A 51-year-old man with a 10-year history of gastroesophageal reflux and suspected Barrett esophagus comes to the office because his omeprazole dose "doesn't work around the Christmas holidays." He states that he prides himself on having a large appetite and "holding his liquor" during the holidays. He currently takes the maximum dose of omeprazole. Which of the following is the most appropriate initial action by the physician?

A 65-year-old woman comes to the office for a follow-up examination one year after she underwent operative resection of the right colon and chemotherapy for stage III colon cancer. She reports fatigue. Physical examination shows no abnormalities. A staging CT scan of the chest and abdomen shows five new 2- to 3-cm masses in the liver and both lungs. This patient's cancer most likely spread to the lungs via which of the following structures?

An 18-year-old girl with sickle cell disease is brought to the emergency department by her parents because of a 2- hour history of severe abdominal pain and nausea. Her parents say that she had a cheeseburger, milk shake, and chocolate bar for lunch. Her temperature is 37°C (98.6°F). Physical examination shows tenderness over the right upper quadrant of the abdomen, radiating to the right shoulder. Ultrasonography of abdomen shows gallstones. Which of the following is the most likely underlying cause of this patient's current condition?

A 5-year-old boy is brought to the emergency department by his mother because of an episode of bloody stool 3 hours ago. The mother says the stool was hard "like pebbles" and she noted bright red blood on the tissue when the patient cleaned himself. His previous bowel movement was 5 days ago. The patient has no abdominal or rectal pain now, but he did have abdominal pain during his bowel movement 5 days ago. He has no history of major medical illness and receives no medications. Anthropometry and Vital signs are within normal limits. Abdominal examination: hypo-active bowel sounds and a soft, slightly distended, non-tender abdomen. Rectal examination shows 1 cm of bright red rectal mucosa protruding from the right side of the anus; there is no rectal bleeding. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of this patient's physical findings?

A 78-year-old woman is admitted to the hospital because of a 1-week history of jaundice. CT abdomen shows a mass suggestive of pancreatic cancer. Three hours later, the on-call physician enters the patient's room to discuss the prognosis and obtain consent for a biopsy scheduled for the next morning. On entering the room, the physician greets the patient and her husband. The physician then learns that the patient speaks only Mandarin. Her husband is fluent in Mandarin and English. The hospital interpreter is not available until tomorrow morning. The patient's husband appears anxious and insists that the physician speaks to him and allows him to serve as an interpreter for his wife. Which of the following is the most appropriate next step in management?

A 73-year-old woman comes to the emergency department because of a 6-hour history of severe abdominal pain. She has chronic atrial fibrillation and underwent placement of a prosthetic mitral valve 4 years ago. Her pulse is 120/min and irregularly irregular, and blood pressure is 80/60 mm Hg. Arteriography shows an embolus in the superior mesenteric artery lodged just beyond the patent middle colic artery. A laparotomy is done. During this procedure, which of the following segments of the abdominal viscera is most likely to appear normal?

A 70-year-old male undergoes colonic resection for tumor. 24 hours later his urine output is 10 ml/hr. Na138, K 6 meq/l, Cl 100 meq/l and HCo3 14meq/l. This metabolic abnormality is consistent with____.

Which of the following is not true about CEA (Carcino Embryonic antigen) in Carcinoma Colon?

A 69-year-old man has been admitted for coronary artery disease. USG abdomen shows multiple non-floating gall stones, largest being 1.2 cm. he has no history of biliary colic or jaundice. what is best treatment advice for him for this condition?

A 40-year-old male comes to you with diagnosis of Acute diverticulitis. He was managed with NPO regime, IV cephalosporin and metronidazole. He says that pain in left lower quadrant has decreased but present. There is no diarrhea now. You have advised a CT scan now. Which of the following features now would now prompt you to advise elective surgery?

A 40-year-old lady presents with fever, chills, pain abdomen and nausea of 2 days duration. She is a non alcoholic and does not take any other drugs. Pain has been progressively increasing since 2 days and is slightly relieved with pain killers. Her Pulse is 110/min, Temp 101.5 degrees, BP 90/60 and appears confused. She is icteric and has tenderness and guarding in right upper quadrant. Total Bilirubin 7.1 mg%, Direct - 6 mg%, Alkaline phosphatase 860 IU/l, GGTP- 567 IU/L, Amylase 60 U/L, SGOT - 124 IU/L, SGPT - 223 IU/L, TLC 17,900 cu mm. Further work up is most likely to reveal______.

A 67-year-old man with no comorbidities presented with dark urine, progressive jaundice and pale-colored stools. He has unintentional weight loss,but no fever, abdominal pain, vomiting nor malena. Skin is normal. There is no lymphadenopathy or hepatosplenomegaly. Sr. Bilirubin is 7.4mg% and ALP 398IU/L. CT abdomen shows a pancreatic mass pressing on the bile duct and pancreatic duct. Which gene mutation is most likely cause of current condition?

A 34-year-old man presents because of a 2-year history of recurrent abdominal pain and diarrhea; and an 11-kg weight loss during this period. He describes his stools as copious, loose, oily and foul-smelling. His bowel movements occur six to eight times daily, often immediately after meals, and are associated with bloating and cramping. Since the age of 21 years, he has had several episodes of acute pancreatitis. He has not had fevers or bloody stools. He is 178 cm (5 ft 10 in) tall and weighs 57 kg; BMI is 18 kg/m2. Physical examination shows a flat abdomen with hyperactive bowel sounds and diffuse mild tenderness. Digital rectal examination shows no abnormalities. Test of the stool for occult blood is negative. Treatment with which of the following enzymes is most likely to be beneficial in this patient?

What is true about the immune mechanism in the small intestine?

A 35-year-old US citizen was in India for the pre-wedding ceremony in Gujarat 2 months back. Now he has anorexia, fever, malaise, RHC pain, and increased counts. USG shows a 6 x 4 x 4 cm single cavitary lesion in right lobe of liver. The possible pathway to liver was?

A surgeon wants to perform a low anterior resection for rectal cancer. What is the desired clearance margins for this procedure?

Which of the following statements is true?

A 55-year-old man, known to suffer from myelofibrosis, presents with onset of severe left upper quadrant and shoulder tip pain of 8 hours duration. On examination he has a low-grade fever and marked tenderness over an enlarged spleen. Counts are normal. A contrast-enhanced computed tomography scan (CECT) shows a perfusion defect in an enlarged spleen. What would be next step for managing this patient?

A 38-year-old female complains of pain in her right iliac fossa over the past 2 days. Her pain in the right iliac fossa was preceded by a bout of sudden onset of severe epigastric and right upper quadrant pain 3 days ago that lasted for a few hours. This initial pain subsided with some antacids, which she has been taking on and off for ‘indigestion’ for almost 18 months. She is unsure about her last menstrual periods. On examination she is pyrexial (39°C) and very tender and rigid over the right iliac fossa. Next step would be to do ?

The following statements are true except:

The following statements are true except:

The following factors increase the chances of peritonitis and systemic sepsis except:

Which of the following statements is true?

A 68-year-old man has been admitted as an emergency with colicky abdominal pain with constipation for 3 days. In between the colics, he is left with a dull ache. On abdominal examination he is in some discomfort with tenderness, more in right iliac fossa and distension particularly in the peripheral part. Over the past 4 months he has been increasingly constipated having to take large amounts of laxatives to open his bowels. As the treating surgeon, what would you like to do next?

Which of the following statements is true regarding the nerve supply of stomach?

Which of the following hormones is not released in duodenum?

A 60 year old female has presented with progressive dysphagia and weight loss. Endoscopy reveals a ulceroproliferative growth at GE junction and extending up to 1 cm below it. According to Siewert classification, what is the type of this lesion?

A 45-years old female presented with right upper abdominal pain and mass. USG reveals a large cystic lesion in liver with daughter cysts. What is the mostly likely class of this hydatid cyst?

A 60-year-old male has presented with Liver metastasis of unknown origin. Immunohistochemistry of liver biopsy sample reveals negative staining for cytokeratin-7, positive staining for cytokeratin 20 and negative staining for CDX-1. What is the mostly like site for the primary tumour?