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A 54 year old female patient arrived to the ER after becoming confused and incoherent to family and having a syncopal episode. Upon arrival to the ER the patient was hypotensive at 75/45, tachycardic at 123, temperature of 100.3 and RR of 20. Blood glucose was 56. CBC was within normal limits. BMP results showed K+ 6.0 mM and Na+ 127 mM. Further lab tests showed cortisol was decreased and ACTH was increased, compared with normal. Which of the following is most likely?
Addison's disease
Two weeks after orthopedic surgery, a 62 year-old female presented with uncontrolled pain and purulent drainage from the surgical incision. She was admitted and taken to the OR for irrigation and debridement of the infection site. Additionally, she was started on antibiotics to control the infection. Later that week she started having 3-4 foul smelling watery stools a day, became febrile, and complained of N/V. Which of the following pathogens is most likely causing her abdominal problems?
C. diff
A 56 year-old male presents with no specific complaint. He works as a truck driver and has been in 2 accidents recently and his boss insists that he gets "checked out" by a medical professional before he can drive again. He claims that objects suddenly appear from out of nowhere. He admits to recent loss of libido and erectile dysfunction. Which of the following is most likely?
prolactinoma
A 63 year-old male presents with depression, confusion, vague pains in his bones, and ulcers. He was recently diagnosed with kidney stones. Blood tests reveal that PTH is decreased, while both serum Ca++ and phosphate are increased. Which of the following is most likely?
metastatic bone cancer
The mother of a 2-year old girl brings her daughter to the pediatrician's office. The mother states that the patient has had frequent watery, foul smelling and sometimes greasy stools on and off for the past 3 months. At other times she seems to be constipated. She is noticeably small for her age - in the 50th percentile for height and 25th percentile for weight. The mother also reports that after the patient's last cold, the cough did not subside for several weeks and each cough was producing thick, grayish mucus. Her medical record shows 3 hospitalizations in the past 2 years from respiratory tract infections, all of which were treated with antibiotics. Today, she appears to be in good health with no apparent cough, but she looks malnourished and pale. Abdominal ultrasound showed no obstructions or mechanical blockages, and stool culture revealed normal bacterial growth, without viral infection. Stool sample was positive for fat and vitamins A, E and D. Chloride sweat test on 150mg of sweat revealed 111mEq/L of chloride (high). Which scenario is most likely in this patient?
cystic fibrosis
A 2 month-old female presents for evaluation of poor feeding. She is in no apparent acute distress, but mom reports that she has difficulty with feeding and get short of breath at times. Mom is concerned that the baby seems to be losing weight and is excessively tired. The baby's weight is below average for age and length. She is alert at this time and does not appear to be in any acute distress. Respiratory rate is 41, and auscultation reveals crackles in bilateral bases. Patient is afebrile and has strong peripheral pulses in upper and lower extremities. Auscultation reveals a HR of 140 with a continuous murmur. Which scenario is most likely in this patient?
patent ductus ateriosus
A 72 year old male presents to the ED comatose. Vitals are HR 132 (Sinus Tachycardia), BP 87/45. CMP shows blood glucose 2250 (mg/dl), pH 7.41, Na+ 133, K+ 4.6, Cl- 97, HCO3- 23, and serum osmolarity 356 mOsm. Which scenario is most likely in this patient?
hyperosmolar hyperglycemic non-ketotic syndrome
an ultrasound of the kidneys and abdomen followed by a magnetic resonance angiography (MRA) of the kidneys. These results indicate a unilateral stenosis of the right renal artery. Which scenario is most likely in this patient?
only the right kidney is producing excessive renin
A 14 year old previously healthy female presents to the ED. She has a 2 day history of increased fatigue, thirst, and frequent urination. She has "fruity" breath odor, and her blood glucose is > 600 mg/dl. Which of the following is expected?
she has elevated anion gap acidosis, urinalysis will show ketones, she has decreased PaCO2, she has dehydration due to polyuria
A 73-year-old male, presents to the ED with a primary complaint of chest pain. He has past medical history of type II diabetes, hypertension, hyperlipidemia, stroke, dementia, complete heart block with permanent pacemaker placement, and bladder cancer. Upon admission to the ED, he is alert but confused, and complains of severe pain/heaviness to his chest. Patient is diaphoretic and short of breath. EKG reveals ST segment elevation. Cardiac enzymes are elevated, and serial cardiac enzymes demonstrate a peak in Troponin. Which scenario is most likely in this patient?
myocardial infarction
A 23 y/o female presents to the ED with general weakness and vomiting. Her PMH includes IDDM. ROS is positive for polyuria, and polydipsia. Pt also reports dysuria that started 3 days prior. Pt denies SOB or cough, chest pain, abdominal pain, bloating, and change in bowel habits. Vitals include: Temp: 101.2, BP: 120/80, HR: 120, RR: 24, SpO2: 98% on RA. She is AAOx3, but drowsy, lungs are CTAB, and heart sounds are normal with tachycardia. Lab tests reveal: Na+: 149 mEq/L; K+: 3.2 mEq/L; HCO3-: 16 mEq/L; pH: 7.2; Anion gap: 18; plasma glucose: 455 mg/dL. Urinalysis was positive for ketones, leukocyte esterase, nitrites, and WBCs. Which of the following best explains the patient's symptoms?
diabetic ketoacidosis
An 82 year old male was brought to the ED after a syncopal (fainting) episode at his nursing facility. Assessment includes a hematoma above the left eye and the patient reports decreased urine output and blurry vision at times. Vitals include: BP 113/68, HR 118, RR 18, Temp 36.9, and SpO2 96% on room air. Lab results included: Na+ 150, Cl- 112, serum osmolality 303, urine osmolality 1280, all other labs were within normal limits. Orthostatic testing was as follows: supine (lying) BP 116/71 HR 97, sitting BP 102/ HR 104, standing BP 82/48 HR 121. Stress test and echocardiogram were unremarkable. Which of the following best explains his orthostatic hypotension?
dehydration
A 76 year old female presents with a chief complaint of shortness of breath, fatigue, and a 20 lbs weight gain over the last 6 weeks. Vitals include: BP 165/78, HR 118, RR 26, SpO2 94% on 3L NC, and Temp 36.9. Assessment consists of S1, S2, and S3 heart sounds, crackles bilaterally in bases of lungs, and 3+ pitting edema to bilateral upper and lower extremities. X-ray showed cardiomegaly and fluid buildup in the lungs. CT was negative for PE. Echocardiogram showed ventricular hypertrophy with an ejection fraction of 35%. Which of the following best explains these findings?
congestive heart failure
A 56 year old male was admitted to the hospital with increased fatigue, weakness, loss of appetite with a 12lb weight loss, dry hackling cough, chest discomfort, and SOB with exertion. The patient had been in and out of the hospital multiple times in the past 3 years with similar symptoms. Pt had an occupational history of working in coal mines for 30 plus years. ABG showed respiratory acidosis. Pulmonary function testing showed FEV1 and FVC were significantly reduced, while the FEV1/FVC ratio was WNL. Which of the following best explains these findings?
interstitial lung disease
A 52 yr old female was admitted into the MICU with sepsis. The patient slowly became increasing lethargic. Vitals included: BP: 60/30, RR: 6, and HR: 55. Shortly afterwards, the patient lost her pulse and went into cardiopulmonary arrest. After approximately 30 minutes of resuscitation, the patient was intubated, started on vasopressors, and a pulse was established. The patient was stabilized. A few hours post arrest, the patient's urine output started to decrease. Subsequent labs showed: BUN: 34mg/dl, serum creatinine: 2.6mg/dl. Urinalysis was positive for tubular cell casts, and red blood cells, urine
A 44-year-old woman was admitted to hospital because of weakness, anorexia, recurrent infections, bilateral leg edema, and breathlessness. Her plasma albumin concentration was 1.9 mg/dl and her urinary protein excretion was 10 g/24 h. Which of the following does this patient most likely have?
nephrotic syndrome
A 54 year-old male with a 30 pack-year history of smoking and small cell lung cancer presents to the oncology outpatient clinic for lab work. Lab results show serum Na+ = 123 mEq/L, serum osmolality = 276 mOsm/kg, and urine osmolality = 559 mOsm/kg. Which of the following is this cancer most likely producing?
ADH
A 42-year-old female presents to her physician complaining of muscle weakness and cardiac abnormalities. Laboratory tests indicate that she is hypokalemic. Which of the following could be the cause of her condition?
primary hyperaldosteronism
A 35 year old female develops tingling and weakness of lower extremities. The weakness continued to progress up her torso and upper extremities resulting in paralysis and the inability to breathe on her own. Which of the following events is most likely associated with the trigger for this problem?
GI illness
A 33-year-old female presents with secondary amenorrhea, hirsutism, significant weight gain of 15 kg within the past 2 months, acne, significant muscle weakness, recurrent headaches, hair loss, wine- colored striae on the abdomen and extremities, facial roundness, a lump over the back of her neck, and feelings of depression. She also complains of a persistent headache, and a neuro exam demonstrates bilateral temporal hemianopsia. Which pattern of lab results is most likely?
elevated ACTH and elevated cortisol
A 45-year-old man has a 4 month history of nonfocal, generalized headaches. On physical examination he is found to have a blood pressure of 170/110 mm Hg. Laboratory studies show serum sodium of 146 mmol/L, potassium 2.3 mmol/L, chloride 103 mmol/L, glucose 82 mg/dL, and creatinine 1.2 mg/dL. His plasma renin activity is 0.1 ng/mL/hr (normal 0.5 - 3.3 ng/mL/hr) and his serum aldosterone 65 ng/mL (normal 2 - 9 ng/dL). Which of the following is the most likely cause for his findings?
adrenal cortical adenoma
A 51 year old female, K.W. with a past medical history significant for only HTN, presented to the ER with BP 276/196 and left-sided weakness. A CT scan of the head revealed a right basal ganglia hemorrhage with intra-ventricular extension. One day after K.W.'s initial presentation, her urinary output increases, and labs show serum Na+ 162, serum osmolality 315. Which of the following statements concerning this case is most likely true?
increased ICP has damaged the hypothalamus and is preventing appropriate ADH secretion
A 20-year-old primigravida delivers a term baby girl following an uncomplicated pregnancy. No anomalies are noted at the time of birth. Five weeks later, the mother brings the baby to the clinic because she has difficulty breathing and occasionally turns pale. On physical examination a continuous murmur is audible. Which of the following congenital cardiac anomalies is most likely to be present in this infant?
patent ductus arteriosus
A 68 year old male presented with new onset chest pain. He reported pain as substernal, and radiating to her shoulders and back. He also complained of shortness of breath and appeared diaphoretic. Vital Signs: Temp 98.8, BP 144/82, Pulse 88, RR 22. BMP and CBC were wnl, but troponin and D-dimer were both elevated. 12 lead EKG revealed ST segment elevation. Which of the following is most likely the cause of these results?
STEMI
A 26 year old woman presented to her OBGYN's office complaining of fever, bilateral flank pain, nausea, aches, chills, dysuria, hematuria, and urinary frequency. Her BP was 128/82, pulse was 100, O2-sat was 99% on room air, and temperature was 38.7 degrees Celsius. She rated her bilateral flank pain as 8/10. She reported experiencing urinary frequency with dysuria and hematuria for the past 24 hours and reported nausea, but denied vomiting. A CT scan of her abdomen and pelvis ruled out kidney stones or an obstruction. Urinalysis was positive for leukocyte esterase. CBC showed that both white blood cell count and neutrophil count were elevated. Which of the following renal problems is most likely to be present in this situation?
pyelonephritis
A 16 year-old female presents to the ED with a 2 day history of polyuria, polydipsia, fatigue, nausea, and disorientation. Blood tests show: Na+ 137 mM, Cl- 96 mM, HCO3- 14 mM, blood glucose 567 mg/dl, serum osmolarity 294 mOsm/L, PaCO2 32 mmHg, pH 7.26. Which of the following statements is LEAST likely to be true?
she has hyperosmolar hyperglycemic nonketotic syndrome
A 53 year-old male was in the ICU with viral pneumonia; throughout his ICU stay he steadily declined. He went into respiratory distress two days after admission and was intubated and a central line was placed. Subcutaneous heparin was given prophylactically to prevent thrombus formation. His BP dropped and he was started on a vasopressor medication. His ventilator settings were increased. An arterial line was placed for blood draws. The bedside nurse noticed the patient coughing up large amounts of think frothy bright blood in his endotracheal tube on day six of admission. The patient was also oozing blood from his central line and arterial line puncture sites. Increased ecchymosis (bruising) was noted on extremities. Urine output was 10-20 ml an hour (low). Labs were sent to look for bleeding cause. Significant lab results were: Hbg 6.8 HCT 22.0, WBC count 24,000, ABG: pH 7.1, PaCO2 36, Bicarb 15, platelet count 12,000, INR 5.0, and elevated D-dimer. Which of the following is most likely the immediate cause of these results?
DIC
A 56 year old female presented to the ER with dry cough for the last month and shortness of breath. Patient has a history of HTN, DM, and breast cancer. EMT found her tachypneic with labored breathing. They immediately placed a non-rebreather on her. When she arrived to the ER she was lethargic. The blood gas showed: PH 7.46, PaO2 59, PaCO2 30, HCO3- 23, on 100% O2. Even on the non-rebreather she was still laboring to breath. Chest x-ray showed her lungs where opaque. Pulmonary function testing showed FEV1 was significantly reduced, approximately 50% of expected, while the FEV1/FVC ratio was WNL. Which of the following is most likely the cause of these results?
interstitial lung disease
A.F. a, 46 year old female patient arrived to the ER after becoming confused and incoherent to family and having a syncopal episode. Upon arrival to the ER the patient was hypotensive at 75/45, tachycardic at 123, temperature of 100.3 and respirations of 20. Blood glucose was 56. Which additional lab results are most likely for this patient?
elevated renin and ACTH
A 72-year-old female patient is in the step-down unit. She is currently being treated for pneumonia with intravenous antibiotics and oxygen therapy but during her stay at the hospital has developed other symptoms. She is now complaining of abdominal cramping, loss of appetite and nausea. Vital signs are as follows: heart rate 85, Blood pressure 130/70, respirations 20, oral temperature 100.7˚F. The patient's abdomen is tender to the touch and hyperactive bowel sounds are auscultated in all four quadrants. Stool is watery and seedy and bowel movements are increasing in frequency, currently at six per day. Which of the following statements is most likely true?
the most likely causative agent for the diarrhea can form spores
A 32 y/o female presents with complaints of anxiety accompanied by a "racing heart." She reports a recent job loss and attributes presenting symptoms with this event. A thorough history revealed concerns of weight loss, and missed period. Physical examination reveals: HR 105 with regular rhythm, B.P. 132/90, presence of fine bilateral hand tremor, presence of perspiration, skin is warm to touch, and minimal non- tender enlargement of thyroid gland is detectable upon palpation. A thyroid panel is done
heavily and started to look pale". Patient's labs were WNL. A chest X-ray ruled out pneumonia. In addition, urine and sputum cultures ruled out all other types of infections. Finally, an echocardiogram was ordered to rule out cardiac defects. The child's echocardiogram showed atrial septal defect (ASD) and auscultation revealed a heart murmur. Which of the following statements is most likely correct?
increase blood flow through the lungs caused pulmonary edema
A 15 year old female presents to the ED c/o of vomiting on and off over the past 2 days, a headache, and "not feeling well." She decided to come to the hospital when she started to have abdominal pain and was having trouble catching her breath. On initial assessment, she is a thin girl who appears lethargic and to be having Kussmaul respirations. Her breath has a fruity odor. Her vital signs are: 36.5 degrees Celsius, HR 115, BP 90/50, RR 34, O2 saturation 94%. The RN instantly collects a finger stick blood glucose due to the fruity odor of her breath to find a glucose level of >500 mg/dl. Other labs are collected and are notable for large urine ketones, a pH of 7.25 and HCO3 of 12. Which of the following statements is most likely true?
the low BP is the result of hypovolemia
A 65 year-old female is post operative day two after a right total knee replacement. After surgery due to her difficulties with pain the patient has refused physical therapy and has been unable to get out of bed. During her morning nursing assessment, the patient complains of moderate chest discomfort with pain level 6/10, some shortness of breath, and quickly thereafter became diaphoretic. Vital signs reveal: BP 152/82, HR 139, RR 26, T: 98.7, O2 sat on RA: 90%. Immediately a 12-lead ECG was ordered and performed revealing sinus tachycardia with ventricular rate of 139 beats per minute. STAT cardiac enzymes were WNL, but D-dimer was elevated. The patient has been placed on the warfarin protocol that began the night after surgery. Her pre-operative INR was 1.01. Her post-op day #2 INR was 1.2 after having received two doses of Coumadin. Her INR goal on the warfarin protocol was 2-3, so the patient was not yet therapeutic. Which of the following is most likely causing this patient's discomfort?
pulmonary embolism
A Thirty year old male presents to his general practitioner for increasing back pain, which he states has become increasingly worse over the past several months. He describes the pain as "sharp and crampy," and indicates to his mid back as the location of the pain. Pt. denies fever, chills, frequent urination, pain
on urination or recent trauma. Past medical history is significant only for moderate hypertension, which is well controlled on current medication regimen. Family history is unobtainable. Routine labs were drawn, including CBC, CMP and urinalysis. Upon physical examination pt. is found to have CVA tenderness. Deep palpation of the abdomen elicits pain bilaterally and evidences enlarged kidneys. Based on physical findings pt. is sent for a CT scan. Urinalysis revealed hematuria and proteinuria; BUN= 40 (normal 7-18) Creatinine 2.7(normal 0.6-1.2); CT scan revealed diffuse renal cysts bilaterally. Which of the following is the most likely diagnosis?
polycystic kidney disease
A 65 year old male presents to the emergency room with complaints of chest pain. He describes it as a chest pressure radiating into left arm and jaw, and states it feels as though somebody is stepping on his chest and it is hard to breathe. Pain is unrelieved by rest, and increases in severity with even minimal activity. Labs were also drawn; CBC was unremarkable, but serum troponin and D-dimer were both elevated. Which of the following is the most likely cause of his pain?
myocardial infarction
A 57-year-old man is found comatose. On physical examination he has decreased skin turgor (he's dehydrated). Laboratory studies show a blood glucose of 780 mg/dl. Urinalysis reveals no ketosis or proteinuria, though there is glucosuria. Which of the following is the most likely diagnosis?
type II diabetes mellitus
A 31 year old female presented to the ED complaining of back pain, nausea, and a fever. She woke up with 9/10 left sided flank pain that radiated to her left lower abdomen. Her BP was 137/76; pulse was 104; pulse ox 100.0% on room air; and a temperature of 38.4 degrees Celsius. She denied dysuria, frequency, or urgency. She was ordered for a renal sonogram to rule out an obstruction or a kidney stone. A CBC showed her WBC's to be 19.3 k/uL. A UA showed positive large leukocyte esterase, 12 WBC, trace RBC, negative nitrites, and many bacteria. A clean catch urine culture showed 10,000-50, cfu/ml of staphylococcus aureus. The renal sonogram showed moderate hydronephrosis with mild dilation of the proximal ureter. There were no obvious renal calculi. The left ureteral jet suggested non- obstructive flow into the bladder. Which of the following is the most likely diagnosis?
A 42-year-old female presents to her physician complaining of muscle weakness, depression, and cardiac abnormalities. Laboratory tests indicate that she is hypercalcemic, with normal serum sodium and potassium. Which of the following could best explain her symptoms?
primary hyperparathyroidism
A 46 year-old female arrived to the ER after becoming confused and incoherent and having a syncopal (fainting) episode. Upon arrival to the ER the patient was hypotensive at 75/45, tachycardic at 123, temperature of 100.3 and respirations of 20. Blood glucose was 56. Which of the following disorders could explain both the hypotension and hypoglycemia?
Addison's disease
A 31-year-old woman who has two healthy children, notes that she has had no menstrual periods for the past 6 months, but she is not pregnant and takes no medications. Within the past week, she has noted some milk production from her breasts. She has been bothered by headaches for the past 3 months. After nearly hitting a bus while changing lanes driving her vehicle, she is concerned with her vision. An optometrist finds her lateral vision to be reduced. On physical examination she is afebrile and normotensive. Which of the following laboratory test findings is most likely to be present in this woman?
pituitary necrosis
A 29-year-old primigravida who received no prenatal care has marked vaginal bleeding after the onset of labor at 38 weeks gestation. Cesarean section is performed and a lacerated low-lying placenta is removed. She remains hypotensive for 6 hours and requires transfusion of 12 packed RBC units. Postpartum, she becomes unable to breast-feed the infant. She does not have a resumption of normal menstrual cycles. She becomes more sluggish and tired. Laboratory findings include hyponatremia, hyperkalemia, and hypoglycemia. Which of the following pathologic lesions is she most likely to have had following delivery?
pituitary necrosis
A baby boy, born of a poorly controlled, chronically hyperglycemic, diabetic mother, was large and chubby (macrosomic) at birth (5 kg) but appeared otherwise normal. He declined rapidly, however, and within 1 h showed all the symptoms of hypoglycemia. Which of the following treatments is most likely to help him?
glucose infusion
A 27-year-old G2 P1 woman has a screening ultrasound performed at 18 weeks gestation. The fetus is appropriate in size for 18 weeks. The fetal kidneys, liver, head, and extremities appear normal. However, the fetus has a heart with a membranous ventricular septal defect, overriding aorta, and marked pulmonic atresia. If the baby were to be liveborn, which of the following characteristics on physical examination would most likely result from these cardiac defects?
cyanosis
A 45-year-old woman complained of right upper quadrant abdominal pain and vomiting after consuming fatty food. The only biochemical abnormality was a modestly raised alkaline phosphatase at 400 U/L (< 260 U/L). Which of the following is most likely?
gall stones
A 44-year-old woman dies as a consequence of a "stroke". At autopsy, she is found to have a large right basal ganglia hemorrhage. She has an enlarged heart with predominantly left ventricular hypertrophy. Her kidneys are small with cortical scarring, and microscopically they demonstrate small renal arterioles that have luminal narrowing from concentric thickening. Which of the following is the most likely diagnosis?
malignant hypertension
A 60-year-old woman is admitted with sudden onset of chest pain and is diagnosed with an acute myocardial infarction. There is difficulty maintaining adequate blood pressure and tissue perfusion for 3
corpuscular volume of 72 dL (reference range 80-96). Serum ferritin concentration was low at 10 μ g/L (reference range 14-200). Which of the following diagnoses is most likely?
iron deficiency anemia
A 45-year-old businessman had a routine medical examination, at which he was found to have a slightly enlarged liver. Tests revealed bilirubin 15 μ mol/L (0.9 mg/dL), AST 434 U/L, ALT 198 U/L, ALP 300 U/L, γ - glutamyl transpeptidase (γGT) 950 U/L, and albumin 40 g/L (4 g/dL). He seemed perfectly well. Which of the following is most likely to help him?
abstaining from alcohol consumption
A 45-year-old woman presented with fatigue, rapid weight gain with central obesity, fullness and redness of her face, and loss of regular menstrual periods. She was mildly hypertensive, and her family doctor had found her also to be diabetic for which she had received dietary advice. Urinary cortisol was 1000 nmol/24 h (normal < 250 nmol/24 h); serum cortisol was 500 nmol/L at midnight (normal < 50 nmol/L) and her 8:00 AM cortisol was 550 nmol/L after 1 mg of dexamethasone (a potent synthetic glucocorticoid) (normal < 50 nmol/L). Plasma ACTH was 100 ng/L (normal < 80 ng/L). What is the most likely diagnosis?
ACTH secreting tumor
A 41-year-old man is found in an obtunded state and taken to the hospital. On admission physical examination he is icteric. His abdomen is enlarged with a fluid wave. An abdominal CT scan shows extensive intraperitoneal fluid and a uniformly enlarged liver that has decreased attenuation (decreased brightness). Laboratory studies show total protein 6.5 g/dL, albumin 2.8 g/dL, total bilirubin 4.8 mg/dL, AST of 563 U/L, ALT 317 U/L, alkaline phosphatase 55 U/L, and ammonia 91 micromol/L (normal range 7
- 27 micromol/L). A liver biopsy is performed and microscopically demonstrates abundant Mallory hyaline, neutrophilic infiltrates, hepatocyte necrosis, portal fibrosis, and extensive macrovesicular steatosis (fatty liver). Which of the following is the most likely diagnosis?
alcoholic hepatitis
A 43-year-old previously healthy woman has noted bouts of sharp upper abdominal pain along with nausea for 3 weeks. On physical examination she has tenderness to palpation of the right upper quadrant. She has scleral icterus. A liver biopsy is performed and on microscopic examination shows only intracanalicular cholestasis in the centrilobular regions, along with swollen liver cells and portal tract edema. There is no necrosis and no fibrosis. There is no increase in stainable iron. Which of the following is the most likely diagnosis?
choledocholithiasis
A 36-year-old woman has had episodes of lower abdominal and pelvic pain for the past 10 years. A bimanual pelvic examination reveals no abnormalities. A Pap smear is negative. She has an abdominal ultrasound scan that reveals no abnormalities. Finally, she undergoes laparoscopy, and her physician notes the presence of several 0.2 to 0.5 cm brown nodular lesions located on serosal surfaces of the uterus, fallopian tubes, and appendix. These lesions are excised. Which of the following microscopic findings is most likely to be present in these lesions?
endometrial glands with stroma
A 35-year-old woman came to her physician complaining of palpitations, difficulty climbing stairs and general fatigue. She also said that she had lost 4 kg of weight recently despite a good appetite and no attempt at dieting. She also reported occasional diarrhea, and increasingly infrequent and light menstrual bleeds. On examination, her skin was warm and moist and she had a fine tremor of outstretched hands. There was mild weakness of the thigh muscles. She had tachycardia (110/min). She also had a mild thyroid enlargement (goiter) and a bruit over the gland. Thyroid function tests show suppressed TSH level (< 0.05; range 0.4-4 mU/L) and increased thyroxine (T4 = 29; range 9-25 pmol/L) and tri-iodothyronine (T3 = 25; range 3.5-6.5 pmol/L). Thyroid receptor antibodies were detected. What is the most likely diagnosis?
Grave's disease
A patient presents with severe abdominal pain, nausea and vomiting. Serum amylase is increased and serum calcium is decreased. Which of the following diseases is most likely?
