1. Mr. John Smith, a 71-year-old man with sudden onset of severe abdominal and back pain is brought to the emergency department for evaluation. He has a history of hypertension. He weighs 300 lb. He has a 45-pack-a-year history of smoking. Physical examination reveals a pulsatile abdominal mass. Both lower extremities reveal pallor with diminished pedal pulses. What is the most likely cause of this patient’s condition?
a. Atherosclerosis
b. Marfan syndrome
c. Meningococcal infection
d. Syphilis
e. Trauma
2. Mr. Robert Johnson, a 78-year-old man is brought to the emergency department with a 12-hour history of abdominal pain, diarrhoea, and vomiting. He has a history of atrial fibrillation and was previously treated for congestive heart failure with digoxin. Physical examination reveals a distended abdomen with significant guarding. Rectal examination reveals guaiac positive stool in the vault. White blood cell count is 24,000/mL. Abdominal x-ray reveals edema of the bowel wall. What is the most appropriate treatment for this patient?
a. Angiographic embolization
b. Antibiotic therapy with ampicillin and gentamicin
c. Antibiotic therapy with gentamicin
d. Heparinization followed by oral warfarin
e. Surgical exploration
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