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* nbme 4 1 15
 #444917  
  zoh - 09/05/09 22:22
 
 
15. A 52-year-old man comes to the physician because he has had a 14-kg (30-lb] weight loss during the past 6 months. He has noticed oily. floating stools during the past 2
months. He received the diagnosis of acute pancreatitis 2 years ago and has had 1- to 3-hour episodes of severe abdominal pain since then. Current medications include
oxycodone. His mother has type 2 diabetes mellitus. and his father died of alcoholic cirrhosis. The patient has smoked one pack of cigarettes daily for 30 years. He has
alcoholism but has been abstinentforthe past 2 years. He is 1?3 cm (5 ft 8 in) tall and weighs 59 kg (130 lb): Blvll is 20 kg.••`m2. His pulse is 100.••`min. and blood pressure is
1201*80 mm Hg. The abdomen is scaphoid with mild diffuse tenderness. The liver edge is firm and is palpated 2 cm below the right costal margin. Laboratory studies show:
Hematocrit 32%
lvlean corpuscularvolume 83 pmg
Leukocyte count 10.300.••`mm3
Platelet count 302.000.••`mm3
Serum
Na+ 139 mEg.••`L
kt 3.5 mEg.••`L
Cl` 108 mEg.••`L
HCO3 19 mEg.••`L
Urea nitrogen 22 mg.••`dL
Glucose 104 mg.••`dL
Creatinine 1.1 mg.••`dL
Alkaline phosphatase 120 U.••`L
AST 23 U.••`L
ALT 29 U.••`L
Amylase 90 U.••`L
Ferritin 250 ng.••`mL
Lipase 43 U.••`L (N:14—280]
Which ofthe following is the most appropriate next step in management?

O A) Dietary supplementation with a multivitamin with iron
O B) Gluten-free diet
O C) Insulin therapy
O D) Pancreatic enzyme replacement therapy
O E) Parenteral nutrition

 
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* Re:nbme 4 1 15
#1869614
  mhrazu - 09/05/09 22:28
 
  DDDDDDDDDDD  
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* Re:nbme 4 1 15
#1869615
  xvv78 - 09/05/09 22:28
 
  DDDDDDDDDDDD  
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* Re:nbme 4 1 15
#2433536
  carnation10 - 07/19/11 18:02
 
  How to rule out C ? Can any one explain ? Thanks  
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