An 82-year-old woman is sent to the hospital from a nursing home after 2 days of fever, confusion, and lethargy.  The patient has a history of mild dementia, hypertension, and osteoarthritis.  Her temperature is 38.8 C (102 F), blood pressure is 90/60 mm Hg, and pulse is 116/min.  She has mild suprapubic and right costovertebral angle tenderness.  Her leukocyte count is 18,000/mm3, and urinalysis is consistent with acute cystitis.  A femoral venous access is planned for administration of intravenous fluids and antibiotics.  The femoral artery pulsation is palpable immediately below the inguinal ligament.  Which of the following describes the optimal cannulation site for the femoral vein?

A 65-year-old woman comes to the emergency department with progressive fatigue and lower-extremity paresthesias.  Medical history is otherwise insignificant and the patient takes no medications.  Laboratory studies show a mean corpuscular volume of 112 fL.  Upper gastrointestinal endoscopy shows atrophic mucosa in the gastric body and fundus and a normal-appearing antrum.  Destruction of which of the following gastric layers is most likely responsible for this patient’s symptoms?

A 54-year-old man comes to the office due to several months of heartburn, acid regurgitation, and dysphagia.  He has taken antacids and over-the-counter medications without relief.  Medical history includes hypertension and hyperlipidemia.  The patient does not use tobacco, alcohol, or illicit drugs.  Vital signs are within normal limits.  BMI is 32 kg/m2.  Physical examination is unremarkable.  Upright chest x-ray shows an opacity with an air-fluid level behind the heart.  A subsequent barium swallow reveals the proximal stomach herniating through the esophageal hiatus.  Which of the following pathophysiological changes most likely contributed to this patient’s current condition?

A 53-year-old man is hospitalized due to chest pain and palpitations.  Cardiac catheterization is planned to evaluate for coronary artery disease.  The femoral artery is palpated in the right groin, and a catheter is introduced into the common femoral artery.  The associated vasculature is visualized after injecting a contrast agent into the catheter.

Which of the following is most likely the artery indicated by the arrow in the image above?

A 63-year-old man comes to the emergency department due to pain and swelling of the right calf.  He has a history of recurrent gastrointestinal hemorrhage and was discharged from the hospital 4 days ago following a prolonged admission for diverticular bleeding requiring multiple blood transfusions.  Temperature is 36.7 C (98 F), blood pressure is 110/60 mm Hg, pulse is 92/min, and respirations are 18/min.  Compression ultrasonography with Doppler reveals deep venous thrombosis in the right popliteal vein.  A filter placement is planned to prevent embolization.  A section of the patient’s abdominal CT at the level of L2 is shown in the image below.  The filter will most likely be placed in which of the following structures?

A 52-year-old man is being evaluated for nonspecific, chronic abdominal pain.  As part of the workup, he undergoes an abdominal CT scan with intravenous contrast, which reveals no significant findings.  An axial image from the scan is shown below.

Which of the following statements best describes the structure indicated by the arrow?

A 47-year-old morbidly obese woman comes to the physician seeking advice regarding weight loss.  She has tried diet and exercise a number of times without success.  Her other medical problems include type 2 diabetes mellitus and obstructive sleep apnea.  Her body mass index is 43 kg/m2.  After a discussion about available surgical options, she expresses interest in the adjustable gastric band, an inflatable silicone device that is placed around the cardiac part of the stomach.  In order to encircle the stomach, the band must pass through which of the following structures?

A 23-year-old man comes to the office with a 2-week history of malaise, loss of appetite, and vague abdominal pain.  The patient has had no nausea, vomiting, changes in bowel habits, dysuria, urinary frequency, or hematuria.  He had an appendectomy for acute appendicitis at age 15; medical history is otherwise unremarkable.  The patient does not use tobacco or alcohol and has had no recent travel.  Physical examination reveals normal bowel sounds and no guarding or rebound tenderness.  Abdominal CT scan obtained as part of this patient’s evaluation is shown in the image below:

The structure indicated by the arrow originates from the same embryologic germ layer as which of the following tissues?

A 35-year-old man comes to the emergency department due to persistent abdominal pain.  Yesterday, during a soccer game, he collided with another player while running at full speed.  The patient had abdominal pain at the time but did not seek care until this morning when the pain seemed to worsen.  It is suspected that he has an injury involving an organ that is supplied by an artery of the foregut although the organ itself is not a foregut derivative.  Which of the following organs is most likely to be injured in this patient?

A 53-year-old man who has not seen a physician in years presents to your office complaining of abdominal distention.  He states “Last month my stomach started to swell up and it hasn’t gotten any better”.  He has no other medical problems.  The patient admits to drinking 10-12 beers a day for the last 20 years.  His temperature is 36.7 C (98 F), blood pressure is 116/72 mm Hg, pulse is 78/min and respirations are 20/min.  On examination his abdomen is distended with engorged paraumbilical veins.  There is also palmar erythema and multiple spider angiomas are present.  You decided to place him on a low-salt diet and start therapy with furosemide and spironolactone, with subsequent improvement of his abdominal distention.  Before beginning this patient’s treatment, which of the following structures labeled on the image below is expected to have an increased pressure?

A 48-year-old man is evaluated for abdominal pain and diarrhea.  The patient characterizes his stool as voluminous and foul smelling.  He has no significant past medical history.  The patient drinks 6 cans of beer daily.  On examination, he has normal bowel sounds and mild epigastric tenderness.  A 72-hour stool collection shows excessive excretion of fecal fat.  A CT scan of the abdomen is shown in the image below.  Involvement of which of the following structures is most likely causing this patient’s symptoms?

A 32-year-old male presents to the ER with sudden-onset heart palpitations.  His blood pressure is 100/70 mmHg, and his heart rate is 160/min with regular rhythm.  The physician instructs the patient to do the “Valsalva maneuver” to relieve these symptoms.  Which of the following structures indicated on the pelvic CT image below is most important in performing the Valsalva maneuver?

A 67-year-old man comes to the emergency department due to progressive fever and lethargy.  The patient has also had severe right shoulder and abdominal pain, nausea, and vomiting for the past 2 days.  He had an appendectomy during childhood and a pacemaker placed 10 years ago for symptomatic sinus bradycardia.  He has no other medical problems and takes no medications.  The patient does not use tobacco but drinks an occasional beer.  Temperature is 38.4 C (101.1 F), blood pressure is 80/50 mm Hg, and pulse is 120/min and regular.  Abdominal examination shows generalized tenderness with rebound tenderness.  Right shoulder examination is normal.  Upright chest x-ray is shown below.

Which of the following is the most likely cause of this patient’s condition?