Aquifer Family Medicine Cases 12-16 Questions And Answers 100% Correct

Aquifer Family Medicine Cases 12-16 Questions And Answers 100% Correct A 35-year-old man presents to clinic with acute onset of constant right upper quadrant abdominal pain. Additionally, he complains of ongoing nausea and vomiting. He denies any past abdominal surgeries or chronic diseases and his only medication is a multivitamin. His AUDIT-10 was positive. What lab(s) would you most likely expect to be abnormal to confirm your diagnosis of acute alcoholic hepatitis? A. GFR and INR B. CRP and alkaline phosphatase C. AST, ALT and total bilirubin D. AST, ALT, INR and WBC E. Lipase and amylase - The correct answer is C. It is expected that someone with acute alcoholic hepatitis would have an elevated AST, ALT and total bilirubin. GFR (glomerular filtration rate) is a marker of kidney function and is often not abnormal in early hepatitis. INR is a marker of synthetic functioning of 2 | P a g e Katelyn Whitman© 2025, All Rights Reserved. the liver and would be elevated in end-stage liver disease. WBC is often elevated in cholecystitis and infectious processes. Elevation of lipase and amylase is associated with pancreatitis. A 35-year-old man presents to clinic with acute onset of abdominal pain. On abdominal exam, you flex the patient's right hip to 90 degrees and take his right ankle in your right hand and with your left hand externally then internally rotate his hip by moving the knee back and forth. The patient denies any abdominal pain with this movement. What physical exam sign did you just perform and what disease is it ruling out? A. Psoas sign to rule out appendicitis B. Psoas sign to rule out cholecystitis C. Obturator sign to rule out appendicitis D. Murphy's sign to rule out appendicitis E. Obturator sign to rule out cholecystitis - The correct answer is C. During an abdominal exam, it is important to rule out other causes of abdominal pain. Appendicitis is another cause of acute abdominal pain and can be ruled out with a number of signs. One of these signs is the Obturator sign and the technique is discussed in the question stem. Another sign to rule out appendicitis is the psoas sign. This sign 3 | P a g e Katelyn Whitman© 2025, All Rights Reserved. includes passive extension of patient's thigh as they lie on their side with their knees extend, or asking the patient to actively flex their thigh and hip. Pain with movement is often indicative of appendicitis due to inflammation and irritation of the psoas muscle. Murphy's sign is to identify cholecystitis. The technique involves having the patent breathe out slowly and completely, then gently placing your hands under the right costal margin. The patient is then instructed to take a deep breath in while you palpate for a hardened mass and determine if you elicit any significant tenderness. A 42-year-old woman presents with nausea, vomiting and RUQ pain radiating to her back for one day. She reports a history of similar episodes but none have ever lasted for this long of a time period. Her vital signs are HR of 108, BP of 145/90, RR of 20, O2 saturation of 98% and temperature of 100.8F. Her labs reveal the following: WBC = 14.0 x 103/mL AST = 55 U/L ALT = 60 U/L Amylase = 70 U/L 4 | P a g e Katelyn Whitman© 2025, All Rights Reserved. Lipase = 7 U/L What is the most likely diagnosis? A. Biliary colic B. Acute cholecystitis C. Acute pancreatitis D. Duodenal ulcer E. Hepatitis - The correct answer is B. Acute cholecystitis has similar pathophysiology to biliary colic and often results from a bile stone that is lodged in the biliary tree. However, there are additional pathophysiologic reasons for acute cholecystitis. The symptoms are similar to biliary colic but typically last longer than 4-6 hours and may be more severe. Symptoms may include fever and elevated WBC. Biliary colic typically lasts 4-6 hours or less, radiates under right shoulder blade, often is accompanied by nausea, vomiting and can often follow a heavy, fatty meal. The hallmark of biliary colic is the stone is still mobile and gallbladder function resumes with relief of symptoms. Acute pancreatitis is often 5 | P a g e Katelyn Whitman© 2025, All Rights Reserved. difficult to distinguish from biliary colic but will have an increased lipase and amylase. A patient with duodenal ulcer typically has epigastric pain that is relieved by food or antacids. Hepatitis is usually distinguished by malaise, anorexia, itching and icterus or jaundice. Signs of hepatitis would include hepatomegaly and elevated transaminases. A 24-year-old male presents to clinic with history of upper abdominal pain, nausea and vomiting. He has previously had his gallbladder removed due to symptomatic gallstones. In reviewing his history, you want to screen for alcohol abuse due to the possibility of pancreatitis. Which one of the following is a sign of alcohol use disorder (AUD)? Choose the single best answer. A. Failure to fulfill work, school or social obligations due to the effects of drinking B. Denial of a drinking problem C. A score of 2 on the AUDIT-C test D. Consumption of 10 drinks per week E. Three drinks per social occasion - The correct answer is A