A 47-year-old man presents to an urgent care center with 18 hours of abdominal pain, nausea, vomiting, and chills. He is a single construction worker, denies smoking, and has at least a 10-year history of drinking 2 - 4 alcoholic beverages daily. A series of lab work is performed on the patient to evaluate his abdominal pain prior to abdominal imaging.
What laboratory results would be most indicative of the patient suffering from acute pancreatitis? (normal Amylase 30-200 U/L, Lipase 0-160 U/L, AST <40, ALT <40, Bilirubin <1.0, WBC <10,000 mm3)
a. Serum amylase 310 U/L and serum lipase 760 U/L
b. Serum amylase 250 U/L and serum lipase 110 U/L
c. Serum AST 32 U/L and serum ALT 29 U/L
d. Serum white blood cell count 14,000/mm3 and serum total bilirubin 1.8 mg/dl
e. Serum AST 120 U/L and serum ALT 40 U/L
In the emergency room, you see a 38-year-old, Caucasian woman. She is nervous, hyperexcitable, and experiencing palpitations. Her pulse is up to 110/min, her blood pressure is 120/80 mm Hg, and you realize a fine tremor of her hands. Upon further questioning, she tells you that she has been losing weight although eating a lot; she sweats increasingly, especially during the night, and has problems sleeping. She also mentions frequent bowel movements, occasional diarrhea, and irregularities in her menstruation.
What should the next diagnostic step be?
b. FSH and LH
c. PTH (parathyroid)
d. Blood glucose
e. Urine catecholamines
A 26-year-old woman of Asian descent presents for an annual physical. She was born in India and has been in the USA for about 1 year. She denies any symptoms or past medical problems; she is not on any medications. On examination, she is afebrile, BP 110/70 mm of Hg, pulse 76/min, and respirations 15/min. The oral exam is normal, and examination of the neck reveals a slight bulge anteriorly without tenderness. This mass is 3 inches by 4 inches in size, firm, smooth, moves with swallowing, and does not have any bruits. There is no fluctuance, and it is not reducible. Lungs are clear; the abdomen is benign, and heart sounds are normal. What should the next step in the diagnosis of this patient be?
A. CT scan of the neck
B. Thyroid function studies
C. Barium swallow evaluation
D. Radionuclide imaging
E. Fine needle aspiration cytology of mass
A 65 year-old man is brought into the VA hospital with complaints of severe
nausea and weakness. He has had problems with peptic ulcer disease in
the past and has been having similar pain for the past two weeks. Rather
than see a physician about this, he opted to deal with the problem on his
own and, over the past week, has been drinking significant quantities of
milk and consuming large quantities of TUMS (calcium carbonate). On his
initial laboratory studies, he is found to have a calcium level of 11.5 mg/dL,
a creatinine of 1.4 and bicarbonate of 35. The resident working in the ER
decides to draw a room air arterial blood gas, which reveals: pH 7.45, PCO2
49, PO2 68, HCO3
- 34. On his chemistry panel, the sodium is 139, chloride