A 56-Year-Old Man Is Evaluated for Fever on Postoperative Day

question 419

Multiple Choice

A 56-year-old man is evaluated for fever on postoperative day 3.  He had undergone coronary artery bypass surgery for multivessel coronary artery disease, requiring 4 grafts.  The patient is still intubated and is receiving mechanical ventilation.  He has a history of type 2 diabetes mellitus, hypercholesterolemia, and hypertension.  Temperature is 38.9 C (102 F) , blood pressure is 130/80 mm Hg, and pulse is 90/min.  BMI is 28 kg/m².  Examination reveals coarse breath sounds bilaterally.  Heart sounds are normal.  The patient grimaces during palpation of the right upper quadrant.  Bowel sounds are decreased.  Laboratory results are as follows: Chest x-ray reveals postoperative changes but no new infiltrate.  Which of the following is the most likely diagnosis in this patient?

• A)Acalculous cholecystitis
• B)Acute cholangitis
• C)Acute pancreatitis
• D)Right lower lobe pneumonia
• E)Right-sided pyelonephritis
• F)Subphrenic abscess

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Definitions:

Joint Legal Custody

A legal arrangement where both parents share the responsibility and authority to make decisions concerning their child's upbringing.

Major Decisions

Significant rulings or conclusions made by an authoritative body or individual that have a considerable impact.

Inter Vivos Trust

A trust created by the grantor, settlor, and effective during the grantor’s lifetime – that is, a trust not established by a will.

Grantor

An individual or entity that creates a trust, transferring ownership of assets to the trust.