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Cholangitis occurs in both ulcerative colitis and Crohn coli- tis cheap 40mg prednisone with mastercard. Toxic megacolon can occur in infectious colitis and Crohn disease as well as ulcerative colitis purchase 40 mg prednisone. A 64-year-old woman presents to the emergency department with abdominal pain, nausea, and vomit- ing of 3 days’ duration. The physical examination reveals a patient with mild obesity; the patient’s temperature is 100. An abdominal CT scan with contrast shows pancreatitis with enhancement of the entire gland and a 5 cm collection of fluid next to the pancreas. Which of the following is the most accurate diagnosis for this patient? Interstitial pancreatitis with an acute fluid collection B. Interstitial pancreatitis with an uncomplicated pseudocyst C. Necrotizing pancreatitis with a peripancreatic phlegmon D. Interstitial pancreatitis with a pancreatic abscess Key Concept/Objective: To understand the diagnosis of acute pancreatitis The definitions used to differentiate acute from chronic pancreatitis have changed recent- ly, and more precise definitions were developed to describe the complications of acute pan- creatitis. An acute fluid collection is defined as a collection of fluid occurring in or around the pancreas early in the course of acute pancreatitis. These collections are seen as areas of low attenuation without a visible capsule on CT. They are quite common in acute pancre- atitis, occurring in 30% to 50% of cases. Many of these acute fluid collections resolve, but some may persist and develop a visible capsule, at which time they should be termed a pseudocyst. Pseudocysts are defined as collections of fluid surrounded by a fibrous capsule. It takes at least 4 to 6 weeks for an acute fluid collection to develop a capsule and become a pseudocyst.

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Dye and Boll6 observed mation about patellar tracking buy generic prednisone 10 mg. No realign- that about one-half of their patients with ante- ment surgical procedure ought to be based rior knee pain presented increased patellar entirely upon the arthroscopic analysis of the uptake in comparison with 4% of the control patellofemoral congruence cheap prednisone 20mg mastercard, as many variable group. Biopsy demonstrated that this increased factors (intra-articular pressure, portal localiza- patellar uptake was secondary to the increased tion, contraction versus quadriceps relaxation, remodelling activity of bone. Bone scintigraphy tourniquet and foot position) may lead to mis- can detect loss of osseus homeostasis, and often taken conclusions (i. Scintigraphy may be espe- The history and physical examination still cially useful in patients with injuries related to remain the first step for making an accurate workers’ compensation cases in which the diagnosis of anterior knee pain and patellar physician wishes to establish objective findings. Imaging studies are a second step and can gle-photon emission computed tomography never replace the former. Surgical indications (SPECT) bone scintigraphy is highly sensitive should not be based only on methods of image for the diagnosis of patellofemoral abnormali- diagnosis as there is a poor correlation between ties. For these authors, SPECT significantly clinical and image data. Finally, arthroscopy improves the detection of maltracking of the should be used judiciously and no realignment patella and the ensuing increased lateral patellar surgery should be based solely on the arthro- compression syndrome. They conclude that scopic analysis of the patellofemoral congruence. Proximal patellar Arthroscopic Evaluation tendinosis and abnormalities of patellar tracking. Patellofemoral Disorders: Diagnosis and realignment procedure is done, an arthroscopy Treatment. Personality in patients with long-term patellofemoral pain syn- patellofemoral joint the scope should be intro- drome. Knee Surg Sports Traumatol Arthrosc 1993; 1: duced through the superomedial portal. Factors of other unsuspected intra-articular pathology patellar instability: An anatomic radiographic study. In meniscus rupture) not obvious at the preopera- Biedert, RM, ed.

Which of the following therapeutic interventions is the most effective for this patient’s symptoms? Removal of the allergen from the patient’s environment C cheap prednisone 40mg amex. Cromolyn sodium Key Concept/Objective: To understand the importance of environmental control of atopic disease Despite the advances in medications and pharmacologic therapy for allergic illnesses 20mg prednisone amex, the most effective therapeutic intervention is still removal of the offending agent or allergen from the patient’s environment. This includes appropriate linens for mattresses and pil- lows, adequate cleaning, and lowering the ambient humidity in the house to minimize mold spores. Pets should be removed from the house or kept out of the room at all times. Patients sensitive to pollen should try to minimize the amount of time spent outdoors dur- ing those times of the year when the specific pollen is prevalent. A 20-year-old woman comes to your office in early spring with complaints of nasal congestion, runny nose, and paroxysms of sneezing. She has been experiencing these symptoms for 10 days. She denies having fever, cough, myalgias, or malaise. She states that she typically experiences bouts of similar symp- toms in September and October. Her medical history includes mild intermittent asthma since childhood. The nasal mucosa appears pale and swollen, and there is clear rhinorrhea. Which of the following statements regarding this patient’s condition is false? Nasal smear is likely to show a preponderance of eosinophils B.

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It is important to note that this disorder is often associated with considerable shame prednisone 40 mg cheap, and patients who have it may be reluctant to reveal their habits prednisone 40mg online. Serotonin-active antidepressants, including clomipramine, are the first-line agents for OCD. Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram also have demon- strated efficacy in the treatment of OCD. Cognitive-behavioral therapy is also highly effective. Social phobia and substance abuse are in the differential diagnosis of this patient. However, the presence of ritualistic behaviors (washing of hands) makes OCD more likely. In this patient, no diagnostic criteria for schizophrenia are present. A 42-year-old man with a history of wheezing and shortness of breath is referred to your pulmonary clin- ic for management of asthma. The diagnosis of asthma was apparently based on symptoms and evidence of obstruction on pulmonary function testing. During an episode of airflow obstruction, which of the following findings would be specific for a diag- nosis of asthma in this patient? Depressed diffusing capacity of the lung for carbon monoxide (DLCO) on pulmonary function testing B. A normal alveolar-arterial difference in oxygen (A-aDO2) gradient C. Improvement after administration of an inhaled bronchodilator D. Improvement after administration of corticosteroids E. The episode is associated with ingestion of a nonsteroidal anti- inflammatory drug (NSAID) Key Concept/Objective: To understand the differential diagnosis of asthma DLCO may be elevated in some patients with asthma, possibly because of greater recruit- ment of capillaries from higher pulmonary arterial pressure.