Internal medicine 4 course Day 8 sem 2nd

Додано: 16 квітня 2021
Предмет:
Тест виконано: 2 рази
15 запитань
Запитання 1

Which one of the following statements is incorrect in regard to stones in the gallbladder?


варіанти відповідей

Pigment stones are due to increased excretion of conjugated bilirubin

Are considered a risk factor for the development of gallbladder carcinoma

10% of gallstones are radio-opaque

A mucocele of the gallbladder is caused by a stone impacted in Hartman’s pouch

Запитання 2

A 40-year-old woman with diabetes and chronic kidney disease present to the clinic for follow-up after an abdominal ultrasound revealed incidental cholelithiasis without inflammation. The ultrasound revealed two stones, which were less than 5 mm in size. The patient's kidneys were normal. The patient denies experiencing abdominal pain, nausea, or vomiting. She has not had cholecystitis in the past. Of the following, which is the best step to take next in the treatment of this patient?  

варіанти відповідей

Cholecystectomy

Observation

Percutaneous transhepatic cholangiogram

Endoscopic retrograde cholangiopancreatography (ERCP)


Запитання 3

A 45-year-old woman presents to the emergency department complaining of right upper quadrant pain, fever, and nausea of 8 hours' duration. On examination, the patient is found to have right upper quadrant tenderness. Laboratory evaluation reveals leukocytosis and a bilirubin level of 2.5 mg/dl. Which of the following tests is the most accurate method of confirming the clinical diagnosis of acute cholecystitis?

варіанти відповідей

Abdominal CT

Cholescintigraphy

Abdominal ultrasound

Abdominal x-ray

Запитання 4

A 54-year-old man with diabetes and peripheral vascular disease presents to the emergency department with complaints of right upper quadrant abdominal pain of 2 days' duration. On physical examination, the patient appears ill. He has hypotension, fever, and right upper quadrant pain. Laboratory evaluation reveals leukocytosis and a bilirubin level of 3.0 mg/dl. In addition, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are three times the upper limit of normal. Ultrasound reveals gas in the gallbladder. You make a diagnosis of emphysematous cholecystitis. Which of the following is the most likely infectious agent in this patient?




варіанти відповідей

Clostridium perfringens

Cryptosporidium

Cytomegalovirus

Staphylococcus aureus

Запитання 5

A 60-year-old woman with diabetes, severe congestive heart failure, and emphysema presented to clinic complaining of occasional right upper quadrant pain, flatulence, and heartburn. She had been experiencing these symptoms for a period of 1 year. At the time, her physical examination was normal, as was her laboratory evaluation. After undergoing an abdominal ultrasound, she was diagnosed as having chronic cholecystitis, with gallbladder stones and a thickened gallbladder wall. She was referred to surgery. However, the surgeon determined that she was a poor surgical candidate. Today she presents to your clinic with the same persistent complaints. What is the best possible treatment option for this patient?

варіанти відповідей

Ursodeoxycholic acid

Urosodeoxycholic acid and chenodeoxycholic acid together

Insist that the patient undergo cholecystectomy

Augmentin

Запитання 6

A 58-year-old man with altered mental status is brought to the emergency department by the emergency medical service. No history can be obtained. On physical examination, the patient is found to have fever, hypotension, jaundice, and right upper quadrant pain with guarding. Laboratory evaluation reveals leukocytosis, an alkaline phosphatase level of 180 U/L, and a bilirubin level of 5 mg/dl. The patient is diagnosed as having cholangitis. For this patient, which of the following imaging modalities has both diagnostic and therapeutic utility?

варіанти відповідей

Endoscopic ultrasound (EUS)

Abdominal ultrasound

Magnetic resonance cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP)

Запитання 7

A 48-year-old African American woman presents to theemergency department with anorexia, nausea, vomiting,and abdominal pain over the last week. The pain wasinitially in the midepigastric area but has shifted to the rightupper quadrant. This most recent episode of pain hasprogressed over the last 5 hours. She has no past medicalhistory, takes no medications, and has never been pregnant.Her temperature is 38.3° C (100.9° F), blood pressureis 135/80 mm Hg, and pulse is 105 beats/min. She isanicteric and has diminished skin turgor. Her abdomen issoft, and she has voluntary guarding and inspiratory arrestwhen palpating the right upper quadrant. Pelvic and rectalexaminations are unremarkable. Her leukocyte count is14,000/cumm with a left shift, direct bilirubin is 2.4 mg/dL,alkaline phosphatase is 250 U/L, and the remainder of herliver function tests, electrolytes, and pancreatic enzymes arewithin normal limits. Which of the following tests is warranted to confi rm a diagnosis of acute cholecystitis in this patient?

варіанти відповідей

Cholescintigraphy with intravenous injection oftechnetium-99m-labeled hepatoiminodiaceticacid (HIDA)

Plain abdominal x-rays (KUB)

Transabdominal ultrasonography (TUS)

CT of the abdomen and pelvis with intravenous contrast

Запитання 8

A 57-year-old man presents to the emergency departmentwith a 3-day history of nausea, vomiting, right upperquadrant pain, and fevers. In the emergency department, histemperature is 38.7° C (101.7° F), pulse is 120 beats/min, andblood pressure is 90/60 mm Hg. He is jaundiced and drowsybut arousable and oriented to person only. There is markedtenderness in the right upper quadrant and an inspiratorypause with palpation but no organomegaly or reboundtenderness. Bowel sounds are diminished, and the stoolexamination did not show occult blood. His leukocyte countis 23,000, with 80% neutrophils and 12% band forms.Hemoglobin is 19 g/dL, total bilirubin is 3.8 mg/dL, directbilirubin is 3.0 mg/dL, alkaline phosphatase is 295 U/L,aspartate aminotransferase (AST) is 210 U/L, alanineaminotransferase (ALT) is 232 U/L, and serum creatinine is2.1 mg/dL. A transabdominal sonogram shows multiplestones in the gallbladder; diffuse gallbladder wall thickening,and 11 mm of common bile duct dilation. After initiationof intravenous fl uids and empiric antibiotics, the patientis transferred to the intensive care unit for furthermanagement. Which one of the following treatment options is most benefi cial in this patient?

варіанти відповідей

Emergent laparoscopic cholecystectomy

Placement of a cholecystostomy tube under ultrasound guidance

Placement of a nasogastric tube for administration of bile binding resins

Observation for 1 week followed by outpatient surgical intervention

Запитання 9

A 52-year-old obese female patient presents to clinic withcomplaints of heartburn, bloating, and mild postprandialmidepigastric fullness. She has painful episodes associatedwith eating two to three times per month. Her past medicalhistory is signifi cant for cholelithiasis, polycystic ovaries,and depression. She is currently only taking acetaminophenon an as-needed basis for her symptoms. She is afebrile,and her physical examination is signifi cant for an obese, softabdomen without organomegaly, masses, or tenderness.Pelvic and rectal examinations are normal. An abdominal x-ray (KUB) shows a normal bowel gas pattern and acalcifi ed gallbladder. Serum electrolytes, creatinine, liverfunction tests, lipase, and a complete blood count are allwithin normal limits. A diagnosis of chronic cholecystitis ismade. In addition to obtaining a transabdominal sonogram, what is the treatment of choice to reduce symptoms for this patient?

варіанти відповідей

Elective laparoscopic cholecystectomy

Endoscopic stent placement

Observation

Addition of ibuprofen 800 mg as needed for her symptoms

Запитання 10

A 68-year-old diabetic man presents to clinic to follow up a recent sonogram. He has a history of an infrarenal abdominal aortic aneurysm (AAA) and underwent recent screening. A total abdominal sonogram shows an infrarenal AAA with a maximal diameter of 3.3 cm and no evidence of dissection. Incidentally, several cholelithiases were noted within a nondistended gallbladder. He has no abdominal pain, nausea, vomiting, bloating, jaundice, or pruritus. What is the best management for this patient's biliary disease?

варіанти відповідей

Initiation of ursodeoxycholic acid with meals

Observation

Referral for elective cholecystectomy

Cholescintigraphy with intravenous injection of a technetium-99m-labeled HIDA scan

Запитання 11

A 43-year-old female presents to clinic with postprandial nausea and vomiting. Occasionally, she develops midepigastric pain that radiates to the right shoulder. These painful episodes last between 4 and 6 hours and resolve spontaneously. She does not have any pruritus, jaundice, weight changes, or changes in stool caliber. She has a history of cholecystitis treated by cholecystectomy 3 years previously, hypertension, and gastroesophageal refl ux disease. She currently takes omeprazole 20 mg daily and lisinopril 10 mg daily. She does not smoke or drink alcoholic beverages. On physical examination, her abdomen is soft and nondistended, and there is diffuse tenderness to palpation. There are no masses or organomegaly. Hemoccult is negative. Her leukocyte count is 6,000 with a normal differential, hemoglobin is 13 g/dL, total bilirubin is 1.8 mg/dL, direct bilirubin is 1.0 mg/dL, alkaline phosphatase is 170 U/L, AST is 110 U/L, ALT is 88 U/L, and serum creatinine is 0.6 mg/dL. CT of the abdomen with intravenous contrast reveals a normalappearing liver, pancreas, and gallbladder fossa but dilation of the common bile duct without visualization of biliary tract stones. What is the next best step in diagnosis of sphincter of Oddi dysfunction (SOD) in this patient?

варіанти відповідей

Endoscopic retrograde cholangiopancreatography (ERCP with SOD manometry

Neostigmine provocation test

Secretin stimulated magnetic resonance cholangiopancreatography (MRCP) with manometry

Empiric treatment with long-acting oral nitrates

Запитання 12

A feature of healthy gallbladder on laparotomy are:

варіанти відповідей

Typical”sea-green”colored

Wall is thin and elastic cannot be emptied

Cannot be emptied

Not easily visible

Запитання 13

True about gallstones:

варіанти відповідей

More common in female

Gallstones, hiatus hernia, CBD stone form saints triad

Limey bile precipitated

Lithotripsy always is done

Запитання 14

Investigation of choice in acute cholecystitis

варіанти відповідей

OCG

HIDA scan

USG

CT

Запитання 15

Acalculous cholecystitis is caused by:

варіанти відповідей

Diabetes mellitus

Total parenteral

Tuberculosis

Malignancy

Anemia

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