A 40-year-old man presents with abdominal pain and vomiting. He has a history of alcohol use and liver disease. On examination, he has jaundice and ascites. His serum bilirubin is elevated, and liver function tests show elevated AST and ALT. Which of the following is the most likely diagnosis?

Correct Answer: B

Rationale: The most likely diagnosis for the 40-year-old man with abdominal pain, vomiting, jaundice, ascites, elevated bilirubin, and elevated AST and ALT is cirrhosis. Cirrhosis is characterized by liver dysfunction due to chronic liver injury, which can be caused by alcohol use and liver disease. The presence of jaundice, ascites, and abnormal liver function tests are classic signs of advanced liver disease like cirrhosis. Chronic pancreatitis (A) typically presents with abdominal pain radiating to the back, and may not cause jaundice or ascites. Hepatitis (C) usually presents with symptoms like fatigue, nausea, and fever, and may or may not cause jaundice. Gallstones (D) can cause abdominal pain, but are less likely to present with jaundice, ascites, and liver function test abnormalities.

Correct Answer: B

Rationale: The most likely diagnosis for a 50-year-old man with a history of heavy alcohol use presenting with abdominal pain, jaundice, and ascites, along with elevated serum bilirubin, AST, and ALT, is cirrhosis. Cirrhosis is a chronic condition characterized by liver damage and scarring, commonly caused by long-term alcohol abuse. The elevated liver function tests and jaundice are indicative of liver dysfunction, while ascites is a common complication of cirrhosis due to portal hypertension. Chronic pancreatitis (choice A) typically presents with pancreatic enzyme abnormalities, not liver dysfunction. Hepatitis (choice C) may present with elevated liver enzymes but is less likely in a patient with a history of heavy alcohol use. Gallstones (choice D) can cause jaundice but are less likely to be the primary cause of liver dysfunction in this case.

Correct Answer: A

Rationale: The most likely diagnosis for the 60-year-old man with difficulty swallowing, weight loss, hoarse voice, smoking, and alcohol use is esophageal cancer. This is supported by the symptoms of dysphagia, weight loss, and hoarseness, which are common in esophageal cancer. Smoking and alcohol use are risk factors for developing esophageal cancer. Achalasia presents with dysphagia without weight loss or hoarseness. Gastroesophageal reflux disease typically presents with heartburn and regurgitation, not hoarseness or weight loss. Peptic ulcer disease usually presents with epigastric pain, not difficulty swallowing or hoarseness.

Correct Answer: C

Rationale: The correct answer is C: Failure of the accommodation reflex. When the pupils constrict in response to light but do not constrict when focused on a near object, it indicates a failure of the accommodation reflex. This reflex is responsible for adjusting the shape of the lens to focus on near objects. In this scenario, the pupils are reacting to light (normal pupillary response) but not adjusting properly for near vision, ruling out A. Failure of the consensual light reflex (B) would result in both pupils failing to constrict when exposed to light. Increased intracranial pressure (D) would typically present with other neurological signs and symptoms.

Correct Answer: A

Rationale: The correct answer is A: Asthma. Wheezing on expiration is a classic finding in asthma due to airway constriction. During expiration in asthma, the narrowed airways cause turbulent airflow, leading to the characteristic high-pitched wheezing sound. Asthma is a chronic inflammatory condition of the airways that results in reversible airflow obstruction. Pneumonia (B) typically presents with crackles on auscultation, not wheezing. Pulmonary edema (C) is associated with crackles and possibly wheezing on inspiration. COPD (D) may present with wheezing on both inspiration and expiration, but it is less likely than asthma to present with wheezing on expiration alone.