Day 11
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1. A 64-year-old woman develops sudden-onset abdominal discomfort after eating a large meal. The pain is constant, localises to the epigastric area with radiation to her right scapula. She also has nausea and vomiting. It eventual subsides 1 hour later. An ultrasound of the abdomen reveals a dilated common bile duct secondary to stones. Which of the following statements regarding common bile duct stones is most likely true? 
(A)  all originate in the gallbladder 
(B)  always produce jaundice 
(C)  produce constant level of jaundice 
(D)  can be painless 
(E)  indicate anomalies of the bile duct. Explain.  Give the related rubrics
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2.  A 33-year-old woman develops mild epigastric abdominal pain with nausea and vomiting of 2 days duration. Her abdomen is tender on palpation in the epigastric region, and the remaining examination is normal. Her white count is 13,000/mL, and amylase is 300 U/L (25–125 U/L). Which of the following is the most common predisposing factor for this disorder? 
(A) drugs
(B) gallstones 
(C) malignancy 
(D) alcohol 
(E) hypertriglyceridemia . Justify.  Give the related rubrics
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3.   A 28-year-old female has hypertension that is difficult to control. She was diagnosed at age 26. Since that time she has been on increasing amounts of medication. On physical examination she appears to be without distress. Blood pressure is 168/100, and heart rate is 84 beats per minute. Cardiac examination is unremarkable, without rubs, gallops, or murmurs. She has good peripheral pulses and has no edema. Her physical appearance does not reveal any hirsutism, fat maldistribution, or abnormalities of genitalia. Laboratory studies reveal a potassium of 2.8 mEq/dL and a serum bicarbonate of 32 mEq/dL. Fasting blood glucose is 114 mg/dL. What is the likely diagnosis?A. Congenital adrenal hyperplasiaB. Fibromuscular dysplasiaC. Cushing’s syndromeD. Conn’s syndromeE. Pheochromocytoma
. Differentiate
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4.  A 30-year-old man complains of chronic diarrhoea for the past 6 months. There is no weight loss, fever, or abdominal pain. He takes no medications and feels fine. His physical examination is completely normal. Further history reveals that this man does not take laxatives; however, in an effort to stay slim he eats a lot of sugar-free gum and sugarless candy. Which of the following explanations is the most likely cause of his diarrhoea? 
(A)  direct stimulant effect of chemicals in the candies 
(B)  lack of fiber in his diet 
(C)  pancreatic insufficiency secondary to chronic protein-calorie malnutrition 
(D)  secondary intestinal mucosal atrophy 
(E)  nonabsorbed carbohydrates . Explain. Give the related rubrics
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5.  A 23-year old sex trade worker develops acute- onset jaundice and seeks medical attention. There is no history of intravenous drug use or travel. On examination, she is icteric, there is no lymphadenopathy, and the heart and lungs are normal. Her liver span is 14 cm and the liver edge is smooth but tender. Her pelvic examination is normal. Serology for viral hepatitis transmitted via the sexual route is positive.
(A) hepatitis A virus (B) hepatitis B virus 
(C) hepatitis C virus (D) hepatitis D virus 
(E) hepatitis E virus 

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