A 65-Year-Old Man Comes to the Emergency Department Because of Worsening

question 159

Multiple Choice

A 65-year-old man comes to the emergency department because of worsening generalized itching for 7 days.  He has experienced abdominal discomfort, bloating, and decreased appetite for several weeks.  He states that he has lost 10-12 lbs (4.5-5.4 kg) during this time, which he attributes to excessive stress at work.  He denies nausea, vomiting, diarrhea, easy bleeding, or bruising.
His temperature is 36.9 C (98.4 F) , blood pressure is 123/70 mm Hg, and pulse is 78/min and regular.  On examination, he has icteric conjunctivae and skin.  He has bilateral diffuse scratch marks.  There is mild tenderness on palpation of his right upper abdominal quadrant.  The tip of the spleen is not palpable.
Laboratory results are as follows:

Abdominal ultrasound reveals an enlarged liver with dilated intrahepatic bile ducts.  A CT scan of the abdomen reveals an ill-defined 3.5 cm pancreatic mass and several low-attenuating foci in the liver consistent with metastasis.
Which of the following would be the best next step in managing this patient?

• A)Biliary decompression surgery
• B)Combination chemotherapy
• C)Endoscopic stenting
• D)Narcotic pain medication
• E)Ursodeoxycholic acid

Understand the role of environmental and personal factors in personality development.

Comprehend the importance of self-concept and strategies for maintaining healthy psychological development.

Recognize the impact of life transitions on personal development and well-being.

Explain the significance of reproductive health knowledge in understanding developmental stages.