Ms. Carpenter is a 28-year-old female who presents in significant pain she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic?

Correct Answer: A

Rationale: The correct answer is A: Temperature > 102°F. A high fever in the context of right lower quadrant colicky pain raises concern for ureteral colic, which is often caused by kidney stones. Fever may indicate infection or obstruction, requiring urgent medical attention. Choices B, C, and D are incorrect because they are common findings in cases of ureteral colic but are not as specific to raise the index of suspicion. White blood cell count elevation and hematuria are common with kidney stones, while vomiting is a common symptom due to severe pain. However, fever is a more concerning sign that necessitates prompt evaluation.

Correct Answer: A

Rationale: The correct answer is A: Cyclosporine. Cyclosporine is a first-line treatment for acute rejection following hepatic transplant due to its immunosuppressive properties. It inhibits T-cell activation and cytokine production, suppressing the immune response against the transplanted liver. This helps in preventing further damage caused by rejection. Azathioprine (B) and Sirolimus (D) are also immunosuppressants, but Cyclosporine is preferred as the initial treatment. Methylprednisolone (C) is a corticosteroid that can be used in combination with Cyclosporine for acute rejection to provide a more potent immunosuppressive effect.

Correct Answer: B

Rationale: The correct answer is B: Gastroesophageal reflux disease (GERD). Achalasia is a motility disorder characterized by impaired esophageal peristalsis and lower esophageal sphincter relaxation. This dysfunction can lead to stagnant food in the esophagus, causing regurgitation and increased intra-esophageal pressure, which can trigger GERD. Squamous cell carcinoma (choice A) is not directly linked to achalasia. Esophageal atrophy (choice C) is not a typical consequence of achalasia. Malabsorption syndromes (choice D) are not directly associated with achalasia.

Correct Answer: A

Rationale: The correct answer is A because high-volume liver resection is typically performed in individuals with significantly compromised hepatic function to ensure adequate liver remnant. Removing 50 to 75% of the liver in a patient with metastatic colon cancer may be necessary for tumor clearance but carries risks due to potential impairment of liver function postoperatively. Choices B and C provide inaccurate information regarding the timeline and extent of liver regeneration following resection. Choice D is incorrect as removing up to 95% of the liver would lead to severe consequences, such as liver failure. Hence, option A is the most appropriate advice given the patient's situation.

Correct Answer: B

Rationale: The correct answer is B: His procedure has put him at significant risk for B12 absorption problems. Rationale: 1. Jejunum is primarily responsible for nutrient absorption, including B12. 2. Resection of a large portion of the jejunum can lead to malabsorption of B12. 3. B12 is essential for neurological function and red blood cell production. 4. Patients with significant jejunum resection are at high risk for B12 deficiency. 5. Monitoring B12 levels and potentially requiring supplementation is crucial for patients like Jake. Summary of other choices: A: Incorrect. Lifetime issues with diarrhea are not necessarily expected following jejunum resection. C: Incorrect. The ileum may assume some functions of the jejunum but cannot fully compensate. D: Incorrect. Enteral nutrition should not be delayed for months as it is essential for Jake's recovery and nutritional needs.