A 47-year-old woman on long-term disability for depression, post-traumatic stress disorder, and fibromyalgia presents with a two-week history of epigastric discomfort, decreased appetite, black sticky stools, and fatigue. While obtaining the history, the physician begins to form a differential diagnosis. Which of the following associated factors would support a diagnosis of upper GI bleed? Recent […]

A 77-year-old woman presents with a six-week history of recurrent vomiting. She reports decreased appetite, ongoing nausea and some vague epigastric pain. She has a history of diabetes mellitus, hypertension, and atrial fibrillation for which she is on an oral anticoagulant medication. As part of the history, the physician inquires about the color and quality […]

A 19-year-old woman presents with a 4-hour history of acute right upper quadrant abdominal pain. She has a body mass index of 31.2, but is otherwise healthy. The pain started shortly after she ate the previous evening. Her pain radiates to her right scapula and she has had nausea and vomiting for the last 2 […]

A 55-year-old woman with a history of dyslipidemia presents with a primary complaint of fatigue for the last several months. On review of symptoms, she reports a three-month history of significant skin itching for which she takes an over-the-counter antihistamine on a nightly basis. Which finding on abdominal examination would most likely be associated with […]

A 21-year-old woman presents with a six-month history of fatigue, muscle, and joint pains. She grew up in a household where heroin use was prevalent. Screening tests indicate that she is seropositive for hepatitis C antibodies. She denies any injection drug use and is very upset with this finding. She has many questions about hepatitis […]

A 76-year-old man presents with left-sided flank pain. He has a history of coronary artery disease and myocardial infarction eight years ago that was treated with two drug eluting stents. He also had a stroke one year ago with residual mild paresis of the left hand. He finally quit smoking last year after his stroke. […]

Question 4 A 68-year-old female has a L5 age-related osteoporotic compression fracture and is in the outpatient facility to have vertebroplasty to restore the vertebral body. The patient is appropriately prepped and local anesthesia with light sedation is administered. A biopsy needle is guided into the fractured vertebra using x-ray guidance. Specially formulated acrylic bone […]

A 67-year-old retired engineer with a history of ankylosing spondylitis has cervical vertebrae that are fused in flexion. During examination, he keeps his head raised off the table. An extra pillow is provided so that his head is supported in cervical flexion both for his comfort. How does this maneuver also facilitate abdominal examination? By […]

A 62-year-old obese, small business owner presents to his primary care physician with recurrent epigastric abdominal pain, nausea, and weight loss of 15 lb over the last five months. On exam, he has right upper quadrant tenderness to palpation and hepatomegaly is appreciated. Which of the following is a correct pairing of risk factor with […]

An 86-year-old retired physician is admitted to the hospital for confusion. He has been incontinent of urine and a urine sample has not been collected yet. His vital signs indicate that he is afebrile with a temperature of 36.5°C, but he is hypertensive with BP 168/74. He has a distended abdomen and suprapubic tenderness. A […]