PLE Category: Surgery

PLE-8313

A 67-year-old woman is brought to the emergency department because of severe chest pain. She experienced the pain 4 hours after undergoing outpatient endoscopy and dilatation of an esophageal stricture caused by reflux. At discharge, she reported no chest pain. However, three hours later, she vomited a small amount of blood and experienced severe pain. Upon examination, she appears pale and has a temperature of 38 C (100.4 F), blood pressure of 140/85 mm Hg, pulse rate of 125/min, and respiratory rate of 22/min. Crepitus is observed in the neck and moderate epigastric tenderness is present. The lungs are clear upon auscultation and breath sounds are equal bilaterally. Rectal examination reveals no masses and a test of the stool for occult blood is positive. The most likely cause of these symptoms is:

PLE-8314

A 67-year-old woman comes to the physician because she has had a lesion on her right eyelid for 3 months. She has no history of similar lesions. Examination shows a 2 x 1.5-cm lesion on the lower lid of the right eye. A biopsy specimen of the lesion shows basal cell carcinoma. Which of the following is the most appropriate step in management?

PLE-8315

A 37-year-old man is brought to the emergency department 6 hours after the onset of constant, increasingly severe abdominal pain and nausea. His symptoms awoke him from sleep, and he has vomited once since that time. He is in acute distress and lying in the fetal position. Any movement exacerbates the pain. His temperature is 37.8 C (100 F), blood pressure is 108/68 mm Hg, pulse is 112/min, and respirations are 24/min. Examination shows a rigid abdomen; bowel sounds are absent. Laboratory studies show: Hemoglobin 14 g/dL, leukocyte count 18,200/mm3, platelet count 150,000/mm3, urea nitrogen (BUN) 34 mg/dL, creatinine 1.9 mg/dL, total bilirubin 1.2 mg/dL. An x-ray film of the chest shows a small amount of free air under the left diaphragm. Administration of antibiotics and fluids is begun. What is the most appropriate next step in management?

PLE-8316

A 19-year-old man is brought to the emergency department 45 minutes after sustaining a single, large stab wound to the right upper quadrant of the abdomen. He is obtunded. His blood pressure is 60/palpable mm Hg, and pulse is 148/min. Breath sounds are equal bilaterally. Examination shows a 4-cm laceration in the right upper quadrant in the midclavicular line. The abdomen is distended. What is the most appropriate next step in management?

PLE-8317

A 70-year-old nursing home resident is admitted to the hospital because of progressive obtundation over the past 2 days. He has tachycardia, tachypnea, and hypotension. Bilateral basilar crackles and an S3 gallop are heard on auscultation. Examination shows jugular venous distention and peripheral edema. Swan-Ganz catheterization shows a cardiac index of 1.8 L/min/m2 (N=2.5-4.2), a mean pulmonary capillary wedge pressure of 23 mm Hg (N=1-10), and markedly increased systemic vascular resistance. What is the most likely diagnosis?

PLE-8309

A 55-year-old man falls on his outstretched hand. He comes to the ER with a deformed wrist that looks like a fork. How would his X-ray show if he has a Colles fracture?

PLE-8310

Where is the most frequent site of peptic ulcer?

PLE-8311

A 37-year-old woman comes to the physician because of increasingly severe pain and masses in both breasts over the past 4 months. She has a 12-year history of similar episodes that were not as severe. The masses vary in size with her menstrual cycles. She has used an oral contraceptive for 16 years. Which of the following is the most likely diagnosis?

PLE-8312

What is the most appropriate analgesic pharmacotherapy for a 64-year-old woman with moderately severe postoperative pain 1 day after a total abdominal hysterectomy and bilateral salpingo-oophorectomy?

PLE-8305

What signs and symptoms are included in Reynolds pentad of cholangitis, except for which one?