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A 53-year-old woman presents complaining of fatigue over the past 6 months. During this time, she has also developed pruritus and lost 4 pounds. She is not sexually active, and her past medical history is significant only for Sjögren syndrome. On physical examination, she is afebrile and has mildly icteric sclera. There are excoriations noted on all four extremities and trunk and back. The liver edge is smooth and non-tender and measures 9 cm at the midclavicular line. There is no ascites, splenomegaly, or peripheral edema. Laboratory results reveal a normal complete blood count, normal electrolytes, and liver function tests with an alkaline phosphatase of 260 U/L (normal, <110 U/L), total bilirubin of 3.1 mg/dL, and normal transaminase levels. Which of the following is the most likely diagnosis? a) Acute cholecystitis b)Acute hepatitis A infection c)Bacterial cholangitis d)Primary biliary cirrhosis e)Primary sclerosing cholangitis  Explanation: The cor...

A decrease in which of the following would be expected in a child exhibiting a congenital absence of enterokinase? A. incidence of pancreatitis B. glucose absorption C. bile acid reabsorption D. gastric ph E. protein assimilation Correct answer: E

1) Lesions of which of the following nuclei cause hypothalamic obesity a. ventromedial nucleus               b. dorsomedial nucleus c. suprachiasmatic nucleus           d. supraoptic nucleus Ans. a 2) The EPSP a. is an all or none response to a presynaptic potential   b. can be temporarily summated during repetitive presynaptic stimulation c. always initiates an action potential      d. lasts only for the duration of presynaptic action potential Ans. b 3) Following statements are true for dopamine except a. it is related to Parkinsonism    b. it is found in the cells uninhibited by Ach in basal ganglia c. it is one of the endogenous opiates from CNS                 d.   it cannot be replaced in CNS from dietary dopamine ...

Which one of the following does not contain ion channels that are activated by mechanical distortion, producing depolarization? A. Olfactory receptors B. Pacinian corpuscles C. Hair cells in chochlea D. Hair cells in semicircular canals E. Hair cells in utricle Correcr answer: A

  A 37-year-old woman presents with complaints of severe heartburn with or without meals. She has a history of hypertension, which has been treated with captopril. She also has a history of Raynaud disease, multiple facial telangiectasias, and very taut skin on the dorsum of both hands. She has failed to obtain relief for her heartburn with large doses of antacids, ranitidine, or omeprazole. Esophageal manometry is ordered. Which of the following would be the most likely results of this test? a) Decreased esophageal peristalsis and decreased LES pressure b)Decreased esophageal peristalsis and increased LES pressure c)Increased esophageal peristalsis and decreased LES pressure d)Increased esophageal peristalsis and increased LES pressure e) Normal esophageal peristalsis and normal LES pressure Explanation: The correct answer is A. This patient has the classic presentation of gastroesophageal reflux disease (GERD) in association with scleroderma. These patient...

A 74-year-old woman presents to her physician for a postoperative medical visit. Three days ago, she underwent a left total knee replacement for severe osteoarthritis. She has a past medical history significant for type 1 diabetes mellitus and glaucoma. Her hospital course was uneventful. She continues to take daily NPH insulin and has good control of her blood glucose. She also takes oxycodone, which was given to her in the hospital for pain. She is involved in a physical therapy rehabilitation program at the local hospital. On review of her medications, which of the following is most acutely indicated at this time? a) An ACE inhibitor b)A nonsteroidal anti-inflammatory agent c)Oral aspirin d)Oral Coumadin e) Subcutaneous unfractionated heparin Explanation: The correct answer is D. This patient is post a total knee replacement and is currently not on any anticoagulation therapy. The risk of deep venous thrombosis (DVT) and subsequent pulmonary embolism is v...

MCQ of the day: Your daily dose of practice mcqs A 70-year-old man presents to the emergency department with a 3-day history of right temporal headache, fever, and profound malaise. He appears acutely ill. His temperature is 39.5 C (103.1 F), blood pressure is 130/80 mm Hg, pulse is 98/min, and respirations are 24/min. Tenderness over the right temporal region is appreciated on palpation. The right temporal artery is tender and slightly nodular. Neurologic examination is normal, including funduscopic examination. However, visual acuity is reduced. Laboratory studies show: Hematocrit 39.0% Hemoglobin 10.9 g/dL Leukocytes 8800/µL (neutrophils 68%) Erythrocyte sedimentation rate 80 mm/hr Which of the following is the most appropriate next step in management? a)Measurement of intraocular pressure b)Visual field assessment c)Low-dose (10 mg/day) prednisone treatment d)High-dose (60 mg/day) prednisone treatment e) Temporal artery biopsy Explanation: The correct a...