GI practice questions

Describe the mnemonic WEAPON for gastric cancer

"WEAPON": Weight loss, Emesis, Anorexia, Pain/epigastric discomfort, Obstruction, Nausea

if active bleeding with esophageal varices, hemoglobin goal is ____. Why?

7-8 more causes increased pressure which will cause them to bleed more. want to prevent shock

A 25-year old lady presents at the clinic with complaint of 8-month history of intermittent crampy lower abdominal pain, with passage of loose stools 4 times a day. Pain is usually worse during her menstrual period, and is relieved by defecation. She also feels bloated. On inquiring, she says she has been undergoing work-related stress for months. No ALARM symptoms. Nothing significant was found on physical examination. What is her most likely diagnosis? A Irritable bowel syndrome B Lactase deficiency C Ulcerative colitis D Crohn disease

A

A 25-year-old man presents for evaluation of intermittent chest pain. He reports a burning sensation in his chest 1-2 days per week after eating. The symptoms are worse with large meals, eating late at night, and excessive alcohol consumption. He denies difficulty swallowing, weight loss, night sweats, chest pain, use of tobacco, or coughing up blood. His vital signs and physical examination are unremarkable. What is the most appropriate treatment for this patient's current symptoms? A H2 receptor agonists B PPI C Antiemetics D antibiotics E Prokinectic agents

A

A 45-year-old man presents with a 30-minute history of substernal chest pain. He describes the pain as burning. He denies any trauma to the chest. He has had similar episodes like this many times. He denies any additional symptoms such as shortness of breath or diaphoresis, but he states that his voice is often hoarse. His medical issues include diabetes mellitus and heavy alcohol use. What is the most likely cause of his chest pain? A Gastroesophageal reflux B Pneumonia C Aortic dissection D Pulmonary embolism E Unstable angina

A

A 51-year-old woman presents with difficulty swallowing. She reports a 2-month history of problems swallowing liquids and solids and bringing up undigested food. X-ray reveals a bird's beak appearance of the esophagus. What medication would be most appropriate in this patient? A Nifedipine B Pantoprazole C Famotidine D Ciprofloxacin E Nystatin

A

Which of the following is a treatment option following failure of conservative treatment for anal fissure? A Lateral anal sphincterotomy. B Cryosurgery. C Infrared coagulation. D Temporary Thiersch operation

A

which of the following infections has been associated with an increased prevalence of IBS? A Giardia lamblia B Escherichia coli C Shigella D Salmonella

A

Which of the following is associated with the 'double bubble' sign on abdominal radiograph? A Duodenal atresia B Pyloric atresia C Hirschsprung's disease D Sigmoid volvulus

A Abdominal plain films in neonates with duodenal atresia will demonstrate dilated stomach and duodenum giving the characteristic 'double bubble' sign with no gas distal to the duodenum.

Which of the statements is false about diverticular disease A Acute diverticulitis most commonly affects the ascending colon. B Patients with Ehlers-Danlos syndrome are disposed to development of diverticulosis. C Diverticular disease is asymptomatic in 95% of cases. D Mild attacks can be treated on an outpatient basis using oral antibiotics such as ciprofloxacin and metronidazole.

A Acute diverticulitis most commonly affects the sigmoid (descending) colon. This may be a result of the relative high-pressure zone within the sigmoid colon.

Carcinoma of the colon most commonly originates in which of the following? A an adenomatous polyp B an inflammatory polyp C a hyperplastic polyp D a benign lymphoid polyp

A The majority of colonic adenocarcinomas evolve from adenomas. Adenomas are a premalignant lesion; in the large bowel, the sequence is adenoma, dysplasia in the adenomas, and adenocarcinoma.

Fullness in the epigastric region and a palpable mass in this patient are most likely due to A pancreatic pseudocyst formation B palpable gallbladder C enlarged spleen D enlarged liver

A The palpable mass in this patient is most likely due to pancreatic pseudocyst formation. These patients are jaundiced and do not present with such acute symptoms and pain.

A 36 year old man presents with sudden onset severe epigastric pain following an alcohol binge. Pain is referred to his back. Pain is alleviated when he sits and leans forward. There is also nausea and vomiting. Physical examination revealed upper abdominal tenderness, bluish discoloration around the umbilicus, bowel sounds are absent. What is the most likely diagnosis? A Acute pancreatitis B Acute appendicitis C Acute cholecystitis D Acute gastroenteritis

A Sudden severe epigastric pain (following alcohol binge) that is referred to the back and relieved by sitting and leaning forward with Cullen's sign (periumbilical ecchymosis) strongly suggest acute pancreatitis.

A patient was treated for community acquired pneumonia with amoxicillin-clavulanate (Augmentin). On day 7 of therapy he develops fulminate diarrhea. The diarrhea is described as greenish and foul-smelling. He admits to associated abdominal cramps. Which of the following is the treatment of choice for this patient? A Vancomycin B Diphenoxylate/atropine (Lomotil) C Clindamycin D Ciprofloxacin

A pts with first epi of mild to moderate c diff should be treated with vancomycin 125 mg for 10 days

A patient presents with reflux. When further questioned, he reports the regurgitation of small amounts of food back into his mouth. You notice he has very foul-smelling breath. What do you suspect? A Zenker's diverticulum B Peptic Ulcer Disease C Achalasia D Gastric Cancer E Pyloric stenosis

A - Zenker's diverticulum defined as an outpouching of the hypopharynx which causes foul smelling breath and regurgitation of solid food

A 60-year-old man with hypertension presents with constipation. He states that he has not had a bowel movement in the past 2 days. He was hospitalized with a myocardial infarction 1 month ago, but he is now stable on a low-fat, low-salt diet. He refuses a docusate sodium enema and is prescribed oral docusate tablets. What precaution should the patient take? A Avoid long-term use of docusate B Consume docusate with fruit juice only C Increase his salt intake D Consume mineral oil E Be aware of the potential for dehydration

A - avoid long term use of docusate

A 15-year-old boy presents with bloody diarrhea and abdominal cramping. A double contrast barium enema shows fine serrations and narrowing of the rectum and sigmoid. Stool contains mucus, blood, and white blood cells, but no parasites or bacterial pathogens. Endoscopy shows inflamed mucosa and pseudopolyps. A biopsy finds an extensive inflammatory process in the mucosa and submucosa. The glands are filled with eosinophilic secretions; there is also mild involvement of the terminal ileum. Sulfasalazine treatment is attempted without improvement. What is the most appropriate next step in management? A Corticosteroids B Metronidazole C 6-mercaptopurine D Diphenoxylate E Loperamide

A Corticosteroids

A 46-year-old woman presents with nausea, vomiting, crampy abdominal pain, and loud bowel sounds for the past several hours. She denies weight loss. She has had one normal bowel movement since the symptoms began, but it did not help her symptoms. She has a past surgical history of an abdominal hysterectomy 7 years prior. On physical exam, she is afebrile, with hyperactive and high-pitched bowel sounds localized to the left upper quadrant. She also has mild diffuse abdominal tenderness. What is the most likely diagnosis? A Small bowel obstruction B Whipple's disease C Diverticulitis D Acute paralytic ileus E Irritable bowel syndrome

A Small bowel obstruction

A 20-year-old woman presents with 2 weeks of anorectal pain. She notes streaks of blood on her stool and toilet paper. She reports "a tearing pain during each bowel movement." She dreads having a bowel movement, and she attempts to hold it as long as she can. She broke her leg in a skiing accident 4 weeks ago and was prescribed oxycodone/acetaminophen (Percocet) for the first few days due to her pain. An anoscope reveals an acute anal fissure. What should be the next step in treatment? A High fiber diet and stool softeners B Topical diltiazem C Lateral internal sphincterotomy D Botulinum toxin E Percocet for rectal pain

A high fiber diet and stool softeners

A 69-year old man presents with epigastric pain which radiates to his back, progressive weight loss, jaundice, and pruritus. On physical examination, patient looks cachectic, is icteric, has scratch marks, palpable gallbladder. His fasting blood sugar (FBS) is 13mg/dl. What is the most likely diagnosis? A Pancreatic cancer B Gastric cancer C Gastric ulcer D Hepatocellular carcinoma

A pancreatic cancer Epigastric pain which radiates to the back with weight loss, jaundice, pruritus, palpable gall bladder and a deranged FBS strongly suggests pancreatic cancer.

fat soluble vitamins

A, D, E, K

A 40-year-old man presents with a 2-year history of severe, burning epigastric pain. A detailed history reveals that the pain is greatest in the early hours of the morning and wakes him up from sleep. The pain is also felt 2-3 hours after meals. He reports diarrhea for the past 2 years. On examination, his pulse is 74/min and blood pressure 136/84 mm Hg. There is slight epigastric discomfort on palpation. Lab examination shows hyperchlorhydria. What is a potential complication of this patient's diagnosis? A Gallstones B Intestinal ulcers C Macrocytic anemia D Kidney stones E Weight gain

B

Which of the following statements regarding carcinoembryonic antigen (CEA) and colorectal cancer is true? A CEA is a cost-effective screening test for colorectal cancer B elevated preoperative CEA levels correlate well with postoperative recurrence rate in colorectal cancer C CEA is a sensitive test for colorectal cancer D CEA is a specific test for colorectal cancer E CEA has no value in predicting recurrence in colorectal cancer

B

Which of the radiologic imaging techniques is the most sensitive in diagnosis of acute pancreatitis and pancreatic pseudocyst? A transabdominal ultrasonography B contrast-enhanced CT of the abdomen C magnetic resonance cholangiopancreatography D plain radiograph (abdominal series)

B

Which of the following concerning femoral hernias is not true? A They are more common in women. B Has a low incidence of strangulation. C Cannot be controlled with a TRUSS. D accounts for about of 5% hernias in men

B Femoral hernias have a high incidence of strangulation mainly because of the narrowness of the neck of the sac and the rigidity of the femoral ring.

A 20-year-old healthy male was treated 4 days ago for an MRSA skin infection with sulfamethoxazole-trimethoprim (Bactrim). The infection is improving but he is increasingly weak and his sclera have turned yellow. Today his hemoglobin is 11 g/ dL (13.5 to 18 g/ dL) and his MCV is 85 (80 to 100 fL); the corrected reticulocyte count is elevated. What is the best test for the most likely diagnosis? A Homocysteine level B Heinz body stain C Hemoglobin electrophoresis D Erythropoietin level E Iron studies

B G6PD deficiency causes a hemolytic anemia when the patient is exposed to oxidant medications, like sulfa or antimalarials, or eating Fava beans. Heinz body stains for G6PD deficiency. Folate and B12 deficiency causes elevated homocysteine levels. Hemoglobin electrophoresis quantifies proteins. Erythropoietin levels are low in chronic renal disease. Iron studies are warranted in microcytic anemia.

Which of the following is not a radiographic feature of intestinal obstruction? A Multiple air-fluid levels on erect film. B Thumbprinting sign. C The jejunum is characterized by its valvulae conniventes. D Large bowel, except for the caecum, shows haustral folds.

B thumbprinting is a radiographic sign of large bowel thickening caused by edema, related to an infective or inflammatory process.

Which of the following is considered the gold standard for imaging the biliary system? A Ultrasonography B ERCP C CT Scan D MRCP

B - ERCP

A 35-year-old male patient presents with a groin mass. The patient says the mass is painless, and there is no known trauma to the region. The mass is present upon standing and disappears when lying flat. Past medical history includes chronic constipation, hypertension, and hyperlipidemia. Past surgical history includes lipoma removal from the left shoulder. The patient denies tobacco use; he drinks about 6 beers per week. Ultrasound confirms the diagnosis, and surgical repair is scheduled. What is the most significant risk factor for this patient's condition? A Alcohol use B Chronic constipation C Hyperlipidemia D Hypertension E Lipoma removal

B Chronic constipation

An otherwise-healthy 7-month old female infant was brought to the clinic by her mother on account of a 3-month history of umbilical swelling which is usually more apparent when she cries. On examination, the swelling was reducible and a defect was felt through the umbilicus. The appropriate management option is A Umbilical herniorrhaphy. B Conservative treatment. C Mayo's overlapping operation. D None of the above

B Conservative treatment In most cases (85%) the hernial defect in the linea alba closes spontaneously by age 4 - 5 years. The patient should therefore be left alone without any form of treatment except in the event of strangulation or incarceration

What type of hernia involves passage of intestine through the external inguinal ring at Hesselbach triangle and rarely enters the scrotum A Indirect inguinal hernia B Direct inguinal hernia C Ventral hernia D Hiatal hernia

B Direct inguinal hernia

A 73-year-old man with hypothyroidism has been hospitalized with a spinal cord injury and is evaluated at bedside. He is unable to have bowel movements; he has only passed a stool twice in the past 10 days. He states that he has had involuntary passage of small loose or liquid stools during this time, associated with abdominopelvic discomfort. Dietary history is remarkable for a low-fiber diet that lacks raw fruits and vegetables. He takes oxycodone for chronic back pain. He denies any abdominal or pelvic pain, weight loss, hematochezia, melena, fever, chills, or urinary issues. Rectal exam reveals good sphincter tone, but a firm immovable mass is detected. Bedside pelvic radiograph shows colonic distension. What is the most likely diagnosis? A Acute colitis B Fecal impaction C Prostatitis D Rectal abscess E Rectal cancer

B Fecal Impaction

What type of hernia involves passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum. Often congenital and will present before age one? A Direct inguinal hernia B Indirect inguinal hernia C Umbilical hernia D Ventral hernia

B Indirect inguinal hernia

A 16-year-old female patient with a 2-year history of ulcerative colitis presents with signs of an acute exacerbation. There is abdominal pain and frequent passing of large quantities of blood and mucus from the rectum. She is treated with sulfasalazine, glucocorticoids, and intravenous alimentation. Diarrhea decreases markedly, but her status continues to deteriorate. Tachycardia, volume depletion, and electrolyte imbalance develop; temperature 38.77°C (101.8°F). Physical examination shows abdominal tenderness, but no mass is observed. Plain radiography shows the transverse colon is dilated up to 7 cm. What is the most appropriate next step in management? A Perform barium enema B Perform colectomy C Stop sulfasalazine D Taper glucocorticoids

B Perform colectomy

A 63-year-old woman presents with acute onset of abdominal pain that describes as a steady deep discomfort in the left lower quadrant. She was constipated initially, but she is now experiencing diarrhea. On physical examination, she has a temperature of 38°C. The abdomen is tender in the LLQ with guarding and rebound tenderness. She has positive fecal occult blood. What is the best test to determine the most likely diagnosis? A Abdominal ultrasound B Abdominal CT C Barium enema D Upper GI series E Colonoscopy

B abdominal CT

water soluble vitamins

B and C

A 50-year-old male patient presents with a 3-month history of weakness, fatigue, and abdominal discomfort. He acknowledges a lack of sexual desire. He denies any photosensitivity. On physical examination, the liver is enlarged, and the spleen is palpable. He has abnormal skin pigmentation on the face, neck, and elbows that gives his skin a metallic gray hue. His labs are as follows:​-TIBC 275 mcg/dL (normal 250-350 mcg/dL)​-Plasma iron 220 mcg/dL (normal 80-160 mcg/dL)​-Transferrin saturation 90% (normal 16-57%​What serious complication is associated with this patient's condition? A Bronchogenic Carcinoma B Hepatocellular carcinoma C leukemia D lymphoma E pancreatic carcinoma

B hepatocellular carcinoma

The mother of a 3-year-old boy asks to have a blood test done on her son for lead poisoning. He has not been tested before. They have moved into an older home, built before 1960. She has noticed some peeling paint on windowsills and doors and has seen small paint chips on the floors. They are now having the house repainted and are staying with relatives. A careful environmental history is obtained, and risk reduction and nutrition education are provided. His fingerstick blood lead level comes back at 13 mcg/dL. What is the next step in the management of this patient? A Oral chelation therapy B Home visit to identify potential lead sources C Repeat lead level in 6 months D Repeat lead level in 1 year E Hospitalization and IV chelation therapy

B home visit

A 35-year-old man presents after several episodes of vomiting in the last 24 hours; there is loose stool and strong pain localized in the upper middle region of the abdomen. Physical examination indicates a temperature of 101°F and a tender epigastrium. Lab tests reveal an initial WBC count of 18x109/L. C-reactive protein level is 325 mg/L, and amylase is 130 U/L. There is a lactate dehydrogenase level of 816 U/L. The patient has no history of pancreatic disease and denies alcohol use. He is overweight. He has a history of type 2 diabetes and hypertension. He takes medicine to control his high blood pressure and obesity. What is the most appropriate next step in establishing the diagnosis? A Abdominal radiography B Abdominal ultrasonography C Abdominal computed tomography scanning D Endoscopic retrograde cholangiopancreatography E Endoscopic ultrasonography

C

A 45-year old woman being managed for ulcerative colitis, developed abdominal pain, vomiting, diarrhea, passage of blood and mucus per rectum and fever. On examination, she was pale, febrile (temp: 102.20C), moderately dehydrated, heart rate: 124bpm. There was abdominal distention and tenderness, bowel sounds were hypoactive. Lab results showed Hb: 9g/dl, WBC: 14 x 109/L, elevated CRP. Stool was negative for C. difficile. HIV status was negative. Abdominal radiograph showed dilated transverse colon of about 11 cm. What is the most likely diagnosis of this patient? A Hirschsprung's disease B Cytomegalovirus colitis C Toxic megacolon D Kaposi's sarcoma

C

A 47-year-old man presents with abdominal pain and difficulties breathing. He has a history of alcohol abuse and confirmed cirrhosis of the liver. On examination, you see a malnourished and jaundiced patient with a distended belly. Percussion of the abdomen reveals a huge amount of fluid and wave sign. What is the primary cause of the ascites? A Increased albumin production B Increased ammonia production C Portal hypertension D Decreased fluid intake E Blockage of the common bile duct

C

A 6-week-old male infant presents with a 2-day history of vomiting after every feeding of cow's milk-based formula with iron, 4 ounces per feeding. There has been no fever, diarrhea, or other symptoms except increased crying. The child appears alert and hungry. The mother describes the vomiting as forceful, traveling about 2 feet. Physical evaluation reveals minimal tear production with mild skin tenting. Bowel sounds are decreased. BUN 29 mg/dL; serum sodium 129 mg/dL; serum potassium 3.4 mg/dL; serum chloride 89 mg/dL; serum bicarbonate 34 mg/dL. What is the next step in this patient's care? A Exploratory laparotomy B Gastric aspirate for Helicobacter pylori C IV fluids and abdominal ultrasound D High-dose IV methylprednisolone E Trial of oral rehydration

C

The skin findings of a patient with phenylketonuria include all of the following except A Fair skin and hair B Atopic dermatitis C Psoriasis D Scleroderma like plaques

C

Which of the following types of H. pylori testing is not useful to confirm eradication? A stool antigen test B urea breath test C enzyme-linked immunosorbent assay (ELISA) serology D Steiner stain of gastric biopsy specimen

C

which of the following meds does not cause constipation? A - opioids B - CCBs C- BBs D - NSAIDS

C

A 65-year old man who is being managed for lung cancer on the ward makes a complaint of a 2-day history of passage of non bloody watery stool up to 4 times per day, anorexia, cramping abdominal pain, and fever. Meanwhile he had a 10-day course of antibiotic 4 weeks ago on account of a lung infection. Which of the following is the most likely cause of his diarrhea: A Salmonella B Rotavirus C Clostridium difficile D E. coli

C Clostridium difficile colitis results from a disturbance of the normal bacterial flora of the colon, colonization by C. difficile, and the release of toxins that cause mucosal inflammation. Antibiotic therapy is the key factor that alters the colonic flora

Advantages of PPIs over H2 blockers include all of the following except A superior acid suppression B faster healing rates C safe for use in hepatically impaired patients D faster symptom relief E lower and less frequent dosing requirement

C Several of the PPIs, namely, lansoprazole and rabeprazole, need to be used with caution in patients with hepatic impairment.

Which of the following is not an endoscopic modality in treating bleeding Mallory-weiss tear? A Sclerosant injection B Band ligation C Angiotherapy D Hemoclip placement

C Angiotherapy is a treatment modality for bleeding Mallory-weiss syndrome. Performed in patient whose lesion failed to respond to endoscopic therapy. Done either by intraarterial vasopressin infusion or arterial embolisation.

A 62-year old woman, a known hypertensive and diabetic patient, presents at the clinic with 4-months history of dull epigastric pain which usually occurs 30 minutes after feeding. This has lead to her having fear to eating. She has lost 11lb in the past 7 weeks. There is also nausea, vomiting and diarrhea. She also complained of what seemed like intermittent claudication. Physical examination reveals signs of malnutrition, diffuse mild abdominal tenderness with no rebound and guarding, abdominal bruit, shiny skin on both legs, hair loss on both legs and feet, and weak dorsalis pedis pulse bilaterally. What is her most likely diagnosis? A Acute mesenteric ischemia B Peptic ulcer disease C Chronic mesenteric ischemia D Gastric cancer

C Chronic mesenteric ischemia typically presents as stated above. Patient with atherosclerosis or at risk of having atherosclerosis are predisposed to CMI. Intermittent claudication, shiny skin on both legs, hair loss on both legs and feet, and weak dorsalis pedis pulse bilaterally are signs of peripheral vascular disease which is due to atherosclerosis. Hypertension and Diabetes are risk factors for atherosclerosis.

Thumb printing, a radiographic sign, is seen in all of the following conditions except A Crohn disease B Ulcerative colitis C Appendicitis D Ischemic colitis

C Thumbprinting is a radiographic sign of large bowel thickening caused by edema, related to an infective or inflammatory process. It is not seen in appendicitis. It is seen in all other options.

Which antibiotic is a major cause of biliary sludge? A Amoxicillin B Ciprofloxacin C Ceftriaxone D Doxycycline

C - ceftriaxone

A 26-year old lady presents at the outpatient clinic with 11 month history of recurrent epigastric pain which is worse when she's hungry. It is temporarily relieved by food and antacids. It is also worse at night. It sometimes awakens her. Pain occurs for a few weeks, then goes and occurs again after several weeks. There is history of chronic NSAID ingestion, nausea and anorexia. Which of the following is the most likely diagnosis? A Esophagitis B Acute pancreatitis C Peptic ulcer disease D Gastroesophageal reflux disease

C - peptic ulcer disease

A 28-year-old man presents with rectal bleeding. He had noticed blood with bowel movements 3 times. The blood is described as bright red in color and small in amount. He also complains of rectal pain, especially with passing hard stools. He has tried some over-the-counter hemorrhoid creams without relief.​The patient admits episodic constipation. He denies dark tarry stools, easy bruising, and prior episodes of rectal bleeding. He has not noticed blood in his urine or with brushing his teeth. He denies nausea, vomiting, diarrhea, fevers, and weight loss. He has no known medical conditions. Family history is negative for gastrointestinal disorders. Social history reveals he is in a heterosexual relationship and denies anal intercourse.​On physical exam, abdomen is normal. The anus has no visible protrusions or rash, but there is a very small erythematous and tender area that appears like a "paper cut" or crack in the skin. The patient experiences pain with digital rectal exam (DRE). No masses are noted in the rectal vault​What is the most appropriate prescription treatment for this patient's current condition? A Bacitracin ointment B Minoxidil topical C Nitroglycerin ointment D Nystatin topical E Tretinoin topical

C Nitro ointment

Which of the following is the most common type of esophagitis? A Infectious esophagitis B Radiation esophagitis C Reflux esophagitis D Medication-induced esophagitis

C Reflux esophagitis

In the winter, an 11-month-old male infant presents with a 2-day history of vomiting, diarrhea, and fever. He has not had routine medical care since birth. Mother reports no significant past medical history. His temperature is 102°F. Clinically, he appears dehydrated; his white blood cell count is 5400 cells/mm3 with a normal differential. His stool and urine are negative for white blood cells. What is the most likely cause of gastroenteritis in this child? A Clostridiodes difficile B Escherichia coli C Rotavirus D Norovirus E Shigella

C Rotavirus

A 20-year-old woman presents with intermittent nose bleeds for the past 2 weeks. She also reports that her menstrual periods have increased in number in the past 2 months. She recently underwent surgery for small bowel resection and eats only one meal a day. Laboratory investigations reveal prolonged prothrombin time, prolonged activated partial thromboplastin time, and a normal platelet count. What is the most likely diagnosis? A Thiamine deficiency B Riboflavin deficiency C Vitamin K deficiency D Vitamin D deficiency E Iron deficiency

C Vitamin K deficiency

A 48-year-old man presents with continuous right upper quadrant pain that developed after eating fried chicken. He has experienced previous episodes of less severe right upper quadrant pain that resolved spontaneously. The pain radiates to his right shoulder, accompanied by nausea, vomiting, and chills. Vital signs include BP 120/85 mm Hg, pulse 117/min, respirations 18/min, temperature 102.5°F. Physical examination is remarkable for scleral icterus and jaundice. His abdomen is slightly distended with right upper quadrant tenderness and a positive Murphy sign. CBC reveals mild leukocytosis, elevated serum aminotransferases and bilirubin, and normal lipase. What is the most likely cause of this patient's symptoms? A hepatitis B choledocholithiasis C pancreatitis D cirrhosis E hepatocellular carcinoma

Choledocholithiasis

A 12-year-old boy has jaundice, non-tender hepatomegaly and splenomegaly, and tremor. He has been healthy and is on no medications. He is afebrile. Golden-brown rings on the peripheral corneas are noted on slit lamp eye exam. Laboratory studies reveal low levels of serum ceruloplasmin and elevated 24-hour urine copper excretion. What is the most likely diagnosis? A Reye syndrome B Autoimmune hepatitis C Drug-induced hepatitis D Wilson disease E Acute hepatitis A virus

D

A 43-year-old man arrives at the emergency department via ambulance. His wife indicated that she found him lying on the living room floor when she came home from running errands around town. She also stated that he seemed "fine" before she left approximately 2 hours prior. He has a history of acid peptic disease. Upon arrival, he is conscious and indicates that he became dizzy upon standing. For the last couple of days, his stools have been coffee ground in color and he has had increasingly worse upper middle abdominal pain and nausea. His vitals are BP 90/48 mm Hg, pulse 145/min and thready, respirations 24/min, and pulse oximetry 88%. You order a hemoglobin and hematocrit, and the results are 8.2 g/dL and 24.8%, respectively. You review his records and find that 2 weeks ago his H&H was 15.6 g/fL and 48.2%, respectively. What is your initial assessment? A Acute upper GI bleed due to noncompliance with treatment B Stool color change due to Pepto-Bismol treatment C Diverticular bleed D Acute massive hemorrhage due to perforation E Underlying ulcerative colitis

D

A 60-year-old African American man presents due to dysphagia. The dysphagia started 3-4 months ago and has progressively gotten worse. He has also lost weight; current weight and height are 170 lb and 72". He appears older than his stated age. He wants something to help him in swallowing. He does not report heartburn.​You note he does not eat on a regular basis, and when he does eat, it is usually fast food. He has smoked for the last 40 years, 2 packs a day. He drinks 12 cans of beer on weekdays and approximately 48 cans of beer during the weekend. He uses recreational drugs occasionally.​What is the most likely diagnosis? A Gastroesophageal reflux disease B Esophageal stricture C Esophageal varices D Esophageal neoplasm E Mallory-Weiss syndrome

D

A 75-year-old woman presents with heartburn and dyspepsia. She was diagnosed with osteoarthritis 4 years ago. For the past 18 months, she has been managing pain with naproxen. The gastroenterologist suggests that the patient be tested for Helicobacter pylori infection. What is the most sensitive and specific non-invasive method to diagnose this infection? A Gastric biopsy B Fecal antigen test C Culture of H. pylori D Urea breath test E Schillings test

D

An 18-year-old man presents for a screening physical exam to join his college freshman lacrosse team. He reports no medical problems, and he does not take any medications. Physical exam is unremarkable. His immunizations are current, and he denies sexual activity or smoking. Review of routine labs reveals an elevation in unconjugated bilirubin. His total bilirubin level 4 mg/dL. Liver enzymes, serum electrolytes, complete blood count, and conjugated bilirubin level are within normal limits. What is the most likely diagnosis? A alcoholic hepatitis B Crigler-Nijjar syndrome C Dubin-Johnson syndrome D Gilbert syndrome E infectious hepatitis

D

Complications of gallstones include all of the following except A acute cholecystitis B hydrops of the gallbladder C gastric outlet obstruction D hepatic vein thrombosis E acute biliary pancreatitis

D

Which of the following drugs has no role in the management of inflammatory bowel disease (IBD)? A Infliximab B Budesonide C Mercaptopurine D Cisapride

D

Which of the following is not a pharmacological option for acute mesenteric ischemia (AMI)? A Papaverine B Urokinase C Heparin D Prednisolone

D

Which of the following organisms is (are) most likely to be involved in the diverticulitis? A - Escherichia coli B - Bacteroides fragilis C - Streptococcus pneumoniae D - a and b

D

The initial management of intussusception includes all of the following except A - Passage of nasogastric tube placed for decompression B - Placing an intravenous line for rehydration. C - Starting intravenous antibiotics. D - Hydrostatic barium enema.

D Adequate resuscitation must be carried out before hydrostatic barium enema is done to confirm the diagnosis and to reduce the uncomplicated intussusception. Options A - C are resuscitative measures.

if you suspect a mallory weiss tear, what investigative modality is required to confirm the diagnosis? A Chest X-ray B Barium swallow C Barium meal D Esophagogasatroscopy

D Esophagogastroscopy is used to make a definitive diagnosis of Mallory-weiss tear and also for treating it if indicated.

Which of the following is not an extraintestinal manifestation of inflammatory bowel disease? A Uveitis B Erythema nodosum C Arthritis D dermatitis herpetiformis

D Dermatitis herpetiformis (A chronic, very itchy skin rash made up of bumps and blisters) is an extraintestinal manifestation of celiac disease. All other options are correct.

Which of the following is not a treatment modality for esophageal stricture? A Proton Pump Inhibitor B Endoscopic dilatation C Endoscopic intralesional steroid D Endoscopic sclerotherapy

D Endoscopic sclerotherapy is used in the treatment of bleeding esophageal varices.

Which of the following is not a cause of distal esophageal stricture? A GERD B Adenocarcinoma C Scleroderma D Infectious esophagitis

D Infectious esophagitis causes stricture mostly at the proximal and mid esophagus

A 45 year old man with decompensated liver cirrhosis (ascites and progressive jaundice) had screening endoscopy done which showed non bleeding large esophageal varices. Which of the following drug would you give to help prevent variceal bleeding? A Omeprazole B Lactulose C Ranitidine D Propranolol

D Nonselective beta-adrenergic blockers (e.g. Propranolol) are recommended to reduce the risk of first variceal hemorrhage in patients with medium/large varices and patients with small varices who either have variceal red wale marks or advanced cirrhosis.

Which of the following statements concerning inflammatory bowel disease is not true? A Ulcerative colitis is more common in non-smokers and ex-smokers. B Appendectomy protects against ulcerative colitis. C Crohn disease causes segmental transmural inflammation of the bowel. D Ulcerative colitis affects the colon in a descending fashion.

D Ulcerative colitis is isolated to colon and confined to mucosa and submucosa. Most common site is the rectum. Ulcerative colitis affects the colon in an ascending fashion starting from the rectum up to the ascending colon.

Initial resuscitation of a patient with toxic megacolon includes all of the following except A Placing of intravenous line for rehydration and electrolyte correction. B Administration of broad spectrum intravenous antibiotics. C Passage of a nasogastric tube for decompression. D Administration of an antidiarrheal agent.

D if pts are on narcotic, antidiarrheals, and anticholinergics they should not be given and should be stopped

Which of the following statements is false? A - Hiatal hernia contributes to the development of GERD. B - Excessive reflux is defined as a pH <4 for >4% of the time C - In most patients with GERD, baseline LES pressures are normal (10-35 mm Hg). D - Endoscopy is indicated in all cases of GERD

D - Endoscopy is indicated in all cases of GERD Endoscopy is not indicated in all cases of GERD. Young patients who present with typical symptoms of GERD with ALARM symptoms can be treated empirically without investigation. Investigation is advisable if patients present in middle or late age, if symptoms are atypical or if a complication is suspected.

A patient's hepatitis B profile showed presence of antibody to hepatitis B surface antigen and antibody to hepatitis B core antigen. Which of the following is correct? A - acute hep B infection B - chronic active hep B infection C - previous hep B vaccination D - previous hepatitis B infection

D - previous infection The presence of antibodies to hepatitis B surface antigen and antibodies to hepatitis B core antigen indicates previous hepatitis B infection. In Acute hepatitis B infection, hepatitis B surface antigen (present for < than 6 months) and no antibody will be seen. IgM antibody to hepatitis B core antigen will be raised. In previous hepatitis B vaccination, only antibodies to hepatitis B surface antigen will be seen. In chronic active hepatitis B infection, hepatitis B surface antigen (present > than 6 months) and no antibody will be seen. IgG antibody to hepatitis B core antigen will be raised.

A 48-year-old Caucasian woman with a chronic history of inability to tolerate oral intake is admitted to the hospital for J-tube placement. The patient also reports a rash that has developed on her upper extremities. Examination reveals diffuse petechiae and perifollicular hemorrhage. What is the most likely nutritional deficiency causing the rash? A Niacin B Cobalamin C Biotin D Ascorbic acid E Choline

D Ascorbic acid

A 58-year-old woman presents with a 3-month history of postprandial abdominal pain that always occurs 30 minutes after eating. Due to these symptoms, the patient has lost 30 pounds and is afraid to eat. Past medical history includes hypertension treated with enalapril and coronary artery disease for which she has undergone a right coronary artery stent; she underwent a carotid endarterectomy for symptomatic carotid stenosis. She has smoked 2 packs of cigarettes a day for 30 years. What is the best initial test for this patient? A Barium enema B Mesenteric angiogram C Mesenteric duplex ultrasound D Computerized tomography angiography E Magnetic resonance angiography

D CTA

The most common site for blood-borne metastasis of rectal cancer is A Lungs B Adrenals C Brain D Liver

D Liver

Early one afternoon, a 12-year-old boy presents with his parents to the ER with lower right abdominal pain, anorexia, nausea, and vomiting. He rates his pain at 8/10. Pain started around the umbilical area and has moved to the right lower abdomen worsening since the onset of symptoms of nausea and vomiting this morning. He denies any known history of gastrointestinal disease or recent illnesses. He denies any known ill contacts. Vital signs include temperature of 101°F, heart rate 80 bpm and regular, blood pressure 118/70 mm Hg. Based on the suspected diagnosis, what do you expect to find on physical exam? A Cullen's sign B Murphy sign C Grey Turner's sign D Rovsing's sign E Dance's sign

D Rovsings sign

A 48-year-old man comes to your office with a vague lower right-sided abdominal fullness (not pain). He describes to you a general feeling of "not feeling well," fatigue, and a somewhat tender area "down near my appendix." He states, "I have no energy. I'm tired all the time." He also suspects that his skin changed color, first to a pale color and then to slightly yellow. On direct questioning, he admits to anorexia, weight loss of 30 pounds in 6 months, nausea most of the time, vomiting twice, some diarrhea that seems to be mucus, and blood in the stool almost every day for the past 3 months. When you ask him what he makes of all of this, he tells you, "Maybe a very bad flu." On examination, the patient looks very pale. Examination of the abdomen reveals abdominal distention. You record the abdominal girth as a baseline. There is a sensation of "fullness" in the right lower quadrant of the abdomen. This area is also dull to percussion and is slightly tender. There is definite percussion of tympani on both sides of the area of dullness. The liver span is approximately 20 cm. The sclerae are yellow. What is the definitive diagnostic procedure of choice in this patient? A complete blood count (CBC) B fecal occult blood samples C air-contrast barium enema D colonoscopy

D colonoscopy The diagnostic procedure of choice in this patient is a total colonoscopy to confirm a mass lesion, to determine the location of that lesion, and to obtain a biopsy specimen of the lesion if possible.

A 33-year-old woman presents for an annual physical. She has past medical history of GERD, asthma, and irritable bowel syndrome. She drinks 1-2 alcoholic beverages per week and has never smoked; she does not use illicit drugs, and she consumes a vegetarian diet. Her past surgical history includes an appendectomy at age 14. Her father passed away from a heart attack at age 63. Her mother is alive with history of colorectal cancer, which was diagnosed at age 41. What is the recommended colorectal cancer screening for this patient? A Screening colonoscopy at age 50 B Screening colonoscopy at age 45 C Screening colonoscopy if she becomes hemoccult positive D Immediate screening colonoscopy

D immediate screening colonoscopy

A 15-year-old girl presents with a 1-year history of intermittent abdominal pain with nausea and occasional bloody diarrhea. She denies fever and weight loss; there is no travel history. Past medical history is significant only for migraines. She takes a multivitamin. Her vital signs are within normal limits. She has mild diffuse abdominal tenderness to palpation and guaiac-positive stool. Her exam is otherwise normal. Hemoglobin 9.7, hematocrit 28%, WBC 12,000/uL. What is the most appropriate next step in her management? A Monitor clinically and schedule follow-up in 2 months B Begin trial antibiotics for possible bacterial gastroenteritis C Order ultrasound of the abdomen D Send stool studies and refer for colonscopy E Refer immediately to the emergency department

D send stool studies and refer for colonoscopy

A 10-year-old boy presents with a 2-month history of intermittent burning pain in the epigastrium. Pain is felt more during the night and between meals; it is partly relieved by eating food or by taking antacids. Pain usually lasts 30-60 minutes and is accompanied by nausea and vomiting. He often has a feeling of bloating and burping. He remains asymptomatic for several days between. There is no history of taking analgesics or anti-inflammatory drugs. Physical examination shows epigastric tenderness. The rest of the examination is essentially normal. Stool examination for occult blood is positive. What is the investigation of choice for establishing the diagnosis? A Abdominal ultrasound B Upper GI barium studies C CT scan abdomen D Stool microscopy E Upper GI endoscopy

E

In patients who present with bleeding esophageal varices what medication is often given IV to stop the bleeding. A PPI B Octreotide C Vasopressin D all of the above E both B and C

E

Which of the following may help prevent formation of new polyps in patients with polyps or colon cancer A Aspirin B Cox-2 inhibitors C Propranolol D Metformin E both a and b

E Aspirin and COX-2 inhibitors may help prevent formation of new polyps in patients with polyps or colon cancer

An African American male neonate born 12 hours ago presents with yellowish coloration of the whites of his eyes. His skin also appears darker and yellowish compared to his twin sister's skin. Pregnancy was normal, and the 23-year-old mother had no infections or complications and took no drugs during the pregnancy. Delivery was uneventful; the neonates were born on term with APGAR score 9 and 10, respectively. Family history of anemia, splenectomy, bile stones, and liver disease is negative, but the father has a "beans allergy" that presents with abdominal pain and jaundice. Peripheral smear does not reveal spherocytosis, echinocytosis, or eliptocytosis, but some keratocytes are present. Bilirubin levels in the patient are high (13 mg/dL) with direct bilirubin 1 mg/dL. Coombs test is negative and hemoglobin is low. What is the most likely diagnosis? A Breastmilk jaundice B Breastfeeding jaundice C Rotor syndrome D Neonatal sepsis E Glucose-6-phosphate dehydrogenase deficiency

E G6PD deficiency

A 2-year-old boy with his parents presents with colicky pain, a history of irritability, and a 2-day history of lethargy. There is also history of rectal bleeding and passage of "currant jelly" stool for the past 2 days. Vital signs reveal blood pressure of 105/70 mm Hg, heart rate of 90 bpm, respiration of 18/minute, and temperature 99.2°F. Plain abdominal film shows evidence of obstruction, and barium enema detects coiled-spring appearance to the bowel. Based on the most likely diagnosis, what is the best next step in management of this patient? A Resection of the bowel B Reduction by contrast enema C Observation for spontaneous reduction D Manual reduction E Reduction by air enema

E Reduction by air enema

A 36-year-old woman presents with a 24-hour history of sudden severe diarrhea described as profuse, gray, cloudy, watery stools without blood or fecal odor. She was recently in Bangladesh for work and returned yesterday, which was when the diarrhea began. She is also experiencing a mildly elevated temperature with a very dry mouth, headache, and severe fatigue. What is the most likely offending organism? A Clostridioides difficile B Enterotoxigenic E. coli C Norwalk virus D Shigella dysenteriae E Vibrio cholerae

E Vibro Cholerae

A 38-year-old man presents with a 2-day history of a mass and severe pain in his scrotum. Physical examination reveals that his right testicle appears much larger than his left. On palpation, you note a small hole in his inguinal canal, and you are unable to place the contents into the canal. The contents of the hernia appear ischemic. What is the best description of this hernia? A Incarcerated B Irreducible C Recurrent D Reducible E Strangulated

E strangulated

Patient will present as → a 20-year-old healthy male was treated 4 days ago for an MRSA skin infection with sulfamethoxazole-trimethoprim (Bactrim). The infection is improving but he is increasingly weak, and his sclera have turned yellow. Today his hemoglobin is 11 g/ dL (13.5 to 18 g/ dL) and his MCV is 85 (80 to 100 fL); the corrected reticulocyte count is elevated, and he has increased indirect bilirubin and decreased haptoglobin. The peripheral smear demonstrates bite cells and Heinz bodies.

G6PD deficiency

Patient will present as → a 55-year-old male with complaints of heartburn, belching, and epigastric pain, which is aggravated by drinking coffee, eating fatty foods, and lying down. He says it gets better when he takes antacids.

GERD

An endoscopy for presumed esophagitis shows multiple shallow ulcers. What is the most likely diagnosis?

HSV

Which type of Hepatitis is associated with a high infant mortality rate in pregnant women?

Hep E = high infant mortality

A 2-year old child was brought in by her mother on account of a 2-day history of profuse watery diarrhea, vomiting, anorexia and lethargy? On examination, child appears lethargic, eyes are very sunken, dry buccal mucosa, decreased skin turgor, drinks water poorly when given, capillary refill: 3s, Pulse rate: 152/min. What is the first step you would take in the management of this patient?

IV rehydration

what is the true gold standard for diagnosing GERD, although rarely ordered?

PH monitoring with intra-esophageal electrode

Patient will present as → a 72-year-old man presents to the emergency department after a fall outside of church. He complains only of left hip pain which has been progressively worsening for the past six months. He denies hitting his head during the fall, but according to his wife, he has been complaining of worsening headaches. His temperature is 98.6°F (37°C), blood pressure is 110/60 mmHg, pulse is 80/min, and respirations are 18/min. Examination of the right lower extremity reveals mild crepitus at the hip, appropriate range of motion, adequate distal sensation, and palpable posterior tibial and dorsalis pedis pulses. Review of his laboratories reveals a serum alkaline phosphatase level that is markedly elevated.

Paget's dz

Patient will present as → a 5-year-old boy who is brought by his parents due to poor growth, weakness, and abnormal gait. On physical exam, there is bowing of the legs and tenderness upon palpation of the lower extremity. Laboratory testing is significant for decreased serum calcium and phosphate levels and elevated parathyroid hormone and serum alkaline phosphatase levels.

Rickets (secondary to vit d deficiency)

Patient will present as → a 65-year-old female with diffuse abdominal pain and vomiting. She has not had a bowel movement in three days. PE reveals high-pitched, hyperactive bowel sounds, tympany to percussion, no rebound tenderness, and a temperature of 100.4 F. Abdominal radiograph reveals distended loops of bowel with a step ladder pattern of differential air-fluid levels.

Small bowel obstruction

What constitutes a positive hydrogen breath test?

The hydrogen breath test is positive for lactose malabsorption if the post lactose breath hydrogen value rises greater than 20 ppm over the baseline measurement

is UC or CD more likely to present with bloody stool

UC, CD can but more rare

Patient will present as → a 49-year-old female with a 2-day history of right-upper-quadrant, colicky abdominal pain, as well as nausea and vomiting. Examination shows significant pain with palpation in the right upper quadrant. Laboratory findings include an elevated WBC count, alkaline phosphatase, and bilirubin level.

acute cholecystitis

ulcer in the anterior duodenum can cause ___

acute pancreatitis due to bleeding into gastroduodenal artery

which type of polyp is more likely to become malignant ?

adenomatous polyps

Patient will present as → a 45-year-old man with severe rectal pain when he defecates, lasts for several hours, and subsides until the next bowel movement. He has been constipated for the past 6 months and when he does have a bowel movement the stool is covered with bright red blood. A sentinel pile is noted on the physical exam.

anal fissure

shortness of breath, hypoxia, hypotension can be signs of

anaphylaxis

surgical management for chronic mesenteric ischemia

angioplasty with or without stenting revascularization

Patient will present as → a 69-year-old male who complains of rectal pruritus, bleeding with defecation, and a sensation of incomplete evacuation. A palpable mass is noted on digital rectal examination.

anorectal cancer

Patient will present as → a 14-year-old boy with nausea, vomiting, constipation, and periumbilical pain that has settled in the lower right quadrant. The patient's mom gave him a piece of toast and some water about 5 hours ago but he vomited 30 minutes after eating. On physical exam, he has tenderness and guarding in the lower right quadrant, pain upon flexion and internal rotation of right lower extremity, RLQ pain with right hip extension, and RLQ pain with palpation of the LLQ. Blood tests reveal leukocytosis with a shift to the left.

appendicitis

what is ischemic bowel disease and what vessel in most commonly blocked?

artery blocked/narrowed bc of tumor, clot, atherosclerosis etc superior mesenteric artery

encephalopathy, oculomotor dysfunction, gait ataxia

b1 deficiency (thiamine)

Macrominerals

calcium, phosphorus, magnesium, sodium, potassium, chloride, sulfur

most common cause bacterial gastroenteritis in children and adults

campylobacter

Patient will present as → a 58-year-old male with acute onset of abdominal pain associated with fever and shaking chills. The patient is hypotensive and febrile with a temperature of 102.2 ° F. Although he is confused and disoriented, he complains of right upper quadrant pain during palpation of the abdomen. His sclerae are icteric and the skin is jaundiced

cholangitis

Microminerals (trace minerals)

chromium, cobalt, copper, fluorine, iodine, iron, manganese, molybdenum, selenium, zinc

Patient will present as → a 63-year-old white male with a chief complaint of blood in his stool. He is accompanied by his wife who also reports weight gain, abdominal distension, and swelling of his legs. Physical exam reveals a healthy-appearing male with 3+ bilateral lower extremity edema and distended abdomen with evidence of shifting dullness. You also note several skin lesions seen here. The patient is hemoccult positive and has blood on his urine dipstick. He denies tobacco and illicit drug use but admits to drinking 1-2 x per week and has about 6 beers on each occasion.

cirrhosis

what antibiotic is most commonly associated with causing cdiff

clindamycin

where is diverticulosis most likely to turn into diverticulitis

colon

Patient will present as → a 65-year-old male with several months of weight loss, vague right upper quadrant pain, and thin-caliber stools. His medical history is notable for 50-pack-years of smoking and obesity. On exam, he appears chronically ill and has firm hepatomegaly. His labs reveal a hemoglobin of 10.7 g/dL and mildly elevated ALT and AST.

colon cancer

Meckel's diverticulum

congenital at terminal ilium that may ulcer, perforate, obstuct

Patients with esophageal spasms will have what abnormality on barium swallow?

corkscrew esophagus

A colonoscopy that shows cobblestone or skip lesions should make you think of what diagnosis?

crohns

A patient presents complaining of blood during bowel movements. She is found to have multiple perianal fistulas on rectal examination. There is also a history of episodic diarrhea, mid and lower abdominal pain/cramping, fatigue, and weight loss. Which of the following is the most likely diagnosis?

crohns

a 25-year-old man with an 18-month history of chronic abdominal pain. The patient has seen several physicians and has been diagnosed as having a "nervous stomach," irritable bowel syndrome, and "depression." Associated with this abdominal pain for the past 3 months have been nonbloody diarrhea, anorexia, and a weight loss of 20 pounds. He has developed a painful area around the anus. On examination, the patient has diffuse abdominal tenderness. He looks thin and unwell. He has a tender, erythematous area in the right perirectal area.

crohns

what disease should you consider if you see a fistula in the anus

crohns

A 79-year old woman presents with left lower quadrant abdominal pain with a history of changes in her elimination pattern. Physical examination reveals abdominal distention, tenderness and a palpable mass in the left lower quadrant. Barium enema shows segmental spasm and muscular thickening with a narrowed lumen. What is the most likely diagnosis? A Celiac disease B Crohn disease C Ulcerative colitis D diverticulitis

d Diverticulitis presents commonly as left lower quadrant pain, tenderness, palpable mass, and abdominal distention.

67-year-old man with a long history of constipation presents with steady left lower quadrant pain. Physical exam reveals low-grade fever, mid-abdominal distention, and lower left quadrant tenderness. Stool guaiac is negative. An absolute neutrophilic leukocytosis and a shift to the left are noted on the CBC.

diverticulitis

a 63-year-old male who is being evaluated in the emergency department for an episode of painless bright red blood per rectum for two hours.

diverticulosis

Patient will present as → a 62-year-old female with complaints of epigastric pain and belching which improves when she eats food but gets worse a few hours after her meal. She said he has noticed a change in the color of her stool.

duodenal ulcer

tests to consider for nausea and vomiting

electrolytes, liver function tests, pancreatic enzymes, pregnancy test; imaging/endoscopy to consider blockage

Patient will present as → a 62-year-old man with a history of alcoholism complains of difficulty swallowing solids that has progressed to difficulty swallowing liquids. He has smoked 1-2 packs of cigarettes per day for the past 38 years. In addition, he reports occasional bouts of hematemesis and hoarseness, along with progressive weight loss and weakness.

esophageal cancer

Patient will present with → solid food dysphagia in a patient with a history of GERD

esophageal stricture

Patient will present as → a 64-year-old man with a history of alcoholism, tobacco use, and hypertension presents to the general surgery clinic where he was referred for further evaluation of blood in his stool. He reports occasional abdominal pain relieved transiently with meals and one episode of painful vomiting. Recently, his stools have been black. Spider angiomas, but no palmar erythema or hepatosplenomegaly are observed on the exam.

esophageal varices

Patient will present as → a 54-year-old female with odynophagia (painful swallowing), dysphagia, and retrosternal chest pain

esophagitis

Patient will present as → an elderly bed-bound patient with impaired mental function and poor fluid/fiber intake who complains of incontinence of liquid stool. He also reports rectal pressure and lower abdominal pain. The pain is cramping in quality and the patient's abdomen is "bloated." Digital rectal examination reveals a large amount of stool in the rectum.

fecal impaction

Patient will present with → abdominal discomfort that is worse with meals and gets better an hour or so later after eating.

gastric ulcer

Dyspepsia and abdominal pain are common indicators of

gastritis

Patient will present as → a 37-year-old male with a history of daily NSAID use complaining of epigastric pain, nausea, and vomiting, all worsened by eating. On physical examination, he is tender to palpation in the epigastrium. He admits to drinking approximately two beers per day.

gastritis

Lactase enzyme breaks down lactose into

glucose and galactose

Patient will present as → a 6-week-old first-born baby boy with projectile vomiting after feedings over the last 24 hours. Mom says that he enjoys feeding, and even after he vomits, he appears eager and hungry. On physical exam, you palpate an olive-shaped mass in the epigastric region at the lateral edge right upper quadrant. Labs show a blood pH of 7.47 and potassium of 3.2 mmol/L. On a barium upper GI series report, the radiologist states a "string sign" is present

hypertrophic pyloric stenosis

Patient will present as → a young mother who brings her 12-month-old daughter to your office reporting that she has had recurrent "belly aches" for the past two weeks. The child experiences sudden, colicky abdominal pain that recurs every 15 to 20 min, often with vomiting. These episodes are interspersed with periods of no complaints. The mother also reports that she has seen her squatting with her knees to her chest, which seems to relieve her of her symptoms. She describes her stool as bloody with mucus, almost as though it were a currant jelly. On physical examination, you note abdominal distention and tenderness along with a sausage-shaped abdominal mass in the RUQ.

intussusception

Patient will present as → a 40-year-old woman who comes to your office with a several-year history of lower abdominal pain associated with constipation (one hard bowel movement every 3 days) and frequent mucous discharge. She states that her abdominal pain is better after a bowel movement. She has never passed blood per rectum. She describes no fever, chills, weight loss or gain, jaundice, or any other symptoms. There is no relationship between the abdominal pain and specific food intake. On physical examination, the abdomen is scaphoid, and no hepatosplenomegaly or masses are palpated. There is a mild generalized abdominal tenderness, but it does not localize.

irritable bowel syndrome

Patient will present as → a 71-year-old male with a history of atrial fibrillation with a sudden onset of severe abdominal pain occurring 10 minutes after eating. Physical exam findings are relatively benign, and the patient has only minimal pain with palpation of the abdomen. Stool guaiac is positive and blood tests reveal leukocytosis with an elevated lactate, amylase, and LDH.

ischemic bowel dz

Patient will present as → a 71-year-old male with abdominal distension and colicky pain. Physical exam reveals high-pitched bowel sounds and diffuse abdominal tenderness. The abdominal radiograph demonstrates a distended proximal colon with haustra, air -fluid-levels and no gas in the rectum.

large bowel obstruction

Patient will present as → a 21-year-old male with hematemesis. He is brought by his girlfriend who reports that he and his buddies have been out drinking every night last week in celebration of his 21st birthday. He reports having vomited each night, but tonight when he started vomiting, he noticed that there was streaking of blood. Concerned, he decided to come to the emergency department.

mallory weiss tear

are there any lab abnormalties seen in ibs

no

Patient will present as → a 2-month-old infant with blond hair, blue eyes, and fair skin. He has microcephaly and progressive impairment of cerebral function. On physical examination, you notice an eczematous rash and the patient is vomiting. In addition, he has a musty, mousy odor.

phenylketonuria Phenylalanine and its metabolites accumulate in the central nervous system, causing mental retardation and movement disorders

Patient will present as → a 47-year-old man with severe rectal pain when he defecates. He has a fever of 102.2 F (39 C). On exam there is perianal swelling, redness and tenderness. A palpable mass is felt at the anal verge as seen here.

rectal abscess/fistula

G6PD deficiency pathophys

reduction in energy available to maintain the red blood cell membrane leading to hemolysis

A patient has a positive Anti-HBc IgG and a positive Anti-HBs. What is the status of this patient's Hepatitis B infection?

resolved acute hep B infection

Deep palpation of the left iliac fossa causing pain in the right iliac fossa is

rovsing's sign (appendicitis)

What is a risk factor for an increased incidence of duodenal and gastric ulcers, as well as a decrease in rate of healing?

smoking

A Schatzki ring will cause dysphagia to:

solids A Schatzki ring is a stricture of the mucosa causing a lower esophageal constriction at the squamocolumnar junction. MC associated with a hiatal hernia.

lymph nodes involved in gastric cancer

supraclavicular left or umbilical

Familial adenomatous polyposis (FAP) is clinically defined by

the presence of more than 100 colorectal adenomas

Patient will present as → a patient brought into the emergency room appearing quite ill. He has a fever of 103.2°F, dry skin and oral mucosal membranes, and abdominal distention and tenderness. His medical history is significant for ulcerative colitis.

toxic megacolon

toxic colitis can become __

toxic megacolon (life threatening)

a 32-year-old woman comes to your office with a 6-month history of loose bowel movements, approximately eight per day. Blood has been present in many of them. She has lost 30 pounds. For the past 6 weeks, she has had intermittent fever. She has had no previous gastrointestinal (GI) problems, and there is no family history of GI problems. On examination, the patient looks ill. Her blood pressure is 130/ 70 mm Hg. Her pulse is 108 beats/ minute and regular. There is generalized abdominal tenderness with no rebound. A sigmoidoscopy reveals a friable rectal mucosa with multiple bleeding points.

ulcerative colitis