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Mid-epigastric pain radiating to back

35-year-old female presents to the hospital with mid-epigastric tenderness that radiates to her back. She has been experiencing this for the past three days. She says the pain is constant and made worse with eating. She also complains of some nausea and vomiting and low grade fever. Patient denies using NSAIDs, alcohol, or drugs. On physical exam, she is in mild distress from pain and also does have mid-epigastric and right upper quadrant tenderness. Liver function tests are done and show elevated transaminase levels with mild elevation in alkaline phosphatase and total bilirubin. Lipase is elevated at 1500U/L. Which of the following is the best diagnostic test to perform at this time?

Answer Choices

A. Ultrasonography of the abdomen
B. CT of the abdomen and pelvis with contrast
C. Endoscopic retrograde cholangiopancreatography (ERCP)
D. Magnetic resonance cholangiopancreatography (MRCP)
E. Endoscopic ultrasound (EUS)


Multiple endocrine neoplasia

Which of the following is a true statement regarding multiple endocrine neoplasia (MEN) syndrome?

Answer Choices

A. MEN type I, MEN type IIa, and MEN type IIb are all autosomal recessive diseases
B. Patients with low sugar and high calcium levels should be suspected to have MEN type IIa
C. Medullary carcinoma of the thyroid is seen in MEN type I
D. Elevated urine catecholamine levels and its metabolites can be seen in MEN type IIa and type IIb
E. Parathyroid hyperplasia is very common in MEN type IIb

Anti-coagulation for atrial fibrillation

64-year-old male with no previous medical condition of note presents with atrial fibrillation. Which of the following is the most appropriate regimen for stroke prevention in this patient?

Answer Choices

A. Aspirin 325mg once daily
B. Aspirin 81mg once daily
C. Warfarin with target INR 2.0 - 3.0
D. Warfarin with target INR 2.5 - 3.5
E. None of the above

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