Test 23

Question 1

Factitious disorder

Answer 1

Repeated polymicorbial bacteremia in a patient with no hx of malignancy or immunosuppressive condition should raise suspicion for a factitious disorder. Factitious disorder is most common in patients who are women and health care workers.

Question 2

Chronic pancreatitis

Answer 2

Abdominal pain accompanied by fat malabsorption should raise suspicion of chronic pancreatitis, particularly in patients with a hx of heavy alcohol intake. The dx can be confirmed with magnetic resonance cholangiopancreatography or an abdominal CT scan, which can identify pathognomonic findings (pancreatic calcifications).

Question 3

Chronic pancreatitis

Answer 3

Alcohol and tobacco cessation, along with dietary modifications, is the first-line tx of chronic pancreatitis. Pancreatitis enzyme replacement and analgesics should be considered if conservative measures are unsuccessful. A variety of minimally invasive and surgical interventions is available for patients with refractory dx.

Question 4

Acute pericarditis

Answer 4

When pharmacologic therapy is needed, high-dose ASA is the tx of choice for symptomatic management of peri-infarction pericarditis. Other anti-inflammatory agents (other NSAID drugs, glucocorticoids) should be avoided as they may impair myocardial healing and increase the risk of ventricular septal or free wall rupture.