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141681 Unknown

A 69-yrs-old man with a 60 pack-year history for smoking presents with dizziness and visual disturbances. Physical examination reveals a purplish discoloration of his face, arms, and neck; retinal vein engorgement; and visible distention of his neck veins. His complete blood count reveals a normocytic anemia. The pathophysiology of this patient’s clinical presentation most likely involves.

ARight heart failure secondary to left heart failure
BObstruction of the superior vena cava by a primary tumor arising in the lungs
CMetastatic disease to the cervical lymph nodes with compression of the jugular veins
DPolycythemia rubra vera
Unknown
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141687 Surgery

A 55-year-old man presents with left lower quadrant (LLQ) abdominal pain of 2-day duration, associated with constipation. On physical examination, he has tenderness localized to the LLQ with fullness in that area leukocyte count is 22,000 and temperature is 101.5degF. Which would be the best diagnostic study to evaluate this man?

ADiagnostic laparoscopy
BBarium enema
CPlain abdominal roentgenogram
DComputed tomography (CT) of the abdomen/pelvis with orally (PO) and intravenous (IV) contrast
Surgery
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