When evaluating a patient with acute pancreatitis, which of the following physical or diagnostic findings is an ominous finding that indicates a seriously illpotentially moribund patient?

Correct Answer: C

Rationale: The Grey Turner sign is characterized by bruising in the flanks and is a rare finding associated with acute pancreatitis. It indicates retroperitoneal bleeding and is considered an ominous finding that suggests a severe and potentially moribund state in patients with acute pancreatitis. The presence of the Grey Turner sign should prompt immediate intervention and close monitoring in a hospital setting. The other options, severe epigastric pain with radiation to the back, abdominal guarding and rigidity, and obturator sign, are indicative of pancreatitis but do not carry the same ominous implication as the Grey Turner sign.

Correct Answer: B

Rationale: When the vomiting precedes pain, the likelihood of surgical abdomen increases appreciably. This statement is based on how the timing of symptoms can indicate the severity of the underlying condition. In cases where vomiting occurs before the onset of abdominal pain, it can be a sign of a more serious issue requiring urgent medical attention, such as a surgical abdomen. This sequence of symptoms suggests that there may be an obstruction or other critical issue in the gastrointestinal tract that is leading to the symptoms of vomiting and pain. Therefore, recognizing the relationship between the timing of symptoms like abdominal pain and vomiting is crucial in determining the urgency of intervention and appropriate medical management.

Correct Answer: C

Rationale: Superfecundation can occur with dizygotic twinning, leading to multiple paternity.

Correct Answer: D

Rationale: In the given scenario where there are no other abnormal findings, it suggests that Mr. Thornton is experiencing anterior wall ischemia. Ischemia occurs due to inadequate blood supply to the heart muscles, often caused by a partial blockage in the coronary arteries. The absence of abnormal findings, such as ST-segment elevation or specific changes on the electrocardiogram (ECG), indicates that the issue is more likely ischemia rather than infarction. Infarction, whether NSTEMI or STEMI, would typically be associated with specific ECG changes and significant abnormalities beyond just the absence of findings. In the absence of these features, the more likely diagnosis is anterior wall ischemia.

Correct Answer: B

Rationale: Rubin’s maneuver involves rotating the posterior shoulder to relieve shoulder dystocia.