ROSH QBank General Surgery EOR

A 36-year-old man presents with abdominal pain after a motor vehicle collision. The patient has seatbelt sign and tenderness in the left lower quadrant. He has a normal CT abdomen and pelvis with IV contrast and no laboratory evidence of anemia. The patient is admitted for serial abdominal exams. On day one of admission, his abdominal exam improves and he tolerates a solid food challenge. One hour after eating, his pain returns and rapidly worsens. Repeat imaging demonstrates large bowel perforation. The patient remains hemodynamically stable and consents to laparoscopic colon resection. Which of the following is the best preoperative prophylaxis for venous thromboembolism for this patient? AIntermittent pneumatic compression BIntermittent pneumatic compression and low-molecular-weight heparin CLow-molecular-weight heparin DNo prophylaxis

BIntermittent pneumatic compression and low-molecular-weight heparin

A 45-year-old man with a history of chronic constipation presents with an acute onset of colicky right lower quadrant pain and abdominal distention. He also reports obstipation, decreased appetite, nausea, and vomiting. On exam, he is noted to have distended abdomen and diffuse abdominal pain with palpation. His barium enema shows a gradual tapering of the sigmoid colon. Which of the following best describes this finding? A"Bird beak" sign B"Coffee bean" sign C"Omega loop" sign D"Whirl" sign

A "bird beak" sign

A 78-year-old man is brought by his daughter to his primary care provider with gradually worsening headaches, light-headedness, apathy, somnolence, and occasional seizures. He has never had these symptoms before. His medications include atorvastatin 10 mg and aspirin 81 mg daily. The daughter denies that the patient has had any falls or major head trauma other than he hit his head one time 3 weeks ago while grabbing an item from underneath the sink. Which one of the following findings would be expected on a noncontrast CT scan of the head given the most likely diagnosis? A Concave, crescent-shaped hyperdensity B Concave, crescent-shaped hypodensity C Convex, lens-shaped hyperdensity D Hyperdensity in the parenchyma and ventricles

A Concave, crescent shaped hyperdensity

A 40-year-old woman presents to the emergency department with right upper quadrant pain. On exam, she is afebrile but has right upper quadrant tenderness. Laboratory testing reveals an alkaline phosphatase of 640 U/L, AST of 204 U/L, and ALT of 220 U/L. The common bile duct measures 9 mm on transabdominal ultrasound, and the gallbladder is present. Which of the following is both diagnostic and therapeutic for the most likely diagnosis? AEndoscopic retrograde cholangiopancreatography BEndoscopic ultrasound CMagnetic resonance cholangiopancreatography DRight upper quadrant abdominal ultrasound

A ERCP

A 17-year-old boy is admitted for acute appendicitis after presenting with fever, abdominal pain, and anorexia for the last 3 days. He undergoes a laparoscopic appendectomy, in which the surgeon notes and removes a ruptured appendix. After the surgery is completed without complications, he is admitted postoperatively for IV antibiotics, pain control, and supportive care. He does not have drains or a urinary catheter. On postoperative day 5, he is still unable to tolerate oral intake though he is passing gas. He is requiring pain medication and has a rising fever curve. On physical exam, his belly is mildly distended and tender to palpation. His surgical wounds are clean, dry, and intact. He reports no dysuria. The rest of his exam is unremarkable. Which of the following is the most important next test? A Abdominal ultrasound B Abdominal X-ray C Chest X-ray D Urinalysis

A abdominal ultrasound

A 24-year-old woman presents to the emergency department with acute right upper quadrant abdominal pain that radiates to her right scapula. She has had similar episodes previously, but they were less severe. Vital signs are T 100.6°F, HR 102 bpm, BP 128/78 mm Hg, RR 16/min, and oxygen saturation 99% on room air. On exam, she has tenderness to palpation of the right upper quadrant. Laboratory studies show a leukocytosis with normal bilirubin, alkaline phosphatase, and liver transaminases. Her abdominal ultrasound is shown above. Which of the following is the most likely diagnosis? AAcute cholecystitis BCholangitis CCholedocholithiasis DUncomplicated gallstone disease

A acute cholecystitis

A 45-year-old woman is an inpatient in the hospital for an acute exacerbation of her Crohn disease that has led to a small bowel obstruction. Despite conservative treatment, the obstruction has not completely resolved. CT scan with contrast shows a 2 cm solid mass in the proximal ileum. Endoscopy shows a solid mass in the proximal lumen with almost complete obstruction. Biopsies are performed. Which of the following is the most likely diagnosis? AAdenocarcinoma BCarcinoid tumor CLeiomyoma DLymphoma

A adenocarcinoma

A 62-year-old man presents to the emergency department with sudden onset of severe upper back pain. He describes the pain as sharp, tearing, and radiating to the abdomen. His vital signs are T 98.7°F, BP 202/108 mm Hg, HR 131 bpm, RR 18 breaths per minute, and pulse oximetry 98% on room air. He has a history of chronic hypertension and asthma and is currently taking lisinopril, albuterol, and budesonide. His initial CXR, 12-lead ECG, and troponin are normal. No murmurs are appreciated on cardiac auscultation. His CTA shows an intimal tear limited to the descending aorta with no evidence of end-organ damage. Which of the following is the most appropriate clinical intervention? AAdminister esmolol BAdminister labetalol CEmergent surgical intervention DEmergent transesophageal echocardiography

A administer esmolol

A 45-year-old woman presents to the emergency department for a three-day history of right upper quadrant abdominal pain and nausea. Her past medical history is significant for obesity. She reports a history of RUQ pain after eating large meals for the past three weeks but states the pain has always subsided until now. Physical exam reveals a fever of 38.9°C, RUQ tenderness, and mild jaundice. The gastrointestinal surgeon has been consulted on the case. What physical exam finding is most consistent with the suspected diagnosis? A Altered mental status B Hypertension C Melena D Splenomegaly

A altered mental status

A 25-year-old man presents to the ED with complaints of abdominal pain, nausea, and vomiting. The patient reports that he has had abdominal pain for about 24 hours that has progressively worsened. The patient's vital signs are BP 140/90 mm Hg, HR 104 bpm, temperature 101.0°F, and RR 20 breaths per minute. On physical exam, the patient appears ill and in pain. Physical exam is positive for generalized abdominal tenderness with guarding and pain in the right lower quadrant and pain with passive right hip extension. What is the most likely diagnosis? AAppendicitis BCecal diverticulitis CCholecystitis DMeckel diverticulum

A appendicitis

A 65-year-old man with a history of hypertension, hyperlipidemia, and diabetes mellitus presents to his primary care provider for a preoperative physical for an upcoming cholecystectomy. While interviewing the patient for a review of systems, he mentions he gets a crushing chest pain when going up more than one flight of stairs. The pain radiates to his jaw but goes away after resting for about 10 minutes. He reports this happens one to two times per week. What medication is recommended to prevent cardiovascular events during his procedure? AAtenolol BIsosorbide mononitrate CIvabradine DRanolazine

A atenolol

A 56-year-old man presents to his primary care provider with complaints of increasing difficulty swallowing, especially solid foods. He also notes an increased frequency of regurgitating "chunks" of food. His partner reports that his breath smells terrible. He reports no chest pain or difficulty breathing. He has not demonstrated any weight loss. Which of the following is the best test to establish the diagnosis? ABarium swallow BManometry CTranscutaneous ultrasound DUpper endoscopy

A barium swallow

A 55-year-old man with a history of alcohol use disorder presents with epigastric abdominal pain, nausea, and several episodes of emesis for the past 2 days. The pain is much worse after eating. A review of systems is positive for unintentional weight loss and steatorrhea over the last few months. He also reports episodes of pain and emesis like this multiple times in the past. Serum amylase and lipase are within normal limits. A CT scan of the abdomen is ordered. Which of the following is the most likely finding on diagnostic imaging? ACalcifications of the pancreas BObstructive gallstone CPancreatic duct stricture DPericholecystic fluid

A calcifications of the pancreas

A 27-year-old woman presents with vomiting and 10/10 right lower extremity pain. The symptoms started suddenly one hour ago when she was lifting weights. The pain is constant and worsening. She has no medical or surgical history, but one month ago, she noticed a painless mass below her right inguinal crease. Her vitals are T 37.1°C, HR 107 bpm, BP 141/92 mm Hg, RR 23/minute, and SpO2 99%. Her body mass index is 22 kg/m2. On examination, she is diaphoretic and pale, and there is a right-sided erythemic mass protruding inferior and lateral to the pubic tubercle. The mass is hot, firm, pulseless, and exquisitely tender to palpation. What is the best way to diagnose this condition? AClinical exam BCT abdomen and pelvis with IV contrast CHernia sac laparoscopy DUltrasound abdomen and pelvis

A clinical exam

A 70-year-old man with a history of hypertension and hypercholesterolemia presents to the office with pain to the thigh and buttocks that has been getting increasingly worse over the past few months. He states that the pain is only present when he is walking his dog in his neighborhood but gets better when he sits down to rest. He is an active tobacco user and has been smoking a pack of cigarettes daily for the past 40 years. Based on the location of his pain, which of the following arteries is most likely affected by atherosclerosis? ACommon iliac artery BDeep femoral artery CDistal superficial femoral artery DPopliteal artery

A common iliac artery

A 67-year-old woman presents to the office with complaints of aching and swelling in the back of her left leg behind her knee into her left ankle. Her symptoms are worse after prolonged standing and walking and are alleviated with elevating her legs. A picture of her leg is shown above. Which of the following is the best next step in treatment? ACompression support BEndovascular laser ablation CRadiofrequency ablation DVenous stripping

A compression support

A 68-year-old woman is two days post-colon resection due to colorectal cancer. She reports her left leg is painful and feels heavy. Physical exam reveals vitals within normal limits, and her left calf is erythematous, swollen, and tender to palpation. What is the initial imaging modality used to evaluate for the suspected diagnosis? ACompression ultrasound with Doppler BComputed tomography angiogram CVentilation-perfusion scan DX-ray of the left leg

A compression ultrasound with doppler

A 74-year-old man presents to his primary care provider with concerns about an ulcer on his leg. His current medications include metformin, hydrochlorothiazide, amlodipine, atorvastatin, aspirin, and varenicline. Which of the following physical examination findings favors a diagnosis of an arterial ulcer rather than a venous ulcer? ADeep, "punched out" appearance BNormal distal pulses CPink or red granulation tissue DPresence of drainage

A deep "punched out" appearance

A 72-year-old man with a history of cirrhosis presents to the emergency department with acute confusion. His wife reports he ran out of his lactulose 3 days ago. On exam, the patient is lethargic but arousable and has asterixis. Laboratory findings reveal a normal basic chemistry panel, and CT of the head shows no acute abnormalities. What is the most likely diagnosis? AGrade II hepatic encephalopathy BGrade IV hepatic encephalopathy CHypoglycemia DUremic encephalopathy

A grade 2 heaptic encephalopathy

A 32-year-old man is admitted to the hospital for fever and severe pain in his right finger. The patient cut his finger with a hedge trimmer 4 days ago and did not seek medical treatment. He has been taking ibuprofen at home. Vital signs are T 39.1°C (102.4°F), BP 88/58 mm Hg, HR 110 bpm, RR 26 breaths per minute, and pulse oximetry 97% on room air. Physical examination is significant for a 2 cm laceration over the distal interphalangeal joint of the right index finger. Hand radiographs are significant for a nondisplaced, oblique fracture of the distal phalanx of the right index finger. Arterial blood gas values are as follows: pH: 7.15 pCO2: 36 mm Hg HCO3: 12 mmol/L Anion gap: 32 mEq/L Which of the following acid-base disorders best describes the patient's condition? AMetabolic acidosis BMetabolic alkalosis CRespiratory acidosis DRespiratory alkalosis

A metabolic acidosis

A 65-year-old man with myasthenia gravis presents with severe headache and drowsiness and is diagnosed with respiratory acidosis. Which of the following arterial blood gas findings would you expect to see in this patient? ApH 7.20, PaCO2 50 mm Hg, and bicarbonate 23 mEq/L BpH 7.25, PaCO2 40 mm Hg, and bicarbonate 20 mEq/L CpH 7.55, PaCO2 30 mm Hg, and bicarbonate 24 mEq/L DpH 7.60, PaCO2 40 mm Hg, and bicarbonate 28 mEq/L

A pH 7.20, PaCO2 50mmHG, and bicarbonate 23 mEq/L

A previously healthy 8-year-old boy presents to your office with his parents for his annual well-child exam. The parents are wondering about the need for cancer screening, given the patient's father having a recent diagnosis of colorectal cancer at age 35 years due to familial adenomatous polyposis. Which of the following is the most appropriate guidance? AScreening starting at age 10 years BScreening starting at age 25 years CScreening starting at age 35 years DScreening starting at age 50 years

A screening starting at age 10 years

A 65-year-old woman with a history of ovarian cancer presents with right lower extremity swelling and discomfort. Physical exam reveals right calf tenderness without any overlying skin changes. She reports no shortness of breath, chest pain, or hemoptysis. An ultrasound confirms the diagnosis. A decision is made to begin anticoagulation therapy after assessing risk factors. Which of the following statements most accurately describes the most appropriate treatment plan? AThis patient will be started on low-molecular-weight heparin for 3 months before reassessing the duration of therapy BThis patient will be started on unfractionated heparin and bridged to apixaban for 12 months CThis patient will be started on unfractionated heparin and bridged to warfarin for 6 months DThis patient will be started on warfarin immediately and it will be continued for 3 months

AThis patient will be started on low-molecular-weight heparin for 3 months before reassessing the duration of therapy

A 65-year-old man presents to his primary care provider for his annual physical. He has a 5 pack-year history of smoking, however, he quit 40 years ago. During his screening for abdominal aortic aneurysm, his aorta is measured to be 4.2 centimeters in diameter. When should he return to the clinic to have a repeat ultrasound completed? A1 month B12 months C3 months DHe should be referred immediately to vascular surgery for urgent repair

B 12 months

A 68-year-old man with a history of type 2 diabetes presents to the ED with altered mental status. His wife found him minimally responsive with incoherent speech and agitation. His medication list includes regular insulin and glyburide. On exam, he is noted to be confused with a Glasgow Coma Scale score of 11. Point-of-care glucose level is 45 mg/dL. Which of the following therapies is indicated? AGlucose tablets BIntravenous dextrose COrange juice DThiamine

B IV dextrose

A 70-year-old man has a solid kidney mass identified on abdominal imaging performed for unrelated reasons. The radiologic features of the mass are concerning for malignancy. Which of the following is the classic triad for the most likely diagnosis? A Abdominal mass, ascites, and weight loss B Abdominal mass, flank pain, and hematuria C Flank pain, hematuria, and weight loss D Flank pain, left-sided varicocele, and weight loss

B abdominal mass, flank pain, and hematuria

A 75-year-old man presents to the emergency department after a motor vehicle collision, in which he was thrown from his vehicle. The patient's vital signs are BP 160/100 mm Hg, pulse 110 bpm, respiration 10/min, and oxygenation 96% on room air. He has a past medical history of atrial fibrillation and is anticoagulated with warfarin. Lab work reveals hemoglobin 9.5 g/dL and an international normalized ratio of 10.5. A noncontrast CT of his head shows a significant subdural hemorrhage. Neurosurgery is consulted on the patient's case. What is the best next step in the management of this patient? A Administer protamine sulfate B Administer vitamin K and fresh frozen plasma C Administer vitamin K only D Transfuse one unit of packed red blood cells

B administer viatmin K and fresh frozen plasma

A 41-year-old woman with a history of well-controlled asthma presents for an elective cholecystectomy. She will require endotracheal intubation. She is currently not experiencing any wheezing or asthma exacerbation. Which of the following interventions would help reduce postoperative pulmonary complications? AAdministering an inhaled glucocorticoid for 1 week before surgery BAdministering an inhaled rapid-acting beta-agonist before surgery CNo intervention is necessary at this time DPrescribing a systemic glucocorticoid for 2 days prior to surgery

B administering an inhaled rapid acting beta agonist before surgery

A 50-year-old man with a history of alcohol use disorder presents to the clinic with intermittent epigastric pain that radiates to his back. The patient still drinks alcohol daily. Laboratory studies, including a lipase, are unremarkable. CT of the abdomen and pelvis shows calcifications of the pancreas. Which of the following is the best initial management of this patient's pain? AAdmission, nil per os diet, intravenous fluids, and intravenous analgesics BAlcohol cessation and reduce dietary fat intake CPancreatic lipase supplementation DSurgical decompression

B alcohol cessation and reduce dietary fat intake

A 23-year-old man presents with anorectal discharge for two weeks. Three weeks ago, he had a painful right-sided perianal mass that he "popped" with his fingers. The pain has continued, and two weeks ago, he noticed pus and blood on toilet paper after each bowel movement. He has no medical or surgical history. His vitals are normal. On examination, there is a subcutaneous nodular structure at the right perianal region with minimal overlying erythema, and on rectal examination, a small amount of pus is expressed with palpation of the right lateral anal canal. The remainder of his physical exam is normal. What is the most likely diagnosis? AAnal fissure BAnal fistula CMarjolin ulcer DPerianal abscess

B anal fistula

A 67-year-old man presents with abdominal pain and fever for the past 2 hours. Physical exam reveals tenderness below the navel and heme-positive stool. Duplex ultrasound is ordered and demonstrates a complete lack of arterial blood flow to the superior mesenteric artery. Which of the following risk factors would you expect to find in this patient's history? AAlcohol use disorder BAtrial fibrillation CCholelithiasis DDiverticulosis

B atrial fibrillation

A 45-year-old man with a history of alcohol use disorder presents with profuse hematemesis that began just prior to arrival. His vital signs demonstrate a heart rate of 120 bpm and a blood pressure of 98/62 mm Hg. Which of the following is the best first step in managing the care of this patient? AAdminister intravenous proton pump inhibitor BBegin fluid resuscitation CBegin nasogastric lavage DOrder a type and crossmatch for transfusion

B begin fluid resuscitation

A 58-year-old man presents to his primary care provider with a complaint of lower extremity edema that has been worsening over the past year. He reports that the symptoms began shortly after he was diagnosed with a deep vein thrombosis in his left leg. He experiences moderate discomfort in his legs, especially after standing on his feet for a long time. Physical examination reveals a morbidly obese man with bilateral pitting edema of the legs and feet. The skin overlying his ankles is taut, shiny, and has a brownish pigmentation. There is no blanching erythema or pain with palpation. What is the most likely diagnosis? ACellulitis BChronic venous insufficiency CErythema induratum DLipedema

B chronic venous insufficiency

A 68-year-old man presents to his primary care provider for follow-up of his left leg pain. He states whenever he goes for a walk with his wife, his left calf continues to cramp and he has to rest for the pain to go away, he has stopped going out as much due to the pain. He has a past medical history of hyperlipidemia and a 40 pack-year smoking history. Physical exam reveals diminished peripheral pulses and hair loss on the dorsal aspect of his left foot. An in-office ankle-brachial index was 0.85. A vascular surgeon was previously consulted and the patient has gone through 3 months of treatment. What medication should be initiated for this patient? AAspirin BCilostazol CClopidogrel DMetformin

B cilostazol

A 32-year-old G1A0P1 woman presents with two days of worsening abdominal pain. She has not passed stool or flatus since an uncomplicated spontaneous vaginal delivery with epidural anesthesia two days ago. Her medical and surgical history is otherwise unremarkable. On examination, her abdomen is distended, tympanic to percussion, and diffusely tender. The remainder of her physical exam and vitals are normal. Which of the following would most likely be seen on a CT abdomen and pelvis with IV contrast? A Acute appendicitis B Colonic dilation without mechanical obstruction C Intraluminal colorectal mass D Small bowel obstruction with adhesions

B colonic dilation without mechanical obstruction

Which of the following presentations is chronic gastroesophageal reflux disease most commonly associated with? A Adenocarcinoma of the proximal esophagus B Columnar metaplasia of the squamous epithelium C Small cell carcinoma of the distal esophagus D Squamous cell carcinoma of the distal esophagus

B columnar metaplasia of the squamous epithelium

A 57-year-old woman who is obese presents with concerns of bilateral lower extremity edema that has been worsening over the last few months. She is complaining of itching, particularly in the medial aspects of the ankles. Physical exam reveals hyperpigmentation of the ankles with 1 pitting edema. There is no tenderness to palpation or ulcerations noted. A venous duplex ultrasound is negative for deep vein thrombosis. Which of the following is the most appropriate intervention? AAntibiotic prescription BCompression stockings CReferral for venous stenting DUnna boot application

B compression stockings

A 54-year-old woman presents to the clinic with an ulcer over her right anterior tibia. Physical exam reveals nonpitting edema and the ulcer shown above. What is the most appropriate initial treatment for this patient? A Antibiotics B Compression therapy C grafting D Wet-to-dry dressings

B compression therapy

A 22-year-old woman presents with several months of intermittent abdominal pain and diarrhea. She describes the abdominal pain as cramping. During these episodes, she has general malaise and fatigue. She is asymptomatic currently and her physical exam is benign. MRI with enterography is ordered and shows transmural inflammation and submucosal thickening with a cobblestone appearance. Which of the following is the most likely diagnosis? ACeliac disease BCrohn disease CIrritable bowel syndrome DUlcerative colitis

B crohn disease

A 55-year-old woman with a history of endometrial cancer is currently hospitalized after having a complicated hysterectomy surgery 4 days ago. She is beginning to complain of right lower extremity pain and tenderness. On exam, her right calf is 3 cm larger in circumference when compared to her left calf, she is very tender to palpation, and there is a positive Homan sign. What is the most likely diagnosis for this patient? ACellulitis BDeep vein thrombosis CSuperficial thrombophlebitis DVaricose veins

B deep vein thrombosis

A 75-year-old man presents to the clinic to discuss concerns regarding cancer screening. His brother was recently diagnosed with esophageal cancer, and he believes that he is having similar symptoms to what his brother had a year ago. What are the most common symptoms of esophageal carcinoma to look for in this patient? AAbdominal pain and food regurgitation BDysphagia and weight loss CHematemesis and odynophagia DHoarseness and diarrhea

B dysphagia and weight loss

A 75-year-old man with a history of hypertension and tobacco use presents with a sense of abdominal fullness and moderate throbbing pain. Approximately a year ago, he was incidentally found to have a 4.5 cm abdominal aortic aneurysm. On exam today, he is noted to have moderate abdominal pain that is located in the hypogastrium. A repeated abdominal ultrasound shows that the aneurysm now measures 5.3 cm in diameter. Which of the following is the most appropriate next step in the management of this patient? AEmergent embolectomy BEndovascular stent-graft placement CRepeat ultrasound in 6 months DThrombolytic therapy

B endovascular stent graft placement

A 68-year-old man presents one day status post endovascular repair of a thoracic aortic aneurysm. He had no complications from surgery or anesthesia. The patient reports adequate analgesia. His vitals are stable, and he has a normal physical exam. A provider is educating the patient on postoperative care, including venous thromboembolism prophylaxis. Which of the following is also indicated for postoperative prophylaxis? AContinuous positive airway pressure BIncentive spirometry CIntermittent positive pressure breathing DNasogastric tube insertion

B incentive spirometry

A 29-year-old man presents with diarrhea and abdominal pain for one week. He has eight bloody stools per day. His vitals are T 37.2°C, HR 120 bpm, BP 101/60 mm Hg, RR 17 breaths/min, and SpO2 93%. On examination, he has LLQ tenderness. A CT abdomen and pelvis with IV contrast shows 5 cm dilation of the descending colon, and his Hb is 7.5 g/dL. He is admitted and managed with blood transfusions, bowel rest, and IV fluids and glucocorticoids. On day three, the patient starts treatment with a TNF-blocking agent. By day seven, the patient has two formed, bloodless stools per day, he tolerates PO liquids and solids, and his vitals and exam are normal. His fecal calprotectin level is 120 mg/g. Which of the following is the best option for maintenance therapy upon discharge? ABudesonide BInfliximab CMesalamine DPrednisone

B infliximab

A 33-year-old woman presents with complaints of painful breasts for the last year. She states she has pain in the bilateral breasts that is worse during the few days before her menstrual cycle begins. She performs regular breast self-examinations and notices tender masses in both breasts during this time that seem to resolve at other times in her cycle. Her breast exam does not reveal a dominant mass. Which of the following is the best intervention at this time? A Arrange for excision of the masses B Instruct patient to wear a supportive bra C Order a bilateral mammogram D Prescribe tamoxifen

B instruct patient to wear a supportive bra

A 56-year-old woman is scheduled for an open reduction internal fixation of her right radius and ulna after she fell in her shower. She has a history of persistent atrial fibrillation and is instructed to hold her rivaroxaban for 48 hours prior to surgery. On the morning of her surgery, the patient suddenly develops pain in her right leg. Her right leg feels cold compared to her left leg. An emergent Doppler ultrasound is performed and reveals 1 pulses over the dorsalis pedis and posterior tibial arteries of the right leg and 3 pulses over the dorsalis pedis and posterior tibial arteries of the left leg. Which of the following physical examination findings is a late sign of the patient's condition? ALoss of distal pulse BLoss of motor function CLoss of sensation DPale color

B loss of motor function

A 64-year-old man presents for a bulge in the groin area that he noticed over the last week. It is not painful or tender. In the morning upon waking, he feels it is smaller, and as the day progresses and he is on his feet for long hours at work, it gets larger. On physical exam, you notice a bulge in the left inguinal area that is soft and increases with Valsalva maneuver. There is no overlying erythema or warmth. Which of the following risk factors is associated with the most likely diagnosis? AAlcohol use disorder BMale sex CSubstance use disorder DYounger age

B male sex

A 32-year-old man is admitted to the hospital for fever and severe pain in his right finger. The patient cut his finger with a hedge trimmer 4 days ago and did not seek medical treatment. He has been taking ibuprofen at home. Vital signs are T 39.1°C (102.4°F), BP 88/58 mm Hg, HR 110 bpm, RR 26 breaths per minute, and pulse oximetry 97% on room air. Physical examination is significant for a 2 cm laceration over the distal interphalangeal joint of the right index finger. Hand radiographs are significant for a nondisplaced, oblique fracture of the distal phalanx of the right index finger. Arterial blood gas values are as follows: pH: 7.15 pCO2: 36 mm Hg HCO3: 12 mmol/L Anion gap: 32 mEq/L Which of the following acid-base disorders best describes the patient's condition? AMetabolic acidosis BMetabolic alkalosis CRespiratory acidosis DRespiratory alkalosis

B metabolic acidosis

A 56-year-old woman presents to the emergency department with bladder pain and inability to urinate. She had an outpatient surgical procedure yesterday to treat urinary incontinence and has been having difficulty voiding since she arrived home. Upon physical exam, the suprapubic area is distended and painful to palpation. Which of the following is the best next step in the management of her condition? AInsert an indwelling Foley catheter BPerform in-and-out catheterization CPrescribe an alpha-adrenergic antagonist DPrescribe an antibiotic

B perform in and out catheterization

A 65-year-old woman is three days post-liver resection. The nurse calls to tell you the patient has been coughing more frequently. Her temperature is 101°F, RR is 30 breaths per minute, oxygen saturation is 92% on room air, and HR is 102 bpm. On physical exam, the patient appears lethargic and coughs occasionally. Lung examination reveals dullness to percussion and decreased breath sounds over the right lower lobe. Which of the following is the most likely diagnosis? AAtelectasis BPneumonia CPulmonary edema DPulmonary embolism

B pneumonia

A 4-week-old infant presents to the emergency department with his mother for a four-day history of projectile vomiting. The mother states the infant is constantly fussy and hungry but vomits after every feeding. Physical exam reveals dry mucous membranes and a small, hard, mobile mass in the right upper quadrant. A pediatric surgeon is consulted and agrees with the initial ED assessment. Which of the following is the most likely diagnosis? AIntussusception BPyloric stenosis CRotavirus infection DWilms tumor

B pyloric stenosis

Which of the following anatomical locations is the most common site for ulcerative colitis? ALeft colon BRectum CRight colon DTerminal ileum

B rectum

A patient with a long-standing history of gastroesophageal reflux disease presents for a preoperative workup. He reports heartburn, occasional difficulty swallowing, and frequent regurgitation for the past year. An endoscopy reveals protrusion of the proximal stomach into the chest cavity. Which of the following is the most common type of this condition? ATelescoping hernia BType 1 sliding hernia CType 2 paraesophageal hernia DType 3 paraesophageal hernia

B type 1 sliding hernia

A 5-week-old boy presents with frequent vomiting for the past few days. His mother states that, after he eats, he vomits forcefully and then acts as if he is hungry again. You note he has not gained any weight since his last visit 1 week ago. Physical exam reveals a firm, mobile mass in the right upper quadrant of the abdomen. An ultrasound is ordered. Which of the following findings on ultrasound is most consistent with the suspected diagnosis? ADuodenum with a "corkscrew" appearance BLack of perfusion with color duplex imaging C"Target" sign on transverse view in the right upper quadrant D"Whirlpool" sign with craniocaudal movement of the transducer

C "target" sign on transverse view in the right upper quadrant

A 60-year-old man presents to the clinic with progressive dysphagia and weight loss for the past 2 months. Esophagogastroduodenoscopy is performed and shows adenocarcinoma of the esophagus. Which of the following is a risk factor for esophageal adenocarcinoma but not squamous cell carcinoma? AAlcohol use disorder BCigarette smoking CGastroesophageal reflux disease DLow body mass index

C GERD

A 54-year-old man presents to the office with a nonhealing, painful lesion on his left thigh for 7 days. He reports no fever or chills. He enjoys karate and is concerned about a fungal infection. He is at the gym 5 days a week and uses the mats frequently. On exam, there is a 3 cm firm, erythematous, tender nodule with 4 cm of circumferential erythema on his left thigh. There is no purulence or drainage. There is no lymphadenopathy. A potassium hydroxide preparation is negative. What is the first-line treatment of choice, given this patient's suspected condition? AAmoxicillin-clavulanic acid BCiprofloxacin CTrimethoprim-sulfamethoxazole DVancomycin

C TMP SMX

A 79-year-old woman with past medical history of hypertension and hypercholesterolemia presents to the office with a month-long history of worsening, dull, aching abdominal pain. The pain is generalized but is often worse in her midabdomen and significantly worsens 30 minutes after eating. The discomfort lasts approximately half an hour and then spontaneously resolves. She has lost all interest in food and avoids eating large amounts in an attempt to avoid abdominal pain. She has no recent medication changes and is consistent with taking hydrochlorothiazide and simvastatin. She reports an 8-pound unintentional weight loss over the last 3 weeks. Which of the following is the most likely diagnosis? A Acute mesenteric ischemia B Cholelithiasis C Chronic mesenteric ischemia D Ischemic colitis

C chronic mesenteric ischemia

A 32-year-old man presents to the emergency department with shortness of breath and pleuritic chest pain for about 1 hour. Upon physical exam, he is slightly anxious but able to answer questions appropriately. He is very tall (his height is 6'4") and is very thin. Breath sounds are slightly diminished on the lower left side compared to the right, with normal resonance to percussion and normal tactile fremitus. He has a normal heart rate and blood pressure. A chest radiograph reveals a visible visceral pleural shadow with the absence of lung markings peripherally to the left lung field. Which of the following increases the risk of this condition? A Chronic beta-agonist inhaler use B Chronic obstructive pulmonary disease C Cigarette smoking D Cystic fibrosis

C cigarette smoking

A 55-year-old woman presents with a history of vague, nonspecific abdominal pain that began 6 months ago. Endoscopy reveals a one centimeter firm growth in the jejunum, which is biopsied and sent for pathology. A 24-hour urinary excretion reveals elevated levels of 5-hydroxyindoleacetic acid. Which of the following additional symptoms is likely present given the most likely diagnosis? AClear urine and increased thirst BDecreased libido and weight loss CDiarrhea and flushing DPeripheral weakness and numbness

C diarrhea and flushing

Which of the following interventions is recommended to decrease the risk of diverticulosis? A Avoiding nuts B Decreased physical activity C High-fiber diet D Increased fat intake

C high fiber diet

A 78-year-old man with a history of metastatic prostate cancer presents with worsening dyspnea. CT pulmonary angiography confirms two subsegmental pulmonary emboli. He weighs 70 kg and is started on LMWH 70 mg subcutaneous once daily. Four days later, his dyspnea acutely worsens, and he becomes tachypneic after walking a distance of three feet. SpO2 is 88% on room air, and the remainder of his vitals are stable. His ECG and troponin and BNP levels are unremarkable. Repeat CT pulmonary angiography shows an additional segmental pulmonary embolism. Which of the following is the best next step in management? AAnticoagulation with low-molecular-weight heparin intravenous BAnticoagulation with low-molecular-weight heparin subcutaneous and apixaban PO CInferior vena cava filter DThrombolysis with r-tPA

C inferior vena cava

A 55-year-old woman presents status post exploratory laparotomy with lysis of adhesions. On postoperative day 3, the patient begins to experience nausea and vomiting and a nasogastric tube is placed. At postoperative day 5, she continues to experience high output from the nasogastric tube and complains of abdominal pain and nausea. Her vital signs are within normal limits. The physical exam reveals diffuse abdominal discomfort, abdominal distention, and absent bowel sounds. Her basic metabolic panel this morning reveals calcium 8.8 mg/dL, glucose 85 mg/dL, and potassium 2.7 mEq/L. Abdominal X-ray reveals air-fluid levels and distended gas-filled loops of both the small and large intestine. What clinical intervention is indicated at this time? ADiscontinue nasogastric tube and start liquid diet BInitiate antibiotics CInitiate intravenous potassium replacement DObtain CT scan of the abdomen

C initiate IV potassium replacement

What is the most appropriate IV fluid for a preoperative patient who is NPO? A5% dextrose in water BHalf-normal saline CLactated Ringer solution DNormal saline

C lactated ringer solution

A 56-year-old man with a history of polymyalgia rheumatica presents for evaluation prior to elective total right knee replacement. His medications include prednisone 10 mg PO daily for the last three months. His vitals and physical exam are normal. Which of the following is the best next step? A Corticotropin ACTH stimulation test B Insulin tolerance test C Morning serum cortisol level D Surgery in 24 hours

C morning serum cortisol level

A 56-year-old man with a history of polymyalgia rheumatica presents for evaluation prior to elective total right knee replacement. His medications include prednisone 10 mg PO daily for the last three months. His vitals and physical exam are normal. Which of the following is the best next step? ACorticotropin ACTH stimulation test BInsulin tolerance test CMorning serum cortisol level DSurgery in 24 hours

C morning serum cortisol level

You are assessing a patient's perioperative cardiac risk for a noncardiac surgery. Which of the following surgical procedures is considered to have high intrinsic cardiac risk? ALaparoscopic appendectomy BOpen appendectomy COpen cholecystectomy DTotal hip arthroplasty

C open cholecystectomy

A 60-year-old man presents to the emergency department with left lower quadrant abdominal pain for 3 days. He also has mild constipation. On exam, he has left lower quadrant abdominal tenderness without any peritoneal signs. CT of the abdomen and pelvis shows colonic wall thickening around diverticula. He is otherwise healthy, tolerates oral intake, and has normal vital signs. Which of the following is the best treatment in addition to dietary modification? A Admission and intravenous piperacillin-tazobactam B Admission and oral ciprofloxacin and oral metronidazole C Outpatient treatment with oral amoxicillin-clavulanate D Supportive care

C outpatient treatment with oral amoxicillin-clavulanate

A 72-year-old man presents with a 6-month history of unintentional weight loss, anorexia, and epigastric abdominal pain. For the past 2 days, his wife was concerned that he looked "yellow." Laboratory testing is obtained as part of the workup, and a CA19-9 is elevated. Which of the following is the most likely diagnosis? AChronic pancreatitis BMucinous pancreatic cystic neoplasm CPancreatic carcinoma DPrimary pancreatic lymphoma

C pancreatic carcinoma

A 44-year-old man presents with pain in the anal area that began 2 days ago and has been gradually worsening. He denies any rectal bleeding or itching. He also denies any constipation or changes in bowel movements, although he states having a bowel movement today was extremely painful. Physical exam reveals a tender, fluctuant mass that is erythematous to the right of the anus and involves the anal verge. Which of the following is the best next step in managing this patient's care? AApply liquid nitrogen to the lesion BInstruct patient to perform warm sitz baths frequently CPerform incision and drainage DPrescribe amoxicillin-clavulanate

C perform incision and drainage

A 32-year-old woman presents to the ED with complaints of progressively worsening dyspnea on exertion, fatigue, and weakness. She reports that her symptoms started about 2 weeks ago after she developed a viral infection. Yesterday, she began to experience a left-sided chest discomfort that has been constant and worsening. Her vital signs are T 37.1°C, BP 90/76 mm Hg with a 12 mm Hg paradoxical pulse, HR 200 bpm, RR 28 breaths per minute, and oxygen saturation 99% on room air. Physical examination is significant for distended jugular veins and muffled S1S2 on auscultation. Her ECG is shown above. Initial troponin is negative. Echocardiogram findings are consistent with the suspected diagnosis. Which of the following is the most appropriate clinical intervention at this time? AAlbuterol and steroids BLarge-bore needle decompression at the second intercostal space CPericardiocentesis DThrombolytic therapy

C pericardiocentesis

A 67-year-old man is undergoing preoperative evaluation for a coronary artery bypass grafting procedure. You are assessing his nutritional status. Which of the following protein measurements best assesses short-term nutritional status? AAlbumin BGlobulin CPrealbumin DTransferrin

C prealbumin

A 55-year-old man with alcoholic liver disease presents to the office with upper abdominal pain, weight loss, and anemia. An endoscopy reveals the presence of small- to medium-sized esophageal varices. Which of the following medications is used as primary prophylaxis for the prevention of variceal hemorrhage? AIsosorbide mononitrate BNitroglycerin CPropranolol DVasopressin

C propanolol

A 45-year-old woman with a history of systemic lupus erythematosus, leukemia, and severe iodine contrast allergy presents with sudden onset of shortness of breath and chest pain. She recently underwent a surgical repair of left tibial plateau fracture and has not been ambulating as recommended due to pain. On exam, she is noted to be tachypneic, tachycardic, and diaphoretic. Laboratory studies reveal an elevated D-dimer but are otherwise within normal limits. A chest radiograph demonstrates the Westermark sign. Her ventilation-perfusion lung scan shows perfusion defects with normal ventilation. Which of the following is the most likely diagnosis? APleural effusion BPneumothorax CPulmonary embolism DPulmonary hypertension

C pulmonary embolism

A 64-year-old man with chronic atrial fibrillation and hypertension presents with sudden-onset severe left lower-extremity pain for 30 minutes. His medications are carvedilol 12.5 mg PO once daily and lisinopril 20 mg PO once daily. His initial vitals are T 37.2°C, HR 105 bpm, BP 137/60 mm Hg, RR 17 breaths/min, and SpO2 97%. On examination of the left lower extremity, the patient has cool and pale toes, capillary refill greater than seven seconds, and decreased sensation over the plantar and dorsal aspects of the foot. The remainder of his physical exam is normal. Which of the following is the best next step? ACT angiography with IV contrast BFasciotomy CRevascularization DSystemic thrombolysis

C revascularization

A 75-year-old man was admitted to the hospital from a long-term care facility for fever and an elevated WBC count. A stage 3 sacral decubitus injury with superficial necrosis is discovered. He is on sequential compression devices for deep vein thrombosis prophylaxis and is not on any anticoagulants. Which of the following is an appropriate clinical intervention? A Autolytic debridement B Reposition the patient every 6 hours C Sharp debridement D Wet-to-dry dressing changes

C sharp debridement

A 55-year-old man presents to his primary care provider with a history of intermittent claudication and pain in his right leg over the past several months. He has a history of diabetes mellitus, hypertension, and hyperlipidemia. He has a 35 pack-year smoking history. His right leg is shown in the image above. Distal pulses are diminished in the right ankle, and the right foot is cool to the touch. Which of the following is the most appropriate clinical intervention at this time? AAngioplasty BSmoking cessation CSurgical debridement DWet-to-dry dressings

C surgical debridement

A 21-year-old man presents to the office complaining of swelling and achiness to the right testicle. He does not have any other complaints. Upon physical exam, there is a palpable, painless, scrotal mass to the right testis with well-defined margins. The mass does not transilluminate when a light is held behind the scrotum. He does not have any palpable lymph nodes to the inguinal or supraclavicular areas. A testicular ultrasound reveals a well-defined hypoechoic lesion within the right testicle. Which of the following is the most likely diagnosis? A Orchitis B Spermatocele C Testicular cancer D Varicocele

C testicular cancer

A 22-year-old woman presents to her primary care provider with complaints of a retro-orbital headache, diplopia, pulse-synchronous tinnitus, and nausea. She reports that bending her head forward worsens the symptoms, while sitting upright relieves them. She has a history of migraine headaches and is currently on propranolol for prophylaxis. Her vital signs are significant for a body mass index of 42.0 kg/m2. Physical examination is significant for bilateral papilledema and restricted visual fields. A brain MRI is unremarkable. Lumbar puncture is significant for an opening pressure of 40 cm H2O. Cerebrospinal fluid cell count, protein, glucose, cytology, and microbiology results are within normal limits. Which of the following is the best next step in the management of this patient's condition? A Furosemide B Optic nerve sheath fenestration C Topiramate D Ventriculoperitoneal shunt

C topiramate

A 50-year-old woman presents to the clinic with a reducible bulge on the right side of her groin. She states she has minimal pain but denies other symptoms. On exam, there is a reducible and nonpulsatile bulge in the right inguinal area below the inguinal ligament. The bulge has no overlying erythema and is nontender to palpation. Which of the following is the most likely diagnosis? APseudoaneurysm of the iliac artery BSports hernia CUncomplicated femoral hernia DUncomplicated inguinal hernia

C uncomplicated femoral hernia

A 65-year-old woman presents to the emergency department via EMS from an apartment fire. Vitals are BP 85/45 mm Hg, respirations 20 breaths/minute, pulse 110 bpm, and oxygen saturation 96% via 2-liter nasal cannula. She is currently unconscious. There is an open fracture of her right, distal radius. Second-degree burns are noted on her anterior upper extremities bilaterally, chest, and portions of her upper abdomen. Her neck and bilateral lower extremities do not have any signs of burning or trauma. Two large bore intravenous lines are placed and orthopedic surgery is consulted for the open fracture. Which of the following is the preferred access site for a central line in this patient? AInsert a central venous catheter in the cephalic vein BInsert a central venous catheter in the femoral vein CInsert a central venous catheter in the internal jugular vein DInsert a central venous catheter in the subclavian vein

CInsert a central venous catheter in the internal jugular vein

A 54-year-old woman with chronic kidney disease who is receiving hemodialysis is admitted to the hospital with acute cholecystitis and is scheduled to undergo a cholecystectomy during the hospitalization. The patient has normal vital signs, and there are no signs of volume overload on physical exam. Which of the following findings would be an indication for urgent preoperative dialysis in this patient? A Blood pressure of 200/105 mm Hg B Blood urea nitrogen of 55 mg/dL C Glucose of 465 mg/dL D Potassium of 6.1 mEq/L with peaked T waves on electrocardiogram

D Potassium of 6.1 mEq/L with peaked T waves on electrocardiogram

A 60-year-old man presents to the clinic with subacute weight loss and blood in his stool. Laboratory tests show iron deficiency anemia. Colonoscopy reveals an endoluminal mass. Which of the following tumor markers has a role in determining the prognosis of the most likely diagnosis? AAlpha-fetoprotein BBeta-human chorionic gonadotropin CCancer antigen 19-9 DCarcinoembryonic antigen

D carcinoembryonic antigen

A 24-year-old man presents after passing out 20 minutes prior to arrival. He was playing football during the day and was asymptomatic. On a break, he sat down, suddenly felt nauseated, and then passed out for three seconds. Witnesses did not observe any convulsive activity. On examination, the patient is well appearing with normal vital signs and a normal physical exam. CBC and electrolytes are within normal limits. Which of the following is the best next test? ACT head without contrast BDix-Hallpike test CEchocardiogram DElectrocardiogram

D electrocardiogram

A 35-year-old man presents to the emergency department today complaining of severe pain to his left forearm. The patient was seen by an orthopedic surgeon yesterday and had a short-arm cast placed after he fractured his ulna. The patient's left hand appears extremely pale, and his cast is immediately removed. He has absent radial pulses to his left arm and 2 radial pulses on his right arm. The dorsal compartment pressure measures 36 mm Hg. What is the most appropriate next step in this patient's management? A Admission for hourly monitoring B Discharge with prescription for oxycodone C Follow-up with orthopedic surgery in 12-24 hours D immediate fasciotomy

D immediate fasciotomy

A 35-year-old man presents to the emergency department today complaining of severe pain to his left forearm. The patient was seen by an orthopedic surgeon yesterday and had a short-arm cast placed after he fractured his ulna. The patient's left hand appears extremely pale, and his cast is immediately removed. He has absent radial pulses to his left arm and 2+ radial pulses on his right arm. The dorsal compartment pressure measures 36 mm Hg. What is the most appropriate next step in this patient's management? A Admission for hourly monitoring B Discharge with prescription for oxycodone C Follow-up with orthopedic surgery in 12-24 hours D Immediate fasciotomy

D immediate fasciotomy

A 7-year-old boy with no past medical history presents to the emergency department with his mother, who reports he had one episode of a bloody stool. Prior to passing the bowel movement, the patient was doing well and was in no acute distress. He denies having abdominal pain, nausea, or any recent episodes of vomiting. His vitals today are as follows: heart rate 112 bpm, respiratory rate 18 breaths per minute, and blood pressure 90/50 mm Hg. On physical exam, he is pale and appears to be in distress. There is no abdominal tenderness to light or deep palpation throughout his abdomen or masses on abdominal exam, and McBurney and Rovsing signs are negative. A contrast enema is negative. Which of the following is the most likely diagnosis? AAppendicitis BGastroenteritis CIntussusception DMeckel diverticulum

D meckle diverticulum

A 65-year-old woman presents to her primary care provider for a preoperative physical. She is undergoing an elective right total knee arthroplasty in two weeks. She has a history of hypertension, diabetes mellitus type 2, hypercholesterolemia, and hypothyroidism. She is compliant with all of her medications. Lab work reveals HbA1C of 7.3%, glomerular filtration rate of 70 mL/min, and creatinine of 1.1 mg/dL. What medication should be stopped one day prior to surgery? AAspirin BAtenolol CLevothyroxine DMetformin

D metformin

Which of the following types of bile duct stones is most likely to be found in the primary form of choledocholithiasis? A Calcium oxalate stone B Cholesterol stone C Mixed stone D Pigmented stone

D pigmented stone

A 25-year-old woman presents to the gastroenterology clinic with chronic and intermittent diarrhea. Laboratory testing shows iron deficiency anemia and low vitamin B12. Which of the following findings on the above upper gastrointestinal series with small intestine follow-through supports a diagnosis of Crohn disease? AMass lesion BNarrow "bird-beak" appearance of the esophagogastric junction CString sign in the pyloric canal DString sign in the terminal ileum

D string stign in the terminal ileum

A 60-year-old man presents to his primary care physician with complaints of lower extremity pain. The patient reports he has pain in his lower legs while walking that is relieved by rest. On physical exam, skin on bilateral lower legs is shiny and hair loss is present. The patient has a history of type 2 diabetes and hypertension. Medications include metformin 500 mg bid and lisinopril 10 mg daily. Ankle-brachial index is 1.5. Which of the following is the most appropriate next step for diagnosis? A Duplex ultrasound B Exercise ankle-brachial index C Magnetic resonance angiography D Toe-brachial index

D toe brachial index

A 40-year-old woman presents with an intense, intermittent right upper quadrant pain that radiates to her back. Pain is exacerbated by eating and is worse at night. She denies any fever or chills. Laboratory studies are unremarkable. Which of the following diagnostic studies is the initial test of choice? A Computed tomography scan B Endoscopic ultrasonography C Hepatoiminodiacetic acid scan D Transabdominal ultrasonography

D transabdominal ultrasonography

A 40-year-old woman presents with an intense, intermittent right upper quadrant pain that radiates to her back. Pain is exacerbated by eating and is worse at night. She denies any fever or chills. Laboratory studies are unremarkable. Which of the following diagnostic studies is the initial test of choice? AComputed tomography scan BEndoscopic ultrasonography CHepatoiminodiacetic acid scan DTransabdominal ultrasonography

D transabdominal ultrasonography

A 56-year-old woman with a history of poorly controlled hypertension, tobacco dependence, and hyperlipidemia presents to the emergency department with severe abdominal pain that started 1 hour ago. She states the pain is epigastric, has a "tearing" quality, and is radiating distally. Vital signs are BP 80/63 mm Hg, HR 110 bpm, RR 26 breaths per minute, and T 98.1°F. The vascular exam demonstrates 2 pulses over the carotid, brachial, and radial arteries bilaterally and 1 pulses over the femoral and dorsalis pedis arteries bilaterally. Which of the following is the most appropriate initial diagnostic study for this patient? AAbdominal radiograph BAbdominal ultrasound CComputed tomography with contrast DTransesophageal echocardiogram

D transesophageal echocardiogram

A 61-year-old man with a history of hypercholesterolemia and hypertension presents to his primary care provider for his annual checkup and medication refills. Other than feeling out of shape, he has no other complaints. With further questioning, he explains he gets tired more quickly than he used to and feels out of breath quickly with exercise. His exam is concerning for a new 3/6 holosystolic murmur best heard at the apex and radiating to the axilla. Which of the following is the best test to establish the diagnosis? ACardiac catheterization BCardiac MRI CTransesophageal echocardiogram DTransthoracic echocardiogram

D transthoracic echocardiogram

A 66-year-old man presents to the clinic with progressive urinary symptoms over the last few months. He notes he has an increase in urinary frequency, nocturia, and dribbling and a decrease in urine stream. He has tried decreasing his fluid intake throughout the day and does not drink any fluids past 7:00 PM, but he has seen no improvement in his symptoms. The patient has also tried oral medications without any improvement of his symptoms. There is no personal or family history of prostate cancer. A digital rectal exam shows an enlarged, soft, nontender, and rubbery prostate. Recent prostate-specific antigen was noted to be 5.3 ng/mL. What is the most appropriate definitive management for this patient? A Oral finasteride B Radiation therapy C Radical prostatectomy D Transurethral resection of prostate

D transurethral resection of prostate

A 24-year-old woman presents to the emergency department with a 3-day history of bloody diarrhea and painful defecation. She reports three to four bowel movements per day and has noticed the presence of mucus. She has had these symptoms before and was using oral and rectal medications but stopped using them after she felt better. She has some tenderness to palpation of the lower left abdominal quadrant with some mild abdominal distention. Which of the following is the most likely diagnosis? A Crohn disease B Irritable bowel syndrome C Toxic megacolon D Ulcerative colitis

D ulcerative colitis

A 65-year-old man with a history of Helicobacter pylori gastritis presents with abdominal pain and dark, tarry stools. He also notes loss of appetite and unintentional weight loss over the past several months. On exam, he is noted to have an enlarged left supraclavicular node. A barium upper GI series demonstrates gastric ulcers. Which of the following endoscopic features increases the likelihood the ulcers may be malignant? AUlcers filled with exudate BUlcers with flat, smooth bases CUlcers with smooth, rounded edges DUlcers with thickened margins

D ulcers with thickened margins

A 66-year-old man with a history of hypertension, diabetes, and tobacco use disorder presents with an acute onset of a warm, red, tender, and swollen left leg. He had a total hip replacement surgery performed 3 days ago. On exam, the circumference of his left leg is noted to be 27 cm, whereas his right leg circumference is 20 cm. His duplex ultrasonography shows abnormal vein compressibility of the left leg. Which of the following is most likely responsible for the development of his symptoms given the most likely diagnosis? ABacterial infection BDecreased blood viscosity CInferior vena cava malformation DVascular endothelial injury

D vascular endothelial injury

A 54-year-old woman with a history of chronic lower extremity edema presents to her primary care provider with concerns about her left leg. She states that she has been traveling on several international flights over the past 2 months for business trips and has been more sedentary than usual. She noticed that the skin of her lower legs has turned brownish-grey and that her left ankle has become mildly erythematous and pruritic. She notes a shallow ulcer formation on her left leg. She reports no shortness of breath or leg pain. Her left leg is shown in the image above. Her D-dimer is 270 ng/mL. Which of the following is the most likely diagnosis? AArterial ulcer BDeep vein thrombosis CPyoderma gangrenosum DVenous ulcer

D venous ulcer

A 79-year-old woman with a history of multiple abdominal surgeries presents with worsening abdominal pain for 2 days. She has not had a bowel movement in the last 2 days and has been vomiting for the past day. CT of the abdomen is completed and shows dilated loops of small bowel and signs consistent with ischemia. Upon physical exam of the abdomen, the patient contracts the abdominal muscles in response to pain in all four quadrants of the abdomen. Which of the following best describes the physical exam findings? ACutaneous hyperesthesia BRebound tenderness CRovsing sign DVoluntary guarding

D voluntary guarding