T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation?

Correct Answer: A

Rationale: The correct answer is A: A temperature of 101.5°F. A fever indicates an inflammatory response, which could be due to a complication like cholecystitis or cholangitis. Elevated leukocyte count (choice B) supports infection but is not as specific as a fever. Palpable gallbladder (choice C) may suggest inflammation but not necessarily a complication. A positive Murphy's sign (choice D) is indicative of gallbladder inflammation but does not directly indicate a complication requiring surgical evaluation.

Correct Answer: D

Rationale: Correct Answer: D. Some form of vagotomy Rationale: 1. Vagotomy is a surgical procedure that involves cutting the vagus nerve to reduce acid production in the stomach, which can help in treating ulcers. 2. Vagotomy is often recommended when ulcers are refractory to medical therapy, making it an appropriate surgical option. 3. Lifelong vitamin D replacement (A) is not typically necessary for ulcer treatment. Excision of the ulcer (B) is not a common treatment and does not address the underlying cause. Eating smaller meals (C) may help manage symptoms but is not a surgical option for refractory ulcers.

Correct Answer: D

Rationale: The correct answer is D: Obturator sign. This finding indicates irritation of the peritoneum and is associated with a ruptured appendix, not acute pancreatitis. A: Severe epigastric pain with radiation to the back is a common presentation of acute pancreatitis, but not necessarily indicative of a seriously ill patient. B: Abdominal guarding and rigidity may suggest peritonitis but are not specific to acute pancreatitis. C: Grey Turner sign, bruising of the flanks, is associated with severe pancreatitis but does not necessarily indicate a seriously ill patient.

Correct Answer: C

Rationale: The correct answer is C: His blood pressure is likely a physiologic response to traumatic head injury. Rationale: 1. Physiologic response: Traumatic head injury can lead to autonomic dysregulation, causing increased sympathetic activity and elevated blood pressure to maintain cerebral perfusion. 2. Compensation mechanism: The body may increase blood pressure in response to hypotension to ensure vital organs receive adequate blood flow. 3. Treatment consideration: Understanding that elevated blood pressure can be a compensatory mechanism helps guide appropriate management strategies for traumatic head injury patients. Summary: A: Vasopressors can be used in traumatic head injury depending on the specific situation, and they are not always contraindicated. B: While hypotension can worsen outcomes in traumatic head injury, this choice overstates the risk without providing context. D: Identifying the cause of hypotension is crucial in managing traumatic head injury patients and should not be disregarded in favor of stabilizing the head injury.