What is/are the possible cause(s) of acute pancreatitis in this patient?

Correct Answer: B

Rationale: The correct answer is B: Cytomegalovirus. Cytomegalovirus is a common cause of acute pancreatitis in immunocompromised patients. The virus can infect the pancreas leading to inflammation. HIV (A) can also cause pancreatitis, but it is typically due to opportunistic infections like CMV rather than the virus itself. Dideoxyinosine (ddI) (C) and Pentamidine (D) are medications that can cause pancreatitis, but they are not the primary cause in this case.

Correct Answer: B

Rationale: The correct answer is B: Measure serum gastrin in response to secretin infusion. This step is necessary to confirm the diagnosis of gastrinoma. Secretin stimulation test is used to differentiate between Zollinger-Ellison syndrome (gastrinoma) and other causes of hypergastrinemia. If serum gastrin levels remain elevated after secretin infusion, it supports the diagnosis of gastrinoma. Choice A: Refer her for an exploratory laparotomy - This is an invasive procedure and should not be the first step in the investigation of gastrinoma. Choice C: Treat her for H. pylori - This is not indicated in the management of suspected gastrinoma. H. pylori infection is not a likely cause of the symptoms described. Choice D: Obtain a dedicated small bowel series - This test is not typically used in the initial evaluation of gastrinoma. The secretin stimulation test is the preferred method for confirming the diagnosis.

Correct Answer: B

Rationale: The correct answer is B: 81 mg of aspirin per day decreases the benefit of using a COX II inhibitor. Aspirin, a non-selective COX inhibitor, can interfere with the action of selective COX II inhibitors by competing for the same binding site on the COX enzyme. This competition can limit the effectiveness of the COX II inhibitor in reducing inflammation and pain. This is particularly important in patients with a history of chronic iron deficiency anemia who may require NSAIDs for pain management. Option A is incorrect because a dedicated small bowel series may not necessarily be positive for identifying the source of blood loss in this patient. Option C is incorrect as a provocative arteriogram with heparin infusion is an invasive procedure and not typically indicated as a first-line investigation for blood loss in patients with iron deficiency anemia. Option D is incorrect as hormonal therapy is not typically used to decrease blood loss from arteriovenous malformations.

Correct Answer: B

Rationale: The correct answer is B: Ischemic colitis affects the watershed areas of the colon, namely, the splenic flexure, right colon, and rectum. This is because these areas have relatively poor collateral blood supply, making them more susceptible to ischemia. Ischemic colitis typically presents with abdominal pain, bloody diarrhea, and tends to affect elderly patients with cardiovascular risk factors. Choice A is incorrect as most cases of ischemic colitis can be managed conservatively without the need for colonic resection. Choice C is incorrect as ischemic colitis can occur in individuals of any age group, although it is more common in the elderly. Choice D is incorrect because colonoscopic intervention is not always necessary for the diagnosis and management of ischemic colitis.

Correct Answer: C

Rationale: The correct answer is C - Metronidazole, lansoprazole, and clarithromycin for 14 days. This regimen includes a proton pump inhibitor (lansoprazole) to reduce stomach acid, clarithromycin to kill the bacteria, and metronidazole as an alternative antibiotic. This combination therapy is recommended by guidelines as it targets H. pylori effectively, reducing the risk of resistance. Choice A is incorrect as bismuth subsalicylate is not included in the recommended regimen. Choice B is incorrect because omeprazole is not the preferred proton pump inhibitor, and using clarithromycin alone can lead to resistance. Choice D is incorrect as the duration of treatment is insufficient for eradication. Overall, choice C is the most effective option based on current guidelines and best practices for treating H. pylori infection.