Answer 15

15.  Choice B is the correct answer.  Proton pump inhibitors such as protonix should be instituted when the patient fails H2 blocker therapy or the patient has 2 or more episodes a week or erosive esophagitis.  Zantac is another H2 blocker and likely will not be of any benefit.  Carafate is an alginate used for help healing erosions to the gastric mucosa.  This patient does not need an emergent EGD.

Question 15

15.  Your patient is a 34 year old female that you are seeing a recheck for GERD.  She was having approximately 2 episodes per week and she has been on Pepcid 20 mg BID, without any improvement.  She does not complain of any exertional symptoms and these symptoms occur post prandial.  She has no history of CAD and had a negative stress test 1 month ago.  Which of the following is the best management option?

A.  Start Zantac 150 mg BID
B.  Start Protonix 40 mg daily
C.  Start Carafate 1 gram PO  AC and QHS
D.  Arrange for emergent EGD

Answer 14

14.  Choice D is the correct answer.  Ibuprofen is not known to be a common cause of hepatitis.  Hepatitis can be caused by viral infections (hep viruses, CMV, herpes simplex, EBV), bacterial infections, fungal infections, parasitic infections, toxic exposures, immunologic, or a side effect of medications (tylenol, INH, oral contraception, erythromycin)

Question 14

14.  All of the following are known causes of Hepatitis except?

A.  Herpes Simplex infections

B.  Fungal infections

C.  CMV

D.  Ibuprofen

Answer 13

13.  Choice A is the correct answer.  The fact that the hernia does not reduce makes it an incarcerated hernia.  When hernias incarcerated they have reduced venous an lymphatic blood flow which leads to edema of the incarcerated tissue.  This can progress to strangulation if left untreated.   Indirect hernias travel through the inguinal ring where the spermatic cord travels in males and round ligament in females.  Direct hernias protrude medial to the inferior epigastric vessels within Hesselbach's triangle.

Question 13

13.  Your patient is a 54 year old male that presents with a hernia protruding through the inguinal ring that will not push back in the abdominal cavity.   There is no evidence of strangulation. Which of the following is the most accurate description of this patients hernia?

A.  Incarcerated indirect inguinal hernia
B.  Incarcerated direct inguinal hernia
C.  Non incarcerated indirect inguinal hernia
D.  Non incarcerated direct inguinal hernia

Answer 12

12.  Choice A is the correct answer.  Clindamycin is the most common antibiotic that causes C. Diff.  Cephalosporins as well an penicillin is also known for causing C. Diff.  Flagyl and vancomycin can actually be used to treat clostridium difficile.   It is usual for Macrobid to cause clostridium difficile.  

Question 12

12.  Your patient is a 54 year old male that presents with abdominal pain and diarrhea for 1 week.  You send off stool cultures and you find that he is positive for clostridium difficile.  Which of the following antibiotics is the most likely cause of clostridium difficile?

A.  Clindamycin
B.  Flagyl
C.  Vancomycin
D.  Macrobid

Answer 11

11.  Choice B is the correct answer.  The Ranson Criteria are as follows:  Age > 55, Glucose > 200, LDH over 350, WBC >16,000,  and AST 250.  After 48 hours if there is a decrease in Hct by 10%, Increase in BUN by 5, Calcium and Pa02 BE 4 or fluid sequestration is greater than 6 liters.  If 0-2 are present this equals 1% mortality, 3-4 equals 16% mortality, 5-6 equals 40% mortality, and > 7 equals 100% mortality.

Question 11

11.  All of the following is a negative prognosticator on admission for pancreatitis except:

A.  WBC > 16,000
B.  Glucose of < 60
C.  LDH over 350
D.  AST over 250