Block 14 Pace 3 Prt 2

The most likely diagnosis based on the symptoms and the results of the imaging tests is achalasia. Achalasia is a condition characterized by the inability of the lower esophageal sphincter to relax properly, leading to difficulty in swallowing both solid and liquid foods. The symptoms of choking episodes, heaviness in the chest, and weight loss are consistent with achalasia. The barium swallow and meal would show a dilated esophagus with a narrowed lower esophageal sphincter, which is typical of achalasia. The other options, such as Hodgkin's lymphoma, carcinoma of the lungs or esophagus with metastases, and esophageal varices, are less likely based on the given information.

The correct answer is drinking mountain stream water. Giardia lamblia is a parasite that commonly infects humans through contaminated water sources. Drinking water from a mountain stream, which may not be treated or purified, increases the risk of acquiring this infection. The symptoms of diarrhea and weight loss are consistent with a Giardia infection. The other options, such as swimming in a chlorinated pool or foreign travel, are less likely to be the source of the infection. Eating ham and potato salad or bathing in a farm pond near animals would not typically lead to a Giardia infection.

The patient's significant weight loss, along with her desire to look better and eat less, suggests that she may be suffering from anorexia. Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight, distorted body image, and self-imposed starvation. It poses immediate risks to cardiovascular health and requires treatment that emphasizes weight replacement to restore the patient's health. Bulimia, pica-type, amnesia, and obsessive eating disorders do not align with the patient's symptoms and do not present the same level of cardiovascular risk.

The most likely diagnosis for this patient is Crohn's disease. The presentation of bloody diarrhea, weight loss, and ulceration involving the rectum, colon, and terminal ileum are all consistent with Crohn's disease. The biopsy findings of glandular disorder, crypt abscesses, paneth cell metaplasia, and granulomas further support this diagnosis. Irritable bowel disease and ulcerative colitis are both types of inflammatory bowel disease, but the specific findings described in this case are more indicative of Crohn's disease. Cholera and E. coli infection are both infectious causes of diarrhea, but they do not typically present with the chronicity and specific findings seen in this case.

The most likely causative agent in this case is Salmonella Typhimurium. The symptoms described, including nausea, vomiting, abdominal cramping, and watery diarrhea, are consistent with a gastrointestinal infection. The fact that leukocytes and red blood cells were present in the stool smear suggests an inflammatory response, which is commonly seen in Salmonella infections. Additionally, the isolation of a motile, hydrogen sulfide-producing, Gram-negative bacillus from the stool culture is consistent with the characteristics of Salmonella Typhimurium.

After successful treatment of Helicobacter pylori infection with a proton pump inhibitor plus antibiotics, it is expected that the patient would have no symptoms when he returns for an examination 2 years later. The resolution of epigastric pain and the absence of any symptoms indicate that the treatment was effective in eradicating the infection. The presence of high levels of antibodies against Helicobacter pylori is not expected because successful treatment would lead to a decrease in antibody levels. Recurrence of ulcer symptoms or the development of adenocarcinoma of the gastric cardia would indicate a failure of treatment or progression of the disease, which is not the case here.

The probable cause of the jaundice in this case is glucose 6 phosphate deficiency. Glucose 6 phosphate deficiency, also known as G6PD deficiency, is an inherited condition that affects the red blood cells. It leads to a decreased ability of the red blood cells to protect themselves against oxidative damage, resulting in the destruction of red blood cells and anemia. This can cause an increase in unconjugated bilirubin levels, leading to jaundice. The presence of increased reticulocytes in the blood also suggests the possibility of hemolysis, which is commonly seen in glucose 6 phosphate deficiency.

The drug that the patient is misusing is most likely directly stimulating the enteric nervous system (ENS). This stimulation is causing neuromuscular damage in the colon, leading to the loss of haustral folds and the development of a cathartic colon. This is consistent with the patient's symptoms of abdominal pain, excessive gas, bloating, and a continual feeling of fullness. The direct stimulation of the ENS is likely disrupting the normal functioning of the colon, resulting in these adverse effects.

This patient is most likely to have Genotype 1/RNAhigh. The fact that the patient is a diabetic man with chronic kidney disease requiring hemodialysis suggests a compromised immune system, which can make it more difficult to achieve a sustained virologic response (SVR) with treatment. Additionally, the high level of serum HCV RNA at 104 IU/mL indicates a high viral replication status. Genotype 1 is also the most common genotype in the United States, further supporting this answer.

The correct answer is Ribavirin. Ribavirin is an antiviral drug that is commonly used to treat viral infections, including Lassa hemorrhagic fever. It has been shown to be effective in reducing the severity and duration of symptoms in patients with this viral infection. Therefore, it is likely that Ribavirin was used to treat the patient in this scenario, leading to his dramatic improvement and full recovery.

The patient's presentation of diffuse muscle pain and weakness, along with laboratory findings of elevated BUN, creatinine, and potassium levels, as well as the presence of blood and protein in the urine, suggest acute renal failure. The presence of muddy brown casts and RBCs in the urine, along with the history of recent influenza, are indicative of rhabdomyolysis-induced acute renal failure. Rhabdomyolysis occurs when muscle breakdown releases myoglobin into the bloodstream, leading to renal damage. The combination of muscle symptoms, laboratory findings, and urine analysis supports this diagnosis.

Based on the given information, the most likely causative agent is Enterococcus faecalis. This is supported by the symptoms of fever, shaking chills, and right-sided low back pain, which are consistent with a urinary tract infection. The positive leukocyte esterase on the urine dipstick suggests the presence of white blood cells, indicating an infection. Additionally, the positive blood cultures further support the presence of a bacterial infection. Enterococcus faecalis is a common cause of urinary tract infections and is known to cause symptoms such as those described.

Explanation: Albuterol decreases [K+], causing metabolic alkalosis. CO2 increases to compensate.