Avascular necrosis is most likely to occur in fracture dislocations involving which of the following?
Answer(s): A
Avascular necrosis occurs following a fracture when the blood supply to a bone fragment is disrupted. The femoral head, humeral head, scaphoid, and talus are particularly vulnerable to this complication because of their precarious blood supply. A dense appearance of the bone on x-ray is a diagnostic clue. Radioisotope scanning can detect avascular necrosis at an earlier stage than is possible with roentgenography.
A38-year-old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to the groin and associated with nausea, perspiration, and frequent urination. He is restless, tossing in bed, but has no abnormal findings. The most likely diagnosis is which of the following?
Answer(s): B
Contraction of hollow organs against obstruction or excessive contraction causes colic. Typical ureteral colic is severe, sudden in onset, radiates from the loin to the groin, and is associated with an urge to urinate. Blood clots and calculi in the ureter can cause colic, the latter being more common. Urine examination demonstrates macroscopic or microscopic hematuria
A 50-year-old man comes to the emergency room (ER) with a history of vomiting of 3 days' duration. His past history reveals that for approximately 20 years he has been experiencing epigastric pain that lasts for 23 weeks during spring and autumn. He remembers getting relief from pain by taking milk and antacids. Physical examination showed fullness in the epigastric area with visible peristalsis, absence of tenderness, and normal active bowel sounds.What is the most likely diagnosis?
In a patient who is known to have had symptoms of peptic ulcer disease for many years and presents with nausea and vomiting, one should consider gastric outlet obstruction. The bstruction can be the result of an exacerbation of the ulcer and subsequent edema or it can be secondary to scar tissue formation. These patients typically describe the sensation of epigastric fullness and demonstrate visible peristalsis going from left to right. A succussion splash may be audible. The history of periodicity and pain relief by taking antacids also favors a diagnosis of previous peptic ulcer disease. Patients with an umbilical hernia will have a mass in the region of the umbilicus. Patients with acute cholecystitis usually present with the sudden onset of pain, radiating to the back, with fever and chills. Volvulus of the sigmoid colon presents with constipation and abdominal distention but vomiting is a late feature. Small bowel obstruction would be associated with a history of colicky abdominal pain, nausea, and vomiting. Additionally, patients with small bowel obstruction usually have hyperactive highpitched bowel sounds on examination.
A 50-year-old man comes to the emergency room (ER) with a history of vomiting of 3 days' duration. His past history reveals that for approximately 20 years he has been experiencing epigastric pain that lasts for 23 weeks during spring and autumn. He remembers getting relief from pain by taking milk and antacids. Physical examination showed a fullness in the epigastric area with visible peristalsis, absence of tenderness, and normal active bowel sounds. What is the most likely diagnosis?Which of the following metabolic abnormalities are typically found in the above patient?
Answer(s): C
In a patient who is known to have had symptoms of peptic ulcer disease for many years and presents with nausea and vomiting, one should consider gastric outlet obstruction. The bstruction can be the result of an exacerbation of the ulcer and subsequent edema or it can be secondary to scar tissue formation. These patients typically describe the sensation of epigastric fullness and demonstrate visible peristalsis going from left to right. A succussion splash may be audible. The history of periodicity and pain relief by taking antacids also favors a diagnosis of previous peptic ulcer disease. Patients with an umbilical hernia will have a mass in the region of the umbilicus. Patients with acute cholecystitis usually present with the sudden onset of pain, radiating to the back, with fever and chills. Volvulus of the sigmoid colon presents with constipation and abdominal distention but vomiting is a late feature. Small bowel obstruction would be associated with a history of colicky abdominal pain, nausea, and vomiting. Additionally, patients with small bowel obstruction usually have hyperactive highpitched bowel sounds on examination
Gastrin secretion is enhanced by which of the following?
Gastrin secretion is increased by vagal stimulation, antral distention, and by the presence of protein in the antrum. Antral acidification (pH = 1.5) decreases gastrin secretion by a feedback mechanism. The same is true with duodenal acidification.
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