A Training Quiz For Correctly Diagnosing Various Diseases

The most likely diagnosis for this patient is multiple gall stones. The patient's symptoms of right upper quadrant pain related to fatty meals, nausea, and occasional loss of appetite are consistent with biliary colic, which is often caused by gall stones obstructing the bile duct. The tenderness in the epigastrium and normal liver size on examination further support this diagnosis. The ultrasound scan would likely show multiple gall stones in the gallbladder or bile ducts, confirming the diagnosis.

The presence of hematuria and acute renal failure, along with the finding of numerous crescents on renal biopsy, suggests rapidly progressive glomerulonephritis. This condition is characterized by a rapid decline in renal function and the formation of crescent-shaped lesions in the glomeruli. Nephritic syndrome and nephrotic syndrome may present with hematuria, but the presence of crescents on biopsy indicates a more severe and rapidly progressing disease. Diabetes and amyloidosis may cause renal complications, but they do not typically present with the combination of hematuria and acute renal failure.

The image shown in the bladder view of the excretory urogram is most likely due to benign prostatic hypertrophy. This condition is characterized by the enlargement of the prostate gland, which can cause urinary symptoms such as weak urinary stream, nocturia, dribbling, and hesitancy. The firm, smooth mass felt on digital rectal examination is consistent with an enlarged prostate. Carcinoma of the bladder or prostate would typically present with different imaging findings or other clinical manifestations. Chronic cystitis and neurogenic bladder would not typically cause an enlarged prostate.

Pregnant women with asymptomatic bacteriuria are at increased risk for developing pyelonephritis later in pregnancy if left untreated. Asymptomatic bacteriuria refers to the presence of bacteria in the urine without any symptoms of a urinary tract infection. While it may not cause immediate symptoms, it can progress to a more serious infection, such as pyelonephritis, which is an infection of the kidneys. Therefore, it is important to identify and treat asymptomatic bacteriuria in pregnant women to prevent complications and ensure the health of both the mother and the baby.

The most likely diagnosis in this case is Wilm's tumor. Wilm's tumor, also known as nephroblastoma, is a malignant tumor that typically occurs in children. It is the most common kidney cancer in children and is often diagnosed before the age of 5. The fact that the patient is a 3-year-old who underwent resection of a renal mass is consistent with Wilm's tumor. The histology of the tumor would also support this diagnosis.

The most likely diagnosis in this case is acute rejection. Acute rejection is a common complication after renal transplantation, typically occurring within the first few months after the procedure. It is characterized by an immune response against the transplanted kidney, leading to infiltration of lymphocytes in the interstitium and tubules. This immune response can result in impaired kidney function, leading to azotemia. Hyperacute rejection occurs immediately after transplantation, chronic rejection develops over a longer period of time, and infection or drug reactions may present with different clinical features.

Interferon alfacon-1 is a recombinant form of the human cytokine interferon alpha whose binding to plasma membrane bound receptors activates the JAK/STAT pathway.

The most likely cause of the renal failure in this patient is decreased renal perfusion. This is indicated by the elevated BUN (indicating impaired filtration and reabsorption) and the normal creatinine (indicating that the kidneys are still able to excrete some waste products). In the setting of an auto accident with extensive burn injury, it is common to have hypovolemia and hypotension, which can lead to decreased renal perfusion and subsequent renal failure.

The most likely diagnosis in this case is central diabetes insipidus. Central diabetes insipidus is characterized by the inability of the kidneys to concentrate urine due to a deficiency or lack of response to vasopressin (ADH). In this case, the patient's urine osmolality is low despite having a high serum osmolality, indicating an inability to concentrate urine. The water deprivation test further supports the diagnosis, as the patient's serum osmolality increases and urine osmolality remains low. Administration of vasopressin leads to an increase in urine osmolality, indicating a response to exogenous ADH.

In patients suffering with HCV infection who are in particular danger of developing cirrhosis, the infection should be treated with a combination of ribavirin and interferon alfa.

The most likely diagnosis for a renal mass in a 64-year-old man is renal cell carcinoma. Renal cell carcinoma is the most common type of kidney cancer and typically presents with a mass in the kidney. Other potential diagnoses such as oncocytoma, urothelial carcinoma, angiomyolipoma, and metastatic colon cancer are less likely based on the patient's age and clinical presentation.

Entecavir is the only listed drug that possesses such a pharmacokinetic profile.

The correct answer is the stimulation of motilin receptors and stimulation of somatostatin receptors. Motilin is a hormone that promotes gastrointestinal motility, and somatostatin is a hormone that inhibits the release of other hormones, including gastrin. Stimulation of motilin receptors can help to increase gastric emptying and promote the movement of blood out of the stomach. Stimulation of somatostatin receptors can help to decrease gastric acid secretion and reduce the risk of further bleeding. These pharmacological agents were likely administered to help treat the patient's suspected condition of gastrointestinal bleeding.

The most likely laboratory result to be seen in this patient is urine osmolality > 500 mOsmol/kg. The patient's symptoms, including passing small quantity of urine and light-headedness, along with the physical examination findings of dry tongue and low blood pressure, suggest dehydration. The high urine osmolality indicates concentrated urine, which is a characteristic finding in dehydration.

Lupus nephritis is classified into six different classes based on the histological findings on kidney biopsy. Class V lupus nephritis, also known as membranous lupus nephritis, is characterized by thickening of the glomerular basement membrane and deposition of immune complexes. This class is commonly associated with the nephrotic syndrome, which includes symptoms like proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Therefore, if a patient with lupus presents with the nephrotic syndrome, a kidney biopsy would most likely show Class V lupus nephritis.

The given clinical presentation of hematuria, azotemia, oliguria, and hypertension, along with the presence of red cell casts in the urine, is consistent with acute proliferative glomerulonephritis (GN). Acute proliferative GN is an immune-mediated inflammation of the glomeruli, often occurring after an infection such as strep throat. A renal biopsy in this case would most likely show the characteristic findings of acute proliferative GN, including glomerular hypercellularity, neutrophil infiltration, and immune complex deposition. This diagnosis is supported by the clinical presentation and urinalysis findings.

A liver biopsy in a 3-year-old baby who presents with acute liver failure after consuming liquid acetaminophen would most likely show extensive necrosis. Acetaminophen overdose can cause severe liver damage, leading to necrosis of liver cells. This occurs due to the toxic effects of acetaminophen metabolites on the liver. Necrosis refers to the death of liver cells, and extensive necrosis would indicate a severe and widespread damage to the liver tissue.

The patient is most likely taking Infliximab to treat her inflammatory bowel disease (IBD). Infliximab is a medication commonly used to manage severe ulcerative colitis. It works by targeting and blocking a specific protein in the body that causes inflammation. This drug has been shown to be effective in inducing and maintaining remission in patients with IBD.

Of all the anti-HBV drugs currently on the market, telbivudine displays the highest incidence of viral resistance to its action.

Based on the given information, the most likely diagnosis is renal cell carcinoma. This is because the patient's family history of adult polycystic kidney disease, along with the presence of hematuria and a CT scan showing one massively enlarged solid and cystic kidney, suggests the possibility of a tumor. Renal cell carcinoma is a common type of kidney cancer that can cause the enlargement of the affected kidney. The normal BUN and creatinine levels indicate that the kidney function is still normal, which is consistent with renal cell carcinoma in its early stages.

The most likely diagnosis for a 60-year-old man presenting with nephrotic syndrome and a PAS stain of his renal biopsy showing changes consistent with diabetes. Diabetes is a common cause of nephrotic syndrome and can lead to diabetic nephropathy, which is characterized by glomerular basement membrane thickening and mesangial expansion. This is supported by the patient's age and the presence of nephrotic syndrome. Minimal change disease and membranous GN are less likely in this age group, while amyloidosis and post-infectious GN would typically present with different histological findings.

Membranoproliferative GN is the most likely diagnosis for a patient with blood and protein in their urine who undergoes a renal biopsy. Membranoproliferative GN is a type of glomerulonephritis characterized by thickening of the glomerular basement membrane and proliferation of mesangial cells. This condition often presents with hematuria (blood in the urine) and proteinuria (protein in the urine). The renal biopsy would confirm the diagnosis by showing the characteristic findings of membranoproliferative GN.

Monitoring of biochemical parameters such as electrolytes, liver and kidney function, urinalysis, and complete blood count is undertaken along with frequent checking of salicylate and blood sugar levels.
ARTERIAL BLOOD GAS ASSESSMENTS WILL TYPICALLY FIND RESPIRATORY ALKALOSIS EARLY IN THE COURSE OF THE OVERDOSE DUE TO HYPERSTIMULATION OF THE RESPIRATORY CENTER,
and may be the only finding in a mild overdose. An anion-gap metabolic acidosis occurs later in the course of the overdose especially if it is a moderate to severe overdose, due to the increase in protons (acidic contents) in the blood

Cholesterol embolism or atheroembolism, occurs when cholesterol is released, usually from an atherosclerotic plaque, and travels along with the bloodsteam (embolism) to other places in the body, where it obstructs blood vessels. Most commonly this causes skin symptoms (usually LIVEDO RETICULARIS), gangrene of the extremities and sometimes renal failure; problems with other organs may arise, depending on the site at which the cholesterol crystals enter the bloodstream. When the kidneys are involved, the disease is referred to as ATHEROEMBOLIC RENAL DISEASE (AERD). The diagnosis usually involves biopsy
Kidney involvement leads to the symptoms of renal failure, which are non-specific but usually cause nausea, reduced appetite (anorexia), raised blood pressure (hypertension), and occasionally the various symptoms of electrolyte disturbance such as an irregular heartbeat. Some patients report hematuria (bloody urine) but this may only be detectable on microscopic examination of the urine. Increased amounts of protein in the urine may cause edema (swelling) of the skin (a combination of symptoms known as nephrotic syndrome).
Tests for inflammation (C-reactive protein and the erythrocyte sedimentation rate) are typically elevated, and abnormal liver enzymes may be seen. If the kidneys are involved, tests of renal function (such as urea and creatinine) are elevated. The complete blood count may show particularly high numbers of a type of white blood cell known as EOSINOPHILS (more than 0.5 billion per liter); this occurs in only 60-80% of cases, so normal eosinophil counts do not rule out the diagnosis. Examination of the urine may show red blood cells (occasionally in casts as seen under the microscope) and increased levels of protein; in a third of the cases with kidney involvement, *** EOSINOPHILS *** can also be detected in the urine. If vasculitis is suspected, complement levels may be determined as reduced levels are often encountered in vasculitis; complement is a group of proteins that forms part of the innate immune system. Complement levels are frequently reduced in cholesterol embolism, limiting the use of this test in the distinction between vasculitis and cholesterol embolism.