A 60-year-old female presents to the ED with right upper quadrant abdominal pain that began several hours ago. She has had occasional RUQ pain over the past 3 months but never this severe. Her PMH is significant for HTN and osteoarthritis. On physical examination, she appears ill. Scleral icterus is present. She has RUQ abdominal tenderness without peritoneal signs. There are no surgical scars on the abdomen. Initial vital signs are as follows: Temperature 102.1°F, RR 16, BP 95/70 mm Hg, pulse 120. Laboratory tests reveal ALT 136 U/L and AST 119 U/L, ALP 105 U/L, direct bilirubin 4.5 mg/dL, and WBC count 16.8 × 103/mm3. Ultrasound of the abdomen shows common bile duct dilatation with obstructing gallstones. Piperacillin-tazobactam is started and the patient is resuscitated with IV fluids. Repeat vitals after antibiotics and 4 L of IV fluids are administered show a BP 110/82 mm Hg, HR 85, and temperature 98.8°F. Repeat hepatic labs show increasingly elevated transaminases and hyperbilirubinemia. What is the next step in managing this patient?

A 17-year-old female is referred to the ED by her primary physician; she presents with a 3-day history of fevers, dysuria, and vomiting. She has not had vaginal discharge, abdominal pain, or diarrhea. She is sexually active with her partner. Vital signs are as follows: Temperature 103°F, RR 20, BP 98/65, pulse 100. She appears ill and is unable to tolerate liquids, but she is alert and oriented. Her examination is positive for suprapubic as well as costovertebral angle tenderness bilaterally. Urinalysis reveals numerous WBCs and bacteria, and it is positive for WBC casts and leukocyte esterase. Other laboratory study results are within normal limits, including a negative urine pregnancy test. What is the likely diagnosis?Ask StudybuddyGroup of answer choicesNephrolithiasisPyelonephritisAppendicitisAcute interstitial nephritisEctopic pregnancy

A 22-year-old man comes to the office because of a 4-month history of intermittent right upper quadrant pain. He has otherwise been healthy. He does not smoke, drink alcoholic beverages, or use illicit drugs. He takes no medications. His mother underwent splenectomy several years ago, but he does not know the reason. The patient is a firearms instructor and also works at a gun store. Vital signs are within normal limits. Examination shows a soft and nontender abdomen. The spleen tip is palpated 2 cm below the left costal margin. Bowel sounds are normal throughout. Complete blood count shows a hemoglobin concentration of 9.9 g/dL, mean corpuscular hemoglobin concentration of 48 pg/cell, and mean corpuscular volume of 90 μm3. A peripheral blood smear is shown.The result of a direct antiglobulin (Coombs) test is negative. Which of the following is the most likely underlying cause of this patient's symptoms?A. Formation of pigment gallstonesB. Hepatic vein thrombosisC. Intermittent vasospasmD. Lead toxicityE. Recurrent microvascular occlusion

19 yo pt with no past medical history presents with acute onset of R lower quadrant pain and a fever.  Your thoughts immediately go to:Group of answer choicesdiverticulitischolecystitisgastroenteritisappendicitis

The patient, who had recently been treated for a UTI, presented with fever, chills, nausea, vomiting, and lumbar pain. She was diagnosed with an inflammation of the renal pelvis and kidneys orSelect one:a.pyelonephritis.b.polycystic kidney disease.c.hydronephrosis.d.ureteritis.

A 45-year-old Caucasian man is referred for further workup of chronic abdominal pain and diarrhea. These symptoms have been present for 2 months, and he has lost 10 kg of weight over this time. He also reports that he has developed pain in multiple joints that comes and goes and seems to spread from one joint to the next. He denies fevers, chills, chest pain, shortness of breath, vomiting, episodes of constipation, or hematochezia. He is married and works as a farmer, with no recent sick contacts or travel. His vitals are within normal limits, and his examination is unremarkable. A complete laboratory workup is unremarkable. He undergoes a colonoscopy, which is normal, and then undergoes an upper endoscopy. Biopsy of the small intestine shows many macrophages within the lamina propria that stain positive with periodic acid-Schiff (PAS). Which of the following is likely to cure this patient of his chronic diarrhea?Ask StudybuddyGroup of answer choicesCorticosteroidsAntibioticsRadioiodineDietary changesAntiretrovirals