A 4-week-old infant is brought to the physician by his mother because of blood-tinged stools for 3 days. He has also been passing whitish mucoid strings with the stools during this period. He was delivered at 38 weeks' gestation by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. He was monitored in the intensive care unit for a day prior to being discharged. His 6-year-old brother was treated for viral gastroenteritis one week ago. The patient is exclusively breastfed. He is at the 50th percentile for height and 60th percentile for weight. He appears healthy and active. His vital signs are within normal limits. Examination shows a soft and nontender abdomen. The liver is palpated just below the right costal margin. The remainder of the examination shows no abnormalities. Test of the stool for occult blood is positive. A complete blood count and serum concentrations of electrolytes and creatinine are within the reference range. Which of the following is the most appropriate next step in management?
APerform stool antigen immunoassay
BPerform an air enema on the infant
CAssess for IgA (anti‑)tissue transglutaminase antibodies (tTG)
DStop breastfeeding and switch to soy-based formula
EContinue breastfeeding and advise mother to avoid dairy and soy products
A 42-year-old G1P0 woman presents to an obstetrician for her first prenatal visit. She has been pregnant for about 10 weeks and is concerned about how pregnancy will affect her health. Specifically, she is afraid that her complicated medical history will be adversely affected by her pregnancy. Her past medical history is significant for mild polycythemia, obesity hypoventilation syndrome, easy bleeding, multiple sclerosis, and aortic regurgitation. Which of these disorders is most likely to increase in severity during the course of the pregnancy?
AEasy bleeding
BHypoventilation
CMultiple sclerosis
DPolycythemia
EHeart murmur
A 25-year-old man presents with abdominal pain and bloody diarrhea. His symptoms have been recurrent for the past few months, and, currently, he says he is having on average four bowel movements daily, often bloody. He describes the pain as cramping and localized to the left side of his abdomen. He also says that he has lost around 4.5 kg (10 lb) over the past 3 months. There is no other significant past medical history and the patient is not on current medications. His temperature is 37.7° C (100.0° F), pulse rate is 100/min, respiratory rate is 18/min, and blood pressure is 123/85 mm Hg. On physical examination, there is mild tenderness to palpation in the lower left quadrant of the abdomen with no rebound or guarding. Laboratory studies show anemia and thrombocytosis. Colonoscopy is performed, which confirms the diagnosis of ulcerative colitis (UC). What is the mechanism of action of the recommended first-line medication for the treatment of this patient’s condition?
ASuppression of cellular and humoral immunity
BTNF-⍺ antagonism
CInhibition of enzyme phospholipase A2
DCross-linking of bacterial DNA
EInhibition of leukotriene synthesis and lipoxygenase
+ 7 more in the PDF
Browse all chapters