A 52-year-old male presents to the ER with acute, severe, epigastric pain radiating to the back.  The patient reports one episode of coffee ground emesis earlier that day.  On examination, the patient is ill-appearing with a rigid, quiet abdomen and rebound tenderness.  Which of the following conditions is the most likely diagnosis for this patient?

Esophageal strictures have many potential etiologies, including benign and malignant conditions.  Patients with esophageal stricture typically initially present with which of the following symptoms?

A patient with abdominal pain is found to have free intraperitoneal air under the diaphragm on an upright chest x-ray.  This finding is most consistent with which of the following diagnoses?

A 68-year-old male with PMH significant for chronic alcohol abuse presents with a history of confabulation, confusion, and loss of memory. On examination he is found to have nystagmus, ataxia, and slight bilateral ophthalmoplegia. Which of the following vitamin deficiencies is the most likely cause of this patient’s symptoms?

A 74-year-old male presents with acute left lower quadrant abdominal pain.  He has nausea, vomiting, and constipation.  He currently has a fever of 101ºF.  On examination, he has guarding and rebound tenderness in his left lower quadrant.  His WBC is elevated.  The patient has no prior history of gastrointestinal disease.  Which of the following conditions is the most likely diagnosis?

A 30-year-old female patient presents with a complaint of rectal pain that has been going on for about a week. She says she has lost 4 pounds (2 kg) over the past four weeks, has a low-grade fever, and has noticed a foul discharge in her undergarments. She also complains of vague abdominal pain and anorexia. The patient has no significant PMH.  She has no allergies. She has never had surgery before. A physical exam reveals a visibly distressed female with tenderness in the anal area. Examination is performed under anesthesia and reveals multiple fistulous tracts just above the dentate line. She has frank pus extruding in the anal canal. Which of the following statements about this condition is true?

You are evaluating a 5-year-old child on your Pediatric rotation and the patient’s mother is concerned that her child may have a nut allergy.  Which of the following statements conveys correct information about peanut and tree nut allergies?

A 74-year-old male with PMH significant for coronary artery bypass surgery (6 years ago), history of alcohol abuse and remote history of cigarette use.  Patient reports that he quit smoking approximately 50 years ago.  Patient presents to your office, complaining of abdominal and ankle swelling, decreased energy, and poor appetite for the past 2 months. He says that he was previously in excellent health and walked 3 miles per day. Now he is too weak and tired to even care for his own yard. The patient is a fragile-appearing elderly man with temporal wasting. There is no jugular venous distention (JVD). The lungs are clear to auscultation. The heart sounds are regular, with no murmurs or gallops. The abdomen is protuberant with bulging flanks. Shifting dullness is present. There is 2+ ankle edema bilaterally and scattered telangiectasias on skin exam. He has no asterixis. Paracentesis is performed and ascites fluid analysis reveals serum-ascites albumin gradient (SAAG) = 1.4. Which of the following statements about this patient’s SAAG result is correct?

A 43-year-old female presents with a 6-month history of vague right upper quadrant discomfort. The patient denies any relation of pain to meals and describes it as a dull constant discomfort. The patient was diagnosed with type 2 diabetes mellitus 1 year ago, which is controlled with diet. She does not smoke but admits to drinking a glass of wine less than 3 times per month. She denies any medications except for over-the-counter acetaminophen, which she takes occasionally for joint pains. She does not have any family history of chronic liver disease. There is no history of blood transfusions in the past. On physical examination, the patient is obese with a BMI of 31; BP 140/90 mm Hg. The liver is palpable 3 cm below the right costal margin and is slightly tender. No other signs of chronic liver disease are evident.  Pertinent laboratory test results include: serum AST 64 U/L ↑, serum ALT 70 U/L ↑, serum AST/ALT < 1, serum Alk phos 112 U/L, serum total bilirubin 1.0 mg/dL, serum albumin 3.6 g/dL, serum ferritin 48 ng/ml, serum iron 100 ug/dL, and negative Hepatitis A, B, and C serology. Based on this information, which of the following conditions is the most likely cause of this patient’s liver disease? 

The accompanying image is showing the otic ganglion at the tip of the arrow.  Which cranial nerve provides preganglionic parasympathetic fibers that will synapse in this ganglion?