A 68-year-old male with PMH significant for chronic alcohol abuse presents with a history of confabulation, confusion, and loss of memory. On examination he is found to have nystagmus, ataxia, and slight bilateral ophthalmoplegia. Which of the following vitamin deficiencies is the most likely cause of this patient’s symptoms?

An 85-year-old nursing home resident is brought to the emergency department due to 2 days of worsening abdominal pain and distension. He has had multiple episodes of vomiting and has not passed stool for 3 days. The patient has a history of Parkinson’s disease, hypertension, and chronic constipation. He has had no prior abdominal surgery.  Match the patient case with the correct Abdominal x-ray image below.

A 74-year-old male with PMH significant for coronary artery bypass surgery (6 years ago), history of alcohol abuse and remote history of cigarette use.  Patient reports that he quit smoking approximately 50 years ago.  Patient presents to your office, complaining of abdominal and ankle swelling, decreased energy, and poor appetite for the past 2 months. He says that he was previously in excellent health and walked 3 miles per day. Now he is too weak and tired to even care for his own yard. The patient is a fragile-appearing elderly man with temporal wasting. There is no jugular venous distention (JVD). The lungs are clear to auscultation. The heart sounds are regular, with no murmurs or gallops. The abdomen is protuberant with bulging flanks. Shifting dullness is present. There is 2+ ankle edema bilaterally and scattered telangiectasias on skin exam. He has no asterixis. Paracentesis is performed and ascites fluid analysis reveals serum-ascites albumin gradient (SAAG) = 1.4. Which of the following statements about this patient’s SAAG result is correct?

A 30-year-old female patient presents with a complaint of rectal pain that has been going on for about a week. She says she has lost 4 pounds (2 kg) over the past four weeks, has a low-grade fever, and has noticed a foul discharge in her undergarments. She also complains of vague abdominal pain and anorexia. The patient has no significant PMH.  She has no allergies. She has never had surgery before. A physical exam reveals a visibly distressed female with tenderness in the anal area. Examination is performed under anesthesia and reveals multiple fistulous tracts just above the dentate line. She has frank pus extruding in the anal canal. Which of the following statements about this condition is true?

A 45-year-old male is admitted to the medical floor of a hospital with complaints of increasing jaundice, swollen legs, and episodes of disorientation for the last several weeks. His abdomen is distended, and he looks ill. According to the family, the patient has a long history of alcohol abuse and has recently been diagnosed with cirrhosis of liver. On examination, he has a temperature of 99˚, BP 100/72 mm Hg, HR 86/minute. Sclerae are icteric, and he has 2+ pitting pedal edema. Lungs are clear, and heart sounds are normal. Abdomen is distended with moderate ascites, caput medusae, and no tenderness. Liver and spleen are not palpable. He is awake but drowsy and oriented to person and place but not to time. He does have a fine tremor in his hands. Labs show WBC 8,000 platelets 100,000, Hgb 12, AST 76 U/L, ALT 56 U/L, AP 62 U/L, and ammonia is 124 mg/dL.  At this time, which of the following interventions is most important, to avoid full decompensation into hepatic encephalopathy?

The accompanying image is showing the pterygopalatine ganglion at the tip of the probe.  Which cranial nerve provides preganglionic parasympathetic fibers that will synapse in this ganglion?

A medical student on their pediatric clerkship arrives to clinic. Their first patient of the day is an exasperated mother bringing in her 2-year-old daughter for a yearly wellness check. After taking a thorough history, the third-year medical student notices that the child is still wearing pull-up diapers and asks the mother about toilet training. The mother says that she has tried to train her daughter, but that the child repeatedly poops her pants before reaching the bathroom. The third-year medical student recalls the physiological control mechanism of defecation and knows that the child needs to learn to voluntarily control which nerve and muscle?

All of the following statements are characteristics of parasympathetic efferent pathways EXCEPT:

The enteric nervous system in the gastrointestinal tract is responsible for all of the following, EXCEPT:

The accompanying image is showing the submandibular ganglion at the tip of the arrow.  Which cranial nerve provides preganglionic parasympathetic fibers that will synapse in this ganglion?