6 months. He has been unable to work out at the gym during this period. He has also had cramping lower abdominal pain and diarrhea for the past 5 weeks that is occasionally bloody. His father was diagnosed with colon cancer at the age of 65. He has smoked half a pack of cigarettes daily for the past 10 years. He drinks 1-2 beers on social occasions. His temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 116/74 mm Hg. Physical examination shows dry mucous membranes. The abdomen is soft and nondistended with slight tenderness to palpation over the lower quadrants bilaterally. Rectal examination shows stool mixed with blood. His hemoglobin concentration is 13.5 g/dL, leukocyte count is 7,500/mm3, and platelet count is 480,000/mm3. Urinalysis is within normal limits. Given the clinical data, what is the most likely differential diagnosis? a. Diverticulitis b. Crohn's disease c. Ulcerative colitis d. Small bowel obstruction

c. Ulcerative colitis

A 26-year-old white man comes to the physician because of increasing generalized fatigue for 6 months. He has been unable to work out at the gym during this period. He has also had cramping lower abdominal pain and diarrhea for the past 5 weeks that is occasionally bloody. His father was diagnosed with colon cancer at the age of 65. He has smoked half a pack of cigarettes daily for the past 10 years. He drinks 1-2 beers on social occasions. His temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 116/74 mm Hg. Physical examination shows dry mucous membranes. The abdomen is soft and nondistended with slight tenderness to palpation over the lower quadrants bilaterally. Rectal examination shows stool mixed with blood. His hemoglobin concentration is 13.5 g/dL, leukocyte count is 7,500/mm3, and platelet count is 480,000/mm3. Urinalysis is within normal limits. Which of the following is the most appropriate next step in management? a. Flexible sigmoidoscopy b. CT scan of the abdomen and pelvis with contrast c. Assessment of auto-antibodies for parietal cells and intrinsic factor d. Colonoscopy e. Wireless capsule endoscopy f. Assessment of anti-gliadin antibodies

d. Colonoscopy

A 33-year-old woman comes to the physician because of a 4-month history of intermittent lower abdominal cramps associated with diarrhea, bloating, and mild nausea. During this period, she has had a 5-kg (11-lb) weight loss. She feels like she cannot fully empty her bowels. She has no history of serious illness. She has a high-fiber diet. Her father is of Ashkenazi Jewish descent. She has smoked 2 packs of cigarettes daily for 15 years. She appears well. Her temperature is 36.9°C (98.5°F), pulse is 90/min, and blood pressure is 130/90 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. Abdominal examination shows mild tenderness to palpation in the right lower quadrant without guarding or rebound. Bowel sounds are normal. Test of the stool for occult blood is negative. Her hemoglobin concentration is 10.5 g/dL, leukocyte count is 12,000/mm3, platelet count is 480,000/mm3, and erythrocyte sedimentation rate is 129 mm/h. A barium enema shows ulceration and narrowing of the right colon. Which of the following is the most likely diagnosis? a. Diverticulitis b. Irritable bowel syndrome c. Celiac diseaseUlcerative colitis d. Crohn's disease

d. Crohn's disease

A 2-week-old infant is brought to the emergency room because of 4 episodes of bilious vomiting and inconsolable crying for the past 3 hours. Abdominal examination shows no abnormalities. An upper GI contrast series shows the duodenojejunal junction to the right of the vertebral midline; an air-filled cecum is noted in the right upper quadrant. Which of the following is the most likely cause of this patient's condition? a. Hypertrophy and hyperplasia of the pyloric sphincter b. Failure of duodenal recanalization c. Defective neural crest migration d. Incomplete rotation of the intestines e. Telescoping of ileum into cecum

d. Incomplete rotation of the intestines

A 10-year-old girl is brought to the emergency department because of lower abdominal pain for the past 12 hours. The pain has progressively worsened and was accompanied by occasional episodes of diarrhea. She has vomited twice. Her mother has Crohn disease. Her temperature is 38.1°C (100.6°F), pulse is 95/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. The abdomen is soft, and there is mild tenderness to palpation in the right lower quadrant without rebound or guarding. Bowel sounds are normal. Her hemoglobin concentration is 13.0 g/dL, leukocyte count is 12,800/mm3, and platelet count is 345,000/mm3. Urine dipstick is negative for nitrites and leukocyte esterase. Urinalysis shows 3 WBC/hpf and no RBCs. Which of the following is the most appropriate next step in management? a. Emergency laparoscopy b. CT scan of the abdomen c. MRI of the abdomen d. Ultrasound of the abdomen e. X-ray of the abdomen f. Colonoscopy

d. Ultrasound of the abdomen

A 2-week-old infant is brought to the emergency room because of 4 episodes of bilious vomiting and inconsolable crying for the past 3 hours. Abdominal examination shows no abnormalities. An upper GI contrast series shows the duodenojejunal junction to the right of the vertebral midline; an air-filled cecum is noted in the right upper quadrant. Which of the following is the most likely cause of this patient's condition? a. Defective neural crest migration b. Hypertrophy and hyperplasia of the pyloric sphincter c. Telescoping of ileum into cecum d. Failure of duodenal recanalization e. Incomplete rotation of the intestines

e. Incomplete rotation of the intestines