gi mcq im3
7. A patient present to your clinic with radiating abdominal pain somewhat localized to the RLQ. You palpate to check for any abnormalities and discover the patient has no pain while flexing their thigh ar rotating the leg internally at the hip. You deduce that the patient has a negative: A. Rovsing's sign B Obturator sign C. Psoas sign D. Murphy's sign
b. obturator sign
12. Hepatitis serologies reveal the following: - HBsAg, - HBeAg, - IgG-HBsAg, + IgM -HbcAg. Which of the following is the most likely diagnosis? A. Acute hepatitis A Infection B. Hepatitis B infection: patient is cured C. Acute hepatitis C Infection D. Hepatitis B infection: window period E. Drug-induced hepatitis F Hepatitis B infection: patient has been vaccinated
D. Hepatitis B infection: window period
11. A 32-year-old woman presents with 3-day history of colicky abdominal pain and fatigue. Laboratory values are as follows: hemoglobin 7.9 g/dL, Hct 22%, MCV 78, platelets 60,000 × 103 /μL, reticulocyte count 9%, direct and indirect Coombs negative, ferritin 10. Abdominal ultrasound scan shows portal vein thrombosis. Urinalysis shows hemosiderin. The most likely diagnosis is: A. Factor V Leiden mutation B. Paroxysmal cold hemoglobinuria C. Warm autoimmune hemolytic anemia D. Paroxysmal nocturnal hemoglobinuria E. Iron deficiency anemia
D. Paroxysmal nocturnal hemoglobinuria
21.A 35-year-old man presents to your clinic with ulcerative colitis. Choose the cause that is probably responsible for the patient's presentation. A. Wilson disease B. Hemochromatosis C. Primary biliary cirrhosis D. Primary Sclerosing cholangitis E. Autoimmune hepatitis F. Alcohol-induced hepatitis G. Viral hepatitis
D. Primary Sclerosing cholangitis
4. The gold standart test for making diagnosis achalasia is? a,Endoscopy B. Contrast esophagogram C. Manometry D. 24-hour pH-monitoring E. Endoscopic US
C. Manometry
9. Nowadays assessment of esophageal function and structure includes such examinations: 1. Contrast esophagogram; 2. Endoscopy; 3. Manometry; 4. Irrigography; 5. Aortography a. 1,2,5 C. 1,3,4 D. 2,4,5 E. 1,2,4 b, 1.2.3
b, 1.2.3
6. A patient present to your clinic with radiating abdominal pain. You notice that the patient has a bluish periumbilical discoloration on their abdomen. Your initial assessment is that the patient may have : A. Acute appendicitis B, Acute cholecystitis C. Acute pancreatitis D. Acute hepatitis
C. Acute pancreatitis
15. Esophageal manifestations of GERD includes: 1. Heartburn; 2. Chest pain; 3. Dysphagia; 4. Weight loss, 5. Bronchospasm. A. 1,2,3 B.1,3,4 C. 1,2,5 D. 2,4,5 E. 3,4,5
A. 1,2,3
36. Which of the following viral causes of acute hepatitis is most likely to cause fulminant hepatitis in a pregnant woman? A. Hepatitis A B. Hepatitis B C. Hepatitis CD. Hepatitis D E. Hepatitis E
Answer: E
7. A 46-year-old man comes to the physician because of intermittent lower abdominal pain over the past 3 months. There is no family history of cancer. Examination shows no other abnormalities. His hematocrit is 38%. Test of the stool for occult blood is positive. Colon contrast studies show a 1.5-cm. polyp in the descending colon. An upper gastrointestinal series shows no abnormalities. Which of the following is the most appropriate next step in management? (A) CT scan of abdomen (B) Repeat test of the stool for occult blood after 3 days on a meat-free diet (C) Measurement of serum carcinoembryonic antigen (CEA) concentration (D) Colonoscopy with polypectomy (E) Total colectomy
(D) Colonoscopy with polypectomy
15. Hepatitis serology reveal the following: - HBsAg,-HBeAg, + IgG-HBsAg, - IgM or IgG-HBcAg. Which of F
. Hepatitis B infection: patient has been vaccinated
6. A 53-year-old moderately obese woman presents with heartburn aggravated mainly by eating and lying down in the horizontal position. Her symptoms are suggestive of gastroesophageal reflux disease (GERD). Which of the following statements is TRUE? A. It is best diagnosed by an anteroposterior (AP) and lateral film of the chest B. It may be alleviated by certain drugs, especially theophylline, diazepam, and calcium channel blockers C. It is not relieved by cessation of smoking D. If it is associated with dysphagia, it suggest a stricture or motility disorder . E It should be immediately treated with surgery
. If it is associated with dysphagia, it suggest a stricture or motility disorder
15.A 58-year-old man presents to the emergency room with a temperature of 102°F, abdominal pain localizing to the left lower quadrant, and mild rebound tenderness. Which of the following diagnostic tests is the best next step? A. Barium enema B. Lower endoscopy C. CT imaging of the abdomen D. Laparoscopic examination
Answer: C
5. A patient present to your clinic with radiating abdominal pain. You palpate to check for any abnormalities and discover the patient has a positive Rovsing's sign and involuntarily guards their abdomen when palpating the RLQ. Your initial thought is that the patient has A. Pancreatitis B. Hepatitis C. Appendicitis D. Cholecystitis
C. Appendicitis
8. Name the most common condition/disease of esophagus: Achalasia B. Diverticulum C. Foreign bodies D. Mallory-Weiss syndrome E. Tumors
?
3. Which of the following patients requires no further testing before making the diagnosis of irritable bowel syndrome and initiating treatment? A. A 76-year-old woman with 6 months of intermittent crampy abdominal pain that is worse with stress and associated with bloating and diarrhea. B. A 25- year-old woman with 6 months of abdominal pain, bloating, and diarrhea that has worsened steadily and now awakes her from sleep at night to move her bowels C. A 30-year-old man with 6 months of lower abdominal crampy pain relieved with bowel movements, usually loose. Symptoms are worse during the daytime at work and better on the weekend. Weight loss is not present. D. A 19-year-old female college student with 2 months of diarrhea and worsening abdominal pain with occasional blood in her stool. E. A 27-year-old woman with 6 months of intermittent abdominal pain, bloating, and diarrhea without associated weight loss. Cra
A 30-year-old man with 6 months of lower abdominal crampy pain relieved with bowel movements, usually loose. Symptoms are worse during the daytime at work and better on the weekend. Weight loss is not present.
17. The most common cause of esophageal injury or perforation is A Instrumental procedures B. Penetrating chest trauma, especially height fall C. Chest tube placement for tension pneumothorax D. Caustic poisoning E. Foreign body ingestion
A Instrumental procedures
Which one of the following patients should be promptly referred for endoscopy? A. A 65-year-old man with new onset of epigastric pain and weight loss B. A 32-year-old patient whose symptoms are not relieved with ranitidine C. A 29-year-old H. pylori-positive patient with dyspeptic symptoms D. A 49-year-old woman with intermittent right upper quadrant pain following meals
A. A 65-year-old man with new onset of epigastric pain and weight loss
19.A 15-year-old adolescent female has elevated liver enzymes and a positive antinuclear antibody (ANA). Choose the one cause (A-G) that is probably responsible for the patient's presentation. A. Autoimmune hepatitis B. Hemochromatosis C. Primary biliary cirrhosis D. Sclerosing cholangitis E. Wilson disease F. Alcohol-induced hepatitis G. Viral hepatitis
A. Autoimmune hepatitis
10. A 38-year-old man develops increasing dysphagia for solid food over many months. What is the most likely cause of his clinical presentation? A. Carcinoma of the esophagus B. Achalasia C. Sliding hiatal hernia D. Paraesophageal hernia E. Esophageal diverticulum
A. Carcinoma of the esophagus
9. A 32-year-old woman has a history of chronic diarrhea and gallstones and now has rectovaginal fistula. Which of the following is the most likely diagnosis? A. Crohn disease B. Ulcerative colitis C. Systemic lupus erythematosus D. Laxative abuse
A. Crohn disease
23. A 54-year-old African man undergoes EGD for evaluation of dyspepsia. Diffuse antral gastropathy is noted, and chronic H. pylori infection is suspected. Which of the following is a potential sequela of chronic gastric H. pylori infection? A. Gastric cancer B. Eosinophilic gastroenteritis C. GI stromal tumor (GIST) D. Duodenal adenocarcinoma E. Carcinoid tumors of the small intestine
A. Gastric cancer ?
17.A 48-year-old man with a long history of GERD undergoes an upper endoscopy that reveals several 2- to 3-cm salmon-colored mucosa extending proximally from the gastroesophageal junction. Biopsies reveal Barrett esophagus. No dysplasia is noted. What is the appropriate surveillance recommendation? A. Biopsy of the Barrett segment every 3 to 6 months B. Biopsy of the Barrett segment annually C. Biopsy of the Barrett segment every 3 to 5 years D. Biopsy of the Barrett segment every 10 years E. No further surveillance is necessary
Answer: C
6. A 44-year-old woman complains of 6 months of epigastric pain that is worst between meals. She also reports symptoms of heartburn. The pain is typically relieved by over-the-counter antacid medications. She comes to the clinic after noting her stools darkening. She has no significant past medical history and takes no medications. Her physical examination is normal except for diffuse midepigastric pain. Her stools are heme positive. She undergoes EGD, which demonstrates a well-circumscribed 2-cm duodenal ulcer that is positive for H. pylori. Which of the following is recommended initial therapy given these findings? A. Lansoprazole plus clarithromycin plus amoxicillin for 14 days B. Pantoprazole plus amoxicillin for 21 days C. Pantoprazole plus clarithromycin for 14 days D. Omeprazole plus bismuth plus tetracycline plus metronidazole for 14 days E. Omeprazole plus metronidazole plus clarithromycin for 7 days
A. Lansoprazole plus clarithromycin plus amoxicillin for 14 days
20. 63-year-old M PMH of DM, HTN, HLD with recent CVA presents to clinic for hospital follow up. He denies any significant complaints and would like his medications refilled. However, on Review of Systems he notes mild difficulty with swallowing. You investigate further and he says that initiation is often difficult with intermittent episodes of nasal regurgitation. He points to his middle cervical neck for the location of where the food feels like it is sticking. He denies any issues with liquids. What is the next best step? A. Modified barium swallow B. Barium swallow C. EGD D.Esophageal manometry
A. Modified barium swallow
18.A 46-year-old man presents with a complaint of intermittent dysphagia for 10 years. He reports that food "sticks in my chest" approximately 1 or 2 times per month and that he needs to either wash down the bolus with water or regurgitate it. He has symptoms only with solid foods, primarily meat, rice, and bread. He has never had difficulty swallowing liquids. He has had no symptoms of odynophagia and has not experienced weight loss. What is the most likely cause of his symptoms? A. Schatzki ring B. Esophageal cancer C. Achalasia D. Diffuse esophageal spasms E. Peptic stricture of the esophagus
A. Schatzki ring
13. A 38-year-old male lawyer develops abdominal pain after having a fatty meal. Examination reveals tenderness in the right hypochondrium and a positive Murphy's sign. Which test is most likely to reveal acute cholecystitis? A. US of the abdomen B. Oral cholecystogram C. Intravenous cholangiogram D. Abdominal x-ray E. ERCP
A. US of the abdomen
22. A 32-year-old man presents to your clinic with Kayser-Fleischer rings, dysarthria, and spasticity. Pick the cause from the following that is probably responsible for the patient's presentation. A. Wilson disease B. Hemochromatosis C. Primary biliary cirrhosis D. Sclerosing cholangitis E. Autoimmune hepatitis F. Alcohol-induced hepatitis G. Viral hepatitis
A. Wilson disease
11. A 25-year-old man is hospitalized for ulcerative colitis. He has now developed abdominal distention, fever, and transverse colonic dilation of 7 cm on X-ray. Which of the following is the best next step? A. 5-ASA B. Steroids C. Antibiotics and prompt surgical consultation D. Infliximab
Answer c
27. Over a 2 months period a 50-year-old woman with a history of polycythemia vera develops abdominal pain and gross ascites. Physical examination demonstrates smooth hepatomegaly and mild jaundice. Pressure applied over the liver fails to distend the jugular veins. The abdomen is grossly edematous and the abdomen shows a tortuous venous pattern. Edema of the legs is prominent. Which of the following is the most likely diagnosis? A. Budd- Chiari syndrome B. Liver cirrhosis C. Hepatocellular carcinoma D. Primary sclerosing cholangitis
Answer: A
3. A 45-year-old man was brought to the emergency room after vomiting bright red blood. He has a blood pressure of 88/46 mm Hg and heart rate of 120 bpm. Which of the following is the best next step? A. Intravenous fluid resuscitation and preparation for a transfusion B. Administration of a proton pump inhibitor C. Guaiac test of the stool D. Treatment for H. pylori
Answer: A
30. Patient with 10-year history of hepatitis C is admitted to emergency department with massive GI bleeding. Within admission there were signs of rebleeding, but patient complains on severe weakness and dizziness. What complications can develop in this case? A. Hepatic encephalopathy B. Bronchial aspiration C. Renal failure D. Portal vein thrombosis E. Acute liver necrosis.
Answer: A
35. A 32-year-old woman is evaluated in the emergency department for abdominal pain. She reports a vague loss of appetite for the past day and has had progressively severe abdominal pain, initially at her umbilicus, but now localized to her right lower quadrant. The pain is crampy. She has not moved her bowels or vomited. She reports that she is otherwise healthy and has had no sick contact. Exam is notable for a temperature of 100.7°F, heart rate of 105 beats/min, and otherwise normal vital signs. Her abdomen is tender in the right lower quadrant and pelvic examination is normal. Urine pregnancy test is negative. Which of the following imaging modalities is most likely to confirm her diagnosis? A. CT of the abdomen without contrast B. Colonoscopy C. Pelvic ultrasound D. Plain film of the abdomen E. Ultrasound of the abdomen
Answer: A
37. A 58-year-old man with severe alcoholism is admitted to the hospital with acute pancreatitis. His symptoms have been present for 3 days and he has continued to drink heavily. He now has persistent vomiting and feels dizzy upon standing. On examination he has severe epigastric and right upper quadrant tenderness and decreased bowel sounds, and appears uncomfortable. A faint blue discoloration is present around the umbilicus. What is the significance of this finding? A. A CT of the abdomen is likely to show severe necrotizing pancreatitis. B. Abdominal plain film is likely to show pancreatic calcification. C. Concomitant appendicitis should be ruled out. D. He likely has a pancreatico-aortic fistula. E. Pancreatic pseudocyst is likely present.
Answer: A
38. A 12-year-old boy complains of pain in the lower abdomen (mainly on the right side). Symptoms commenced 12 hours before admission. He had noted anorexia during this period. Examination revealed tenderness in the right iliac fossa, which was maximal 1 cm below McBurney's point. In appendicitis, where does the pain frequently commence? A. In the umbilical region and then moves to the right iliac fossa B. In the back and moves to the right iliac fossa C. In the rectal region and moves to the right iliac fossa D. In the right iliac fossa and remains there E. In the right flank
Answer: A
40. A 28-year-old man is admitted to the emergency department complaining of pain in the umbilical region that moves to the right iliac fossa. Which is a corroborative sign of acute appendicitis? A. Referred pain in the right side with pressure on the left side B. Increase of pain with testicular elevation C. Relief of pain in lower abdomen with extension of thigh D. Relief of pain in lower abdomen with internal rotation of right thigh E. Hyperesthesia in the right lower abdomen
Answer: A
12.A 35-year-old woman has chronic crampy abdominal pain and intermittent constipation and diarrhea, but no weight loss or gastrointestinal bleeding. Her abdominal pain is usually relieved with defection. Colonoscopy and upper endoscopy with biopsies are normal, and stool cultures are negative. Which of the following is the most likely diagnosis? A. Infectious colitis B. Irritable bowel syndrome C. Crohn disease D. Ulcerative colitis
Answer: B
4. A 62-year-old woman complains of diarrhea, weight loss and abdominal pain with malaise and fever. She has oral ulcers, red itchy eyes and tender nodules on her shins. She has tenderness in the right iliac fossa and a vague right iliac fossa mass. What is the most likely diagnosis? A. Crohn's disease B. Ileocecal tuberculosis C. Ulcerative colitis D. Appendicular abscess E. Ovarian mass
B. Ileocecal tuberculosis ?
13.A 48-year-old woman is admitted to the hospital with left lower quadrant abdominal pain, leukocytosis, and a CT showing sigmoid wall thickening consistent with diverticulitis. Her only significant medical history is a similar hospitalization with the same diagnosis less than a year previously. Which of the following is the most appropriate treatment? A. Urgent surgical consultation for exploratory laparotomy and sigmoid resection. B. Intravenous antibiotics with follow-up colonoscopy after hospital discharge, and surgical consultation for elective sigmoidectomy. C. Intravenous antibiotics and barium enema to evaluate for possible colonic malignancy. D. Intravenous antibiotics and recommendations for post discharge diet high in fiber with whole grains and nuts to minimize the risk of diverticular progression.
Answer: B
16.A 67-year-old woman complains of dysphagia initially to solids, which has progressed over 3 months to both solids and liquids. She has no history of prior gastroesophageal reflux, and her only other medical problem is hypertension. Her only current medication is lisinopril. Her physical examination and routine blood tests are unremarkable. She undergoes a barium swallow, which shows a dilated esophagus with a bird's beak appearance of the gastroesophageal junction. The patient should next: A. Be referred to a surgeon B. Undergo an upper endoscopy examination C. Be started on a calcium channel blocker D. Have an esophageal manometry examination E. Have a CT of the chest and abdomen
Answer: B
18.A 58-year-old woman presents with a 5-year history of progressive dysphagia for liquids and solids. She describes occasional nocturnal regurgitation of food. An upper gastrointestinal series reveals a dilated esophagus with beak-like narrowing at the level of the gastroesophageal junction. An upper endoscopy reveals no masses. Esophageal manometry is notable for high normal basal LES pressure, failure of the LES to relax with swallows, and esophageal body aperistalsis. Appropriate management of her disease would include any of the following except: A. Pneumatic dilation B. Surgical resection of the distal esophagus C. Peroral endoscopic myotomy D. Botulinum toxin injection
Answer: B
23. Hepatitis serologies reveal the following: - HBsAg - HBeAg + IgG-HBsAg + IgM or IgG-HBcAg Which of the following is the most likely diagnosis? A. Acute hepatitis A infection B. Hepatitis B infection: patient is cured C. Acute hepatitis C infection D. Hepatitis B infection: window period E. Drug-induced hepatitis F. Hepatitis B infection: patient has been vaccinated
Answer: B
28. A 28-year-old mane comes to the ED complaining of abdominal pain. He has no significant past medical history, has had no recurrent illnesses and denies any alcohol or drug abuse. He reports that three days ago, he developed acute pain in his right upper quadrant. The pain was radiating and was associated with nausea and two episodes of nonbloody, nonbilious emesis. He also reports that two days ago, he began to turn "yellow", On examination, he is afebrile and has scleral icterus with mild jaundice, of his skin. His right upper quadrants is tender, with no palpable gallbladder and no Murphy's sign. Determination of which of the following is the most appropriate next step in diagnosis? A. Serum hepatitis An IgG titer B. Serum hepatitis An IgM titer C. Serum hepatitis B surface antibody titer D. Serum hepatitis C antibody e. Serum hepatitis C RNA level
Answer: B
33. Which of the following has a well-established association with gastroesophageal reflux? A. Chronic sinusitis B. Dental erosion C. Pulmonary fibrosis D. Recurrent aspiration pneumonia E. Sleep apnea
Answer: B
34. All of the following are direct complications of short bowel syndrome EXCEPT: A. Cholesterol gallstones B. Coronary artery disease C. Gastric acid hypersecretion D. Renal calcium oxalate calculi E. Steatorrhea
Answer: B
A 42-year-old overweight but otherwise healthy woman presents with sudden onset of right upper abdominal colicky pain 45 minutes after a meal of fried chicken. The pain is associated with nausea and vomiting, and any attempt to eat since has caused increased pain. Which of the following is the most likely cause? A. Gastric ulcer B. Cholelithiasis C. Duodenal ulcer D. Acute hepatitis
Answer: B
25. You are asked to consult on a 62-year-old white female with pruritus for 4 months. She has noted progressive fatigue and a 5-lb weight loss. She has intermittent nausea but no vomiting and denies changes in her bowel habits. There is no history of prior alcohol use, blood transfusions, or illicit drug use. The patient is widowed and had two heterosexual partners in her lifetime. Her past medical history is significant only for hypothyroidism, for which she takes levothyroxine. Her family history is unremarkable. On examination she is mildly icteric. She has spider angiomata on her torso. You palpate a nodular liver edge 2 cm below the right costal margin. The remainder of the examination is unremarkable. A right upper quadrant ultrasound confirms your suspicion of cirrhosis. You order a complete blood count and a comprehensive metabolic panel. What is the most appropriate next test? a.24-hour urine copper b.Antim
Answer: B no prior risk factors for viral or alcoholic cirrhosis should raise the possibility of primary biliary cirrhosis (PBC)
39. A 29-year-old woman presents to her physician's office with pain in the right iliac fossa. Examination reveals tenderness in this region. Her last menstrual cycle was 2 weeks previously. CBC: leukocyte count -7,2x109 /1, RBC-2,9x1012/1, Hb- 105 g/l. Make the diagnosis. A. Acute superficial appendicitis B. Ovarian apoplexy C. Renal colic D. Acute destructive appendicitis E. Acute pancreatitis
Answer: B (ovarian plexy - middle or second half of the menstrual cycle, decrease in hemoglobin levels, ultrasound- affected ovary- a large corpus luteum cyst with signs of hemorrhage in it and/or free fluid (blood) in the abdominal cavity.
10.A 45-year-old man with a history of ulcerative colitis is admitted to the hospital with 2 to 3 weeks of RUQ abdominal pain, jaundice, and pruritus. He has no fever and a normal WBC count. Endoscopic retrograde cholangiopancreatography (ERCP) shows multifocal strictures of the both intrahepatic and extrahepatic bile ducts with intervening segments of normal and dilated ducts. Which of the following is the most likely diagnosis? A. Acute suppurative cholangitis B. Cholangiocarcinoma C. Primary sclerosing cholangitis D. Choledocholithiasis with resultant biliary strictures
Answer: C
14.A 78-year-old is noted to have fever and chills, decreased mentation, tachycardia, and right lower quadrant abdominal tenderness and guarding. Which of the following is the most likely diagnosis? A. Ruptured diverticulitis B. Meningitis C. Ruptured appendicitis D. Ischemic bowel E. Urosepsis
Answer: C
22. A 42-year-old accountant presents with recurrent RUQ pain of 3-year duration. He had undergone a laparoscopic cholecystectomy 2-years ago for presumed symptomatic cholelithiasis, but the pain persisted. An upper GI endoscopy is normal. A sonogram and CT scan of the abdomen are normal. An ERCP is performed, and the pressure in the CBD is 45-cm saline (normal bile duct pressure is 10-18- cm saline). What is the most likely diagnosis? A. Acalculous cholecystitis B. Emphysematous cholecystitis C. Biliary dyskinesia D. Cancer of the gallbladder E. Myasthenia gravis
Answer: C
24. A 26-year-old woman presents to your clinic and is interested in getting pregnant. She seeks your advice regarding vaccines she should obtain, and in particular asks about the hepatitis B vaccine. She works as a receptionist for a local business, denies alcohol or illicit drug use, and is in a monogamous relationship. Which of the following is true regarding hepatitis B vaccination? A. Hepatitis B vaccine consists of two IM doses 1 month apart. B. Only patients with defined risk factors need to be vaccinated. C. Pregnancy is not a contraindication to the hepatitis B vaccine. D. This patient's hepatitis serologies should be checked before vaccination. E. Vaccination should not be administered to children under 2 years old
Answer: C
5. A 38-year-old male is seen in the urgent care center with several hours of severe abdominal pain. His symptoms began suddenly, but he reports several months of pain in the epigastrium after eating, with a resultant 10- lb weight loss. He takes no medications besides overthe-counter antacids and has no other medical problems or habits. On physical examination temperature is 38.0°C (100.4°F), pulse 130 beats/min, respiratory rate 24 breaths/min, and blood pressure 110/50 mmHg. His abdomen has absent bowel sounds and is rigid with involuntary guarding diffusely. A plain film of the abdomen is obtained and shows free air under the diaphragm. Which of the following is most likely to be found in the operating room? A. Necrotic bowel B. Necrotic pancreas C. Perforated ulcer D. Perforated gallbladder
Answer: C
6. A 43-year-old man who is an alcoholic is admitted to the hospital with acute pancreatitis. He is given intravenous hydration and is placed NPO. Which of the following findings is a poor prognostic sign? A. His age B. Initial serum glucose level of 60 mg/dL C. Blood urea nitrogen (BUN) level rises 7 mg/dL over 48 hours D. Hematocrit drops 3% E. Amylase level of 1000 IU/L
Answer: C
21. Hepatitis serologies reveal the following: - HBsAg - HBeAg - IgG-HBsAg + IgM -HBcAg Which of the following is the most likely diagnosis? A. Acute hepatitis A infection B. Hepatitis B infection: patient is cured C. Acute hepatitis C infection D. Hepatitis B infection: window period E. Drug-induced hepatitis F. Hepatitis B infection: patient has been vaccinated
Answer: D
26. A 46-year-old female presents to the clinic complaining of mild abdominal pain and "fullness". She says that this has persisted for the last three weeks and has gradually worsened. She is otherwise in good health besides a diagnosis of Sjogren's disease which is effectively treated with artificial tear. She drinks 2 glasses of wine per night. On physical examination, you note a distended abdomen with a positive fluid wave and visible superficial veins. There is also some mild peripheral edema. Which of the following is most likely diagnosis of this patient? A. Hepatitis A B. Alcoholic cirrhosis C. Primary sclerosing cholangitis D. Primary biliary cirrhosis
Answer: D
8. A 45-year-old man was admitted for acute pancreatitis, thought to be a result of blunt abdominal trauma. After 3 months he still has epigastric pain but is able to eat solid food. His amylase level is elevated at 260 IU/L. Which of the following is the most likely diagnosis? A. Recurrent pancreatitis B. Diverticulitis C. Peptic ulcer disease D. Pancreatic pseudocyst
Answer: D
31. The advantages of endoscopy over barium radiography in the evaluation of dysphagia include all of the following EXCEPT: A. Ability to intervene as well as diagnose B. Ability to obtain biopsy specimens C. Increased sensitivity for the detection of abnormalities identified by color, e.g., Barrett's metaplasia D. Increased sensitivity for the detection of mucosal lesions E. No meaningful risk to procedure
Answer: E
32. A 47-year-old man is evaluated in the emergency department for chest pain that developed at a restaurant after swallowing a piece of steak. He reports intermittent episodes of meat getting stuck in his lower chest over the past 3 years, but none as severe as this event. He denies food regurgitation outside of these episodes or heartburn symptoms. He is able to swallow liquids without difficulty and has not had any weight loss. Which of the following is the most likely diagnosis? A. Achalasia B. Adenocarcinoma of the esophagus C. Esophageal diverticula D. Plummer-Vinson syndrome E. Schatzki's ring
Answer: E
24.A 37-year-old woman is noted to have gallstones on ultrasonography. She is placed on a low-fat diet. After 3 months she is noted to have severe right upper quadrant pain, fever to 102°F, and nausea. Which of the following is the most likely diagnosis? A. Acute cholangitis B. Acute cholecystitis C. Acute pancreatitis D. Acute perforation of the gallbladder
B. Acute cholecystitis
7. A 37-year-old woman is noted to have gallstones on ultrasonography. She is placed on a low-fat diet. After 3 months she is noted to have severe right upper quadrant pain, fever to 102°F, and nausea. Which of the following is the most likely diagnosis? A. Acute cholangitis B. Acute cholecystitis C. Acute pancreatitis D. Acute perforation of the gallbladder
B. Acute cholecystitis
19. Hepatitis serologies reveal the following: +HBsAg +HBeAg -IgG-HBsAg +IgM or IgG-HBcAg Which of the following is the most likely diagnosis? A. Acute hepatitis A infection B. Acute hepatitis B infection C. Acute hepatitis C infection d. chronic hepatitis b infection e. drug induced hepatitis
B. Acute hepatitis B infection
6. A 56-year-old man with severe exertional dyspnea is admitted with jaundice and ascites. His father died of respiratory illness at 54 years of age. Bilirubin, AST and alkaline phosphatase are elevated and liver biopsy reveals the presence of PAS-positive, diastase-resistant globules in periportal hepatocytes. What is the most likely diagnosis? A. Alcoholic liver disease B. Alpha1-antitrypsin deficiency C. Cor pulmonale D. Budd-Chiari syndrome E. Haemochromatosis
B. Alpha1-antitrypsin deficiency
18. A 45-year-old woman presents to the emergency department complaining of right upper quadrant pain, fever, and nausea of 8 hours' duration. On examination, the patient is found to have right upper quadrant tenderness. Laboratory evaluation reveals leukocytosis and a bilirubin level of 2.5 mg/dl. Which of the following tests is the most accurate method of confirming the clinical diagnosis of acute cholecystitis? Abdominal ultrasound B. Cholescintigraphy C. Abdominal CT D. Abdominal x-ray
B. Cholescintigraphy
20.A 56-year-old man has brittle diabetes (, tan skin, and a family history of cirrhosis. Select the cause (A- G) that is probably responsible for the patient's presentation. A. Wilson disease B. Hemochromatosis C. Primary biliary cirrhosis D. Sclerosing cholangitis E. Autoimmune hepatitis F. Alcohol-induced hepatitis G. Viral hepatitis
B. Hemochromatosis
9. A 23-year-old woman is evaluated by her primary care physician for diffuse, crampy abdominal pain. She reports that she has had abdominal pain for the last several years, but it is getting worse and is now associated with intermittent diarrhea without flatulence. This does not waken her at night. Stools do not float and are not hard to flush. She has not noted any worsening with specific foods, but she does have occasional rashes on her lower legs. She has lost about 5 kg over the last year. She is otherwise healthy and takes no medications. Which of the following is the most appropriate recommendation at this point? A. Increased dietary fiber intake B. Measurement of anti-endomysial antibody C. Measurement of 24-hour fecal fat D. Referral to gastroenterologist for endoscopy E. Trial of lactose-free diet
B. Measurement of anti-endomysial antibody
15. A 55-year-old man presents with a 4-month history of intermittent, watery diarrhea, severe heartburn, and epigastric pain. He is diagnosed with four duodenal ulcers on endoscopic evaluation. He denies aspirin or nonsteroidal anti-inflammatory drug (NSAID) use. Gastric antral biopsy testing for Helicobacter pylori bacteria is negative. His symptoms fail to respond to an acid suppression regimen consisting of omeprazole, 20 mg twice daily. A fasting serum gastrin level is 1850 pg/mL. Which of the following is true of his likely diagnosis? A. Omeprazole may falsely lower serum gastrin levels. B. The tumor responsible for this disorder is most often located in the duodenum. C. The tumor responsible for this disorder is usually benign. D. The duodenal ulcers will not respond to any level of acid suppression therapy.
B. The tumor responsible for this disorder is most often located in the duodenum.
11. In cases of ACHALASIA, the majority of patients presenting between the ages 20-40 years B. 10-20 years C. 40-60 years D. More than 60 years E. No age predisposition
C. 40-60 years
19. A 41-year-old woman who works as a tattoo artist, has had increasing malaise and nausea for 2 weeks. On physical examination, she has icterus and mild right upper quadrant tenderness. Laboratory studies show serum AST of79 U/L, ALT of 85 U/L, total bilirubin of 3.3 mg/dL, and direct bilirubin of 2.5 mg/dL. She continues to have malaise for the next year. A liver biopsy is undertaken, and the biopsy specimen shows minimal hepatocyte necrosis, mild steatosis, and minimal portal bridging fibrosis. An infection with which of the following viruses is most likely to produce these findings? A HAV B HBV C HCV D HEV E Coinfection with HBV and HDV
C HCV
1.A 48-year-old man presents to the gastroenterology clinic. He has been suffering from heartburn for some time and has noticed occasional regurgitation of his morning toast. Endoscopy reveals a gastric- looking mucosa spreading up into the esophagus, with areas of columnar metaplasia on biopsy. What diagnosis fits best with this clinical picture? A. Hiatus hernia B. Erosive esophagitis C. Barrett's esophagus D. Gastro-esophageal reflux disease E. Gastritis
C. Barrett's esophagus
4.A 72-year-old nursing home resident is brought to the ED because of significant right-sided abdominal pain that began two hours ago and has worsened. He had no significant symptoms until today. BP 115/75, HR 105. RR 19, T 101.4 F. Physical examination reveals localized tenderness along ascending colon. A Barium enema X-ray is taken, which shows no signs of pneumoperitoneum. There is some bowel wall thickening and traces of air in the wall. While the XR is being read, he passes stool with dark clots. Which of the following is the most likely diagnosis in this patient? A. Appendicitis B. IBD C. Bowel wall perforation d. Ischemic colitis
C. Bowel wall perforation
5. A 70-year-old man presents to casualty with lower abdominal pain and fever. He is not jaundiced and blood analysis revealed only a raised white cell count, with normal liver function tests. Previous upper GI endoscopy is reported as normal and urinalysis and MSU were normal. What is the most likely diagnosis? A. Pyelonephritis B. Cholecystitis C. Diverticulitis D. Gastritis E. Carcinoma of the bowel
C. Diverticulitis
13. Which is the most sensitive and specific test for H. pylori infection? A. H. pylori antibody serology B. H. pylori fecal antigen testing C. Histologic assessment of gastric biopsy specimen with multiple samples obtained D. H. pylori culture of gastric biopsy specimen with at least three samples obtained E. C and D
C. Histologic assessment of gastric biopsy specimen with multiple samples obtained
8. A 25-year-old man who had a long history of heavy alcohol intake is admitted with nausea and frequent vomiting four hours after a meal in a restaurant. During review in the Emergency department he vomits a cupful of blood. What is the cause of his hematemesis? A. Duodenal ulceration B. Esophageal varices C. Mallory-Weiss tear D. Esophagitis E. Hemorrhagic gastritis
C. Mallory-Weiss tear
16.A patient with well-compensated cirrhosis caused by alcohol abuse is found to have large esophageal varices on upper endoscopy. here is no history of prior upper gastrointestinal (GI) bleeding. What is the appropriate therapy to prevent future variceal bleeding? A. Ursodiol B. Interferon C. Nonselective beta- blocker D. Endoscopic sclerotherapy E. Proton pump inhibitor therapy (e.g., omeprazole)
C. Nonselective beta- blocker
7. A 59-year-old woman is admitted to the Emergency Department with a productive cough and pyrexia. She is usually fit and well but is undergoing investigation for dysphagia. This has been present for the past 3 months and affects both food and drink. A chest x-ray shows an air-fluid level behind a normal-sized heart. What is the most likely diagnosis? A. Massive pericardial effusion B. Achalasia C. Pharyngeal pouch D. Hiatus hernia E. Tuberculosis
C. Pharyngeal pouch or achalasia ?
10. A 28-year-old woman is seen for evaluation in the clinic. Her past medical history is notable for significant bleeding after extraction of her wisdom teeth, such that additional sutures were required. She takes no medications regularly and does not smoke cigarettes or drink alcohol. Her family history is notable for the fact that her mother required blood transfusions several days after the birth of each of her two children. Her sister also had major bleeding several days after the birth of her child. The patient wants to become pregnant, but she is concerned because of her family history. An appropriate evaluation now would include the following: A. PT, PTT, and Fibrinogen assays B. No evaluation necessary, perform testing for vWD if patient becomes pregnant C. Von Willebrand antigen level, ristocetin cofactor level, and factor VIII level D. Urea clot solubility test
C. Von Willebrand antigen level, ristocetin cofactor level, and factor VIII leve
1. A 69-year-old man is admitted to the emergency department with an acute UGI hemorrhage, following a bout of repeated vomiting. Fiberoptic gastoscopy reveals three linear mucosal tears at the GE junction. What is the diagnosis? A. Reflux esophagitis with ulceration B. Barrett's esophagus C. Carcinoma of the esophagus D Mallory-Weiss tear E. Scleroderma
D Mallory-Weiss tear
17. A 66-year-old man presents to the ED with a history of one episode of hematemesis and melena. Past medical history includes coronary artery disease, hypertension and abdominal aortic aneurism repair. He is on one baby aspirin daily. An urgent upper endoscopy is negative. What is the most appropriate next step? A. UGI series with small bowel follow-through B. Colonoscopy C. Angiography D. Abdominal CT scan with contrast
D. Abdominal CT scan with contrast
3. A symptomatic patient has a barium swallow that reveals a 3-cm Zenker's diverticulum. The next step in management is? A. H2 blockers B. Anticholinergic drugs C. Elemental diet D. Bougienage Surgery (cricopharyngeal myotomy and diverticulectomy)
D. Bougienage Surgery (cricopharyngeal myotomy and diverticulectomy)
29. A 35-year-old woman is found to have abnormal results of iron studies on a routine physical examination. Her liver biochemical tests are normal, and her physical examination is unremarkable. She does not consume alcohol or over-the- counter medications or supplements. Her iron studies are as follows: Serum iron 186 μg/dL Total iron binding capacity (TIBC) 255 μg/dL Serum ferritin 300 ng/mL (normal 25-240 ng/mL) What is the next test that should be ordered to facilitate the diagnosis? A. Percutaneous liver biopsy B. Serum B12 and folate levels C. Glucose tolerance testing D. Gene testing for hereditary hemochromatosis E. Abdominal CT scan with intravenous contrast
D. Gene testing for hereditary hemochromatosis
14. A 57-year-old woman presents with a 2-month history of pruritus and mild fatigue. Her skin examination reveals excoriations but no visible rash. Laboratory examination reveals an alkaline phosphatase elevated to 3× normal, with otherwise normal liver biochemical tests. Her thyroid-stimulating hormone is also elevated, and she has a positive antithyroid microsomal antibody test. What is the most likely diagnosis, and what treatment is indicated? A. Primary sclerosing cholangitis; ursodiol B. Primary biliary cirrhosis; prednisone C. Primary sclerosing cholangitis; liver transplantation D. Primary biliary cirrhosis; ursodiol E. Congenital hepatic fibrosis; liver transplantation
D. Primary biliary cirrhosis; ursodiol
16. Extraesophageal manifestations of GERD include all of the following EXCEPT: A. Chronic cough B. Laryngitis C. Dental damage D. Regurgitation of undigested food E. Chronic sinusitis
D. Regurgitation of undigested food
9. A 79-year-old retired opera singer presents with dysphagia, which has become progressively worse during the last 5 years. He states that he is sometimes aware of a lump on the left side of his neck and that he hears gurgling sounds during swallowing. He sometimes regurgitates food during eating. What is the likely diagnosis? A. Carcinoma of the esophagus B. Foreign body in the esophagus C. Plummer- Vinson syndrome D. Zenker's diverticulum E. Scleroderma
D. Zenker's diverticulum
39. A 58-year-old man has been admitted to the general medical ward with abdominal pain and fluctuating consciousness. On examination he has shifting dullness and is scleral icterus. A social history has been taken and he has been started on a reducing regime of chlordiazepoxide. Blood tests have been under- taken, which show: Hb 92 g/l (normal 135-180), MCV 130fl (80-102fl), platelet count 145 (140-450). What is the most likely cause for this patient's anemia? A. Autoimmune pernicious anemia B. Malabsorp- tion causing folate deficiency C. Iron deficiency anemia D Anemia of chronic disease E Chronic excess alcohol
E Chronic excess alcohol
Which of the following is the most accurate statement regarding H pylori infection? A. It is more common in developed than underdeveloped countries. B. It is associated with the development of colon cancer. C. It is believed to be the cause of nonulcer dyspepsia. D. The route of transmission is believed to be sexually transmitted. E. It is believed to be a common cause of both duodenal and gastric ulcers.
E. It is believed to be a common cause of both duodenal and gastric ulcers.
3. A 45-year-old woman with ulcerative colitis is admitted with a history of jaundice, pruritus and intermittent abdominal pain. Examination shows hepatosplenomegaly and mild ascites. Blood tests confirm an obstructive jaundice, and mitochondrial antibodies are not detected. What is the most likely diagnosis? A.Liver cirrhosis B. Chronic active hepatitis. C. Pancreatic carcinoma D. Metastatic carcinoma E. Primary Sclerosing cholangitis
E. Primary Sclerosing cholangitis
2. A 56-year-old woman has a family history of haemochromatosis and is homozygous for the C282Y mutation. Her ferritin is 927 mg/L (normal range 15-150), hemoglobin 12.5 g/dL (normal range 11.5-16) and aspartate aminotransferase 87 U/L (normal range <40). Which is the best course of action? A. Intravenous deferoxamine B. Weekly venesection until she is anemic C. Start aspirin. D. Watchful waiting, with 6 monthly checks of the ferritin level E. Weekly venesection to drop her ferritin into the low-normal range
E. Weekly venesection to drop her ferritin into the low-normal range
A 40-year-old woman with diabetes and chronic kidney disease presented to the clinic for follow-up after an abdominal ultrasound revealed incidental cholelithiasis without inflammation. The ultrasound revealed two stones, which were less than 5 mm in size. The patient's kidneys were normal. The patient denies experiencing abdominal pain, nausea, or vomiting. She has not had cholecystitis in the past. Of the following, which is the best step to take next in the treatment of this patient? Cholecystectomy Observation Percutaneous transhepatic cholangiogram Endoscopic retrograde cholangiopancreatography (ERCP)
Observation
12. A 36-year-old male patient, with a 2 years history of dysphagia, underwent barium swallow, which reveals typical bird's-beak deformity in the distal esophagus with more proximal esophageal dilatation. What is the most likely diagnosis? a.Achalasia B. Foreign body of the esophagus C. Hiatal esophageal hernia D. Diverticula E. Distal esophagitis
a.Achalasia
19.A 52-year-old obese female patient presents to clinic with complaints of heartburn, bloating, and mild postprandial mid epigastric fullness. She has painful episodes associated with eating two to three times per month. Her past medical history is significant for cholelithiasis, polycystic ovaries, and depression. She is currently only taking acetaminophenon an as-needed basis for her symptoms. She is afebrile, and her physical examination is significant for an obese, soft abdomen without organomegaly, masses, or tenderness. Pelvic and rectal examinations are normal. An abdominal x-ray (KUB) shows a normal bowel gas pattern and acalcified gallbladder. Serum electrolytes, creatinine, liver function tests, lipase, and a complete blood count are allwithin normal limits. A diagnosis of chronic cholecystitis is made. In addition to obtaining a transabdominal sonogram, what is the treatment of choice to reduce symptoms f
a.Elective laparoscopic cholecystectomy
7. A 54-year-old clerk complains of having had dysphagia for 15 years. The clinical diagnosis of achalasia is confirmed by a barium study. What is TRUE in this condition? a.The most common symptom is dysphagia B. The dysphagia is not typical C. The incidence of sarcoma is increased D. Recurrent pulmonary infections are rare E. Endoscopic dilatation should be avoided
a.The most common symptom is dysphagia
5. A 42-year-old woman comes to your office with complaints of diarrhea for 6 months. She has stopped dairy products but there has been no improvement. There is no blood or pus with the stool. She takes maximum doses of omeprazole daily, along with famotidine, and still has ulcer symptoms. He has a mild hypercalcemia. Which of the following is most likely diagnosis in this patient? A. Peptic ulcer disease b.Zollinger-Ellison syndrome C. Non dyspepsia D. Chronic gastritis
b.Zollinger-Ellison syndrome
10. Esophageal manometry is essential to confirm the diagnosis of primary esophageal motility disorders: Achalasia; 2. Diffuse esophageal spasm; 3. After burnings esophageal strictures; 4. Hypertensive lower esophageal sphincter; 5. Gastroesophageal reflux disease. A. 1,2,3 B. 1,3,5 c. 1,2,4 D. 2,4,5 E. 3,4,5
c. 1,2,4
2. A 38-year-old male is seen in the urgent care center with several hours of severe abdominal pain. His symptoms began suddenly, but he reports several months of pain in the epigastrium after eating, with a resultant 10-lb weight loss. He takes no medications besides over the-counter antacids and has no other medical problems or habits. On physical examination temperature is 38.0°C (100.4°F), pulse 130 beats/min, respiratory rate 24 breaths/min, and blood pressure 110/50 mmHg. His abdomen has absent bowel sounds and is rigid with involuntary guarding diffusely. A plain film of the abdomen is obtained and shows free air under the diaphragm. Which of the following is most likely to be found in the operating room? A. Necrotic bowel B. Necrotic pancreas c. Perforated ulcer D. Perforated gallbladder
c. Perforated ulcer
14. Gastroesophageal reflux (GERD) is a mechanical disorder that is caused by: 1. Defective lower esophageal sphincter; 2. Gastric emptying disorder; 3. Underlying epiphrenic diverticulum; 4. Underlying achalasia 5. Failed esophageal peristalsis. A. 1,2,3 B. 1,3,4 c.1,2,5 D. 2,4,5 E. 3,4,5
c.1,2,5
3. A 35-year-old man presents to your clinic with ulcerative colitis. Choose the cause that is probably responsible for the patient's presentation.
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