I n t e r n a L medicine questions Bank

In kidney biopsy, linear deposits of IgG were found along basement membrane, diagnosis is:

A. Good pasture’s syndrome

30. 
    A patient had infectious mononucelosis, 3 weeks later, he developed pain in the tip of the left scapula and…
    

1. 
   Pancreatitis
   
2. 
   Splenic rupture
   
   
   
   

31. 
    A patient with RUQ pain, fever, chills, rigors, clay colored stool and dark urine. Diagnosis is:
    

1. 
   Acute hepatitis
   
2. 
   Ascending cholangitisi
   
3. 
   Acute cholecystisi
   

CLINICAL MANIFESTATIONS — The classic triad of Charcot — fever, right upper quadrant pain, and jaundice — occurs in only 50 to 75 percent of patients with acute cholangitis [8]. Confusion and hypotension can occur in patients with suppurative cholangitis, producing Reynold's pentad, which is associated with significant morbidity and mortality [9]. Hypotension may be the only presenting symptom in elderly patients or those on corticosteroids, while septic shock in severe cases can lead to multiorgan failure.

The incubation period averages 30 days (range 15 to 49 days), after which the illness begins with the abrupt onset of prodromal symptoms including, fatigue, malaise, nausea, vomiting, anorexia, fever, and right upper quadrant pain. Within a few days to one week, patients note dark urine, acholic stool (light-colored stools lacking bilirubin pigment), jaundice, and pruritus. The prodromal symptoms usually diminish when jaundice appears. The most common physical findings are jaundice and hepatomegaly. (See 'Clinical evaluation' above.)

32.