Friday, September 18, 2009

Question 32

54 year male patient comes to the ER with pain in abdomen. The pain is present since a week, but it is become so severe now that he had to rush to the ER. He also gives history of having pain in his calves for the last week. On examination, he has a palpable liver and spleen. There is shifting dullness present. He also gives history of severe itching after taking showers, and had been on allopurinol for Gout since a few months. His Liver enzymes are raised and PT is 24 with an INR of 2.0, Hb is 17 gm%, and Hct is 60. He has a remote history of alcohol dependence, and smokes 2 - 3 cigerettes per day for last 10 years. He lives with his only sexual partner for the last 30 years and occassionally uses condoms. He has never been treated with any STDs. What is pathological cause of his condition at present?

a) Peliosis hepatis

b) Myeloproliferative diseases

c) Alcoholism

d) CBD obstruction

e) Hematobilia


Question 32

What is the definitive treatment for this patient discussed under question 31?

a) Methylene Blue

b) Vitamin C

c) 100 % Oxygen

d) Blood Transfusion

e) Bronchodilators

f) Surgery


Question 31

37 year old white male is brought to the ER with acute onset breathlessness. He is a known case of HIV on Triple therapy. Last month his CD4 count was 180 when he visited his physician. He appears to be thin and weak. His BP is 90/40 mm Hg, pulse is 92/min, and he has no fever. He lives with his same sex partner for last 3 years. The partner is also HIV positive and on treatment. He is a chronic smoker and occasionally consumes alcohol and marijuana. No other significant history is obtained. On chest auscultation, there are few scattered rhonchi and rest of the examination is unremarkable. He appears to be cyanotic and the arterial blood gas shows decreased Saturation with a normal PaO2. What is the most likely cause of his decreased saturation?

a) Drug induced

b) Tuberculosis

c) Pneumocystic Carini

d) CO Poisoning

e) Anemia

f) Smoking induced


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