A 68-year-old man with a history of obesity comes to the emergency department with severe abdominal and chest pain, vomiting, and signs of shock. Imaging shows the entire stomach has migrated into the chest with parts of the omentum. Which type of paraesophageal hernia does this patient most likely have?

A 55-year-old woman presents with symptoms of reflux, epigastric discomfort, and intermittent dysphagia. Imaging reveals that the gastroesophageal junction has moved above the diaphragm along with a portion of the stomach. Which type of hiatal hernia does this patient most likely have?

Proton Pump Inhibitors and Infection Risk A 65-year-old male with a history of GERD has been taking a proton pump inhibitor (PPI) daily for the past two years. He presents with a 3-day history of diarrhea, abdominal cramps, and fever after eating at a local restaurant. Stool cultures reveal Salmonella infection. Which of the following mechanisms best explains this patient’s increased susceptibility to the infection?

A 25-year-old male presents to the emergency department after falling on an outstretched hand while skateboarding. He reports pain and swelling in the wrist, particularly over the radial side. Physical examination reveals tenderness in the anatomical snuffbox. Initial X-rays are unremarkable. Which of the following is the most concerning complication of this patient’s injury?

A 62-year-old female with a 10-year history of gout presents with hard, painless nodules on her fingers and elbows. She reports occasional joint stiffness but no acute pain currently. Imaging reveals joint erosions near the nodules. What is the most likely composition of the nodules (tophi) observed in this patient with chronic gout?

A 70-year-old male with a long-standing history of untreated gout presents with firm, nodular deposits on his elbows, fingers, and ears. He also reports chronic joint pain and stiffness. X-ray of the affected joints shows erosions with overhanging edges. Which of the following best describes the pathogenesis of tophi formation and joint destruction in chronic gout?

Patient Case: A 48-year-old male with an acute gout flare in his right ankle is started on treatment. His symptoms resolve within 12 days without further intervention. Laboratory tests during the flare showed elevated interleukin-1 beta (IL-1β) levels. Question: Which mechanism most likely contributed to the spontaneous resolution of this patient’s acute gout flare?

A 62-year-old male with poorly controlled diabetes and a history of recurrent gout attacks presents with a self-resolving episode of joint pain in his left knee. He reports that his symptoms usually improve in 10–14 days without medication. Laboratory tests show hyperuricemia, but synovial fluid analysis is negative for bacterial infection. Which of the following mechanisms contributes to the spontaneous resolution of gout flares?

A 55-year-old male presents to the emergency department with severe pain, redness, and swelling in his right big toe that started suddenly overnight. He has a history of hypertension and admits to consuming alcohol frequently. His serum uric acid level is 9.2 mg/dL (normal range: 3.4–7.0 mg/dL). What is the primary mechanism by which monosodium urate (MSU) crystals initiate inflammation in this patient’s acute gout flare?

A 55-year-old male with a history of hypertension, obesity, and chronic kidney disease presents with sudden-onset severe pain, redness, and swelling in his right first metatarsophalangeal (MTP) joint. He states that the pain started overnight and is excruciating. Joint aspiration reveals negatively birefringent needle-shaped crystals under polarized light microscopy. Which of the following is the primary inflammatory mediator responsible for the acute gout flare in this patient?