The Quizzes about Gastroenterology disease – Part 1 (20 test)

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The Quizzes about Gastroenterology disease – Part 1 (20 test)
5 (100%) 2 votes

Select the ONE answer that is BEST in each case.

A 56-year-old woman presents with weight loss and watery diarrhea. She also notices periumbilical pain and bloating after eating. A small bowel x-ray reveals an area of narrowing and the lesion is surgically resected. The pathology report shows this to be the most common endocrine tumor of the GI tract.

Carcinoid tumors account for up to 75% of all GI endocrine tumors. They are frequently multiple. Primary carcinoid tumors of the appendix are common but rarely metastasize. Those in the large colon may metastasize but do not function. Carcinoids are the most common GI endocrine tumors. They arise from neuroendocrine cells most commonly in the GI tract, pancreas, or bronchi. GI carcinoids cause abdominal pain, bleeding, or even obstruction (usually via intussusception). Carcinoid syndrome is characterized by flushing, diarrhea, and valvular heart disease.

 

See all quizzes of  the Gastroenterology disease at here:

Part 1Part 2 | Part 3 |

 

1. A 56-year-old woman presents with weight loss and watery diarrhea. She also notices periumbilical pain and bloating after eating. A small bowel x-ray reveals an area of narrowing and the lesion is surgically resected. The pathology report shows this to be the most common endocrine tumor of the GI tract. (SELECT ONE)

(A) polypoid adenoma

(B) leiomyoma

(C) lipoma

(D) adenocarcinoma

(E) primary gastrointestinal (GI) lymphoma

(F) carcinoid tumor

2. A 72-year-old man is investigated for iron deficiency anemia. There is no clinical history of upper or lower GI bleeding, but his stools are fecal occult blood positive. His colonoscopy is negative for any obvious sources of bleeding, but upper endoscopy reveals ulceration in the distal duodenum that is biopsied. The pathology report shows this to be the most common primary malignancy of the small bowel. (SELECT ONE)

(A) polypoid adenoma

(B) leiomyoma

(C) lipoma

(D) adenocarcinoma

(E) primary gastrointestinal (GI) lymphoma

(F) carcinoid tumor

3. A 23-year-old man of Middle Eastern decent is investigated for symptoms of chronic diarrhea, vomiting, and abdominal cramps. He has lost 20 lb and appears unwell. A small bowel x-ray shows diffuse nonspecific mucosal abnormality. Upper endoscopy is performed to visualize the small bowel and obtain biopsies. The pathology report identifies the mucosal abnormality as “immunoproliferative small intestinal disease” (IPSID). This form of small bowel tumor can be treated with antibiotics in its early stages. (SELECT ONE)

(A) polypoid adenoma

(B) leiomyoma

(C) lipoma

(D) adenocarcinoma

(E) primary gastrointestinal (GI) lymphoma

(F) carcinoid tumor

4. A 21-year-old woman develops acute periumbilical pain that localizes to the right lower quadrant. She appears unwell, and on examination, there is tenderness and guarding in the right lower quadrant. A pregnancy test is negative and a pelvic examination rules out pelvic inflammatory disease. A clinical diagnosis of acute appendicitis is made and she has an uncomplicated laparoscopic appendectomy. The pathology report notes acute inflammation and a tumor for which the appendix is a very common site of involvement. (SELECT ONE)

(A) polypoid adenoma

(B) leiomyoma

(C) lipoma

(D) adenocarcinoma

(E) primary gastrointestinal (GI) lymphoma

(F) carcinoid tumor

5. A 57-year-old woman with a 20-year history of celiac disease now presents with weight loss, cramps, and abdominal discomfort. She is adherent to her gluten-free diet, and is not taking any new medications. On examination, her abdomen is soft and there is fullness in the right lower quadrant. A small bowel x-ray reveals an area of narrowing in the distal ileum, and there is thickening and nodularity of the mucosal folds. She undergoes surgical resection of the lesion, and the pathology report confirms a tumor that is more common in patients with celiac disease, Crohn’s disease, or depressed immune function such as human immunodeficiency virus (HIV). (SELECT ONE)

(A) polypoid adenoma

(B) leiomyoma

(C) lipoma

(D) adenocarcinoma

(E) primary gastrointestinal (GI) lymphoma

(F) carcinoid tumor

10. A 43-year-old woman has had a 10-year history of severe and recurrent peptic ulcer disease (PUD) that is refractory to medical therapy. She has had ulcers at multiple sites of the small bowel including the distal duodenum and jejunum. She also has chronic diarrhea, but not enough fat to make the diagnosis of steatorrhea. Evaluation for Helicobacter pyloriinfection is negative. (SELECT ONE)

(A) celiac sprue

(B) gastrinoma

(C) associated with decrease in pancreatic enzymes

(D) hyperthyroidism

(E) regional enteritis

(F) associated arthritis

(G) associated with skin pigmentation

(H) increase in pancreatic enzymes

(I) hypersensitivity reaction

(J) an infectious agent

(K) may present with iron deficiency

(L) associated with skin disease

11.  A 79-year-old woman with severe constipation is found to have multiple diverticuli on colonoscopy. Which of the following is the most appropriate next step in management?

(A) stool softeners

(B) prophylactic surgery

(C) phenolphthalein laxatives

(D) increasing dietary fiber

(E) psychotherapy

12. A 77-year-old woman is brought to the emergency room because of nonspecific abdominal discomfort. She has no anorexia, fever, chills, or weight loss. Her abdomen is soft and nontender on physical examination. Abdominal x-rays show lots of stool in the colon, but no free air or air-fluid levels. The amylase is 150 U/L (25–125 U/L), and the rest of her biochemistry and complete blood count are normal. Which of the following conditions can cause a falsepositive elevation in the serum amylase?

(A) maturity-onset diabetes mellitus (DM)

(B) gastric ulcer

(C) renal failure

(D) sulfonamide therapy

(E) gastric carcinoma

13. A 71-year-old man develops progressive weight loss and dysphagia over a 3-month period. Upper endoscopy and biopsy of the lesion confirm esophageal cancer. Which of the following statements regarding this cancer is most likely correct?

(A) is very responsive to chemotherapy

(B) is more common in females

(C) has a 5-year cure rate of 20%

(D) may be either adenocarcinoma or squamous cell carcinoma

(E) is characterized by significant complications from hemorrhage

14. A 23-year-old woman presents with weight loss and chronic diarrhea. She appears unwell and cachectic. Routine laboratory tests reveal a low hemoglobin level and an increased international normalized ratio (INR) even though she is not taking any anticoagulants. The liver enzymes are normal, but the albumin and calcium levels are low, suggesting generalized malnutrition. Which of the following is the most appropriate initial diagnostic test for malabsorption?

(A) xylose absorption

(B) Schilling test

(C) x-ray studies

(D) stool fat quantitation

(E) small intestinal biopsy

15. A 33-year-old man has never been vaccinated for hepatitis B. Serologic tests reveal negative hepatitis B surface antigen (HBsAg) and positive antibody to surface antigen. Which of the following conditions does this serologic pattern best fit with?

(A) previous hepatitis B infection

(B) chronic active hepatitis

(C) acute hepatitis B infection

(D) poor prognosis

(E) need for vaccine to hepatitis B

16. A 29-year-old woman is found, on routine annual blood testing, to have an increase in unconjugated bilirubin. There is no evidence of hemolysis and liver tests are otherwise normal. Which of the following is the most likely diagnosis?

(A) Crigler-Najjar syndrome

(B) Dubin-Johnson syndrome

(C) Rotor’s syndrome

(D) Gilbert’s syndrome

(E) pregnanediol therapy

17. An 18-year-old woman was diagnosed 7 years earlier with precocious pseudopuberty secondary to ovarian tumor. Physical examination reveals oral and lingual dark pigmentation. Which of the following is the most likely diagnosis?

(A) Peutz-Jeghers syndrome

(B) Gardner’s syndrome

(C) Lynch syndrome

(D) juvenile polyposis

(E) Turcot’s syndrome

18. A 63-year-old man has stools positive for occult blood. Which of the following is the most likely location of bowel cancer?

(A) cecum

(B) sigmoid

(C) transverse colon

(D) appendix

(E) ascending colon

19. A 74-year-old man underwent some type of peptic ulcer surgery years ago. He has symptoms that include abdominal pain and bloating about 30–40 minutes after eating, accompanied by nausea. If he vomits, the symptoms are relieved. Which of the following is the most likely cause for his symptoms?

(A) early dumping syndrome

(B) late dumping syndrome

(C) bile reflux gastropathy

(D) retained gastric antrum

(E) afferent loop syndrome

20. A 29-year-old man with acquired immune deficiency syndrome (AIDS) comes to the emergency department because of progressively increasing abdominal discomfort. Examination shows voluntary guarding in the upper abdomen. His biochemistry is normal except for an elevated amylase at 370 U/L (25–125 U/L). Which of the following infections can trigger this disorder in AIDS patients?

(A) toxoplasmosis

(B) Mycobacterium aviumcomplex

(C) Mycobacterium tuberculosis

(D) Pneumocystis carinii

(E) herpes virus

21. A 55-year-old man from China is known to have chronic liver disease, secondary to hepatitis B infection. He has recently felt unwell, and his hemoglobin level has increased from 130 g/L, 1 year ago, to 195 g/L. Which of the following is the most appropriate initial diagnostic test?

(A) alkaline phosphatase

(B) alpha-fetoprotein (AFP)

(C) aspartate transaminase (AST)

(D) alanine transaminase (ALT)

(E) unconjugated bilirubin

22. A 63-year-old man with a long history of alcohol abuse presents with ascites. He is experiencing mild abdominal discomfort and nausea. Examination reveals tense ascites and generalized tenderness but no rigidity. A diagnostic paracentesis of the fluid is performed. Which of the following ascitic fluid results is most likely to suggest an uncomplicated ascites due to portal hypertension from cirrhosis?

(A) hemorrhage

(B) protein >25 g/L

(C) bilirubin level twice that of serum

(D) serum to ascites albumin gradient >1.1 g/dL

(E) more than 1000 white cells/mm

23. A 64-year-old woman develops sudden-onset abdominal discomfort after eating a large meal. The pain is constant, localizes to the epigastric area with radiation to her right scapula. She also has nausea and vomiting. It eventual subsides 1 hour later. An ultrasound of the abdomen reveals a dilated common bile duct secondary to stones. Which of the following statements regarding common bile duct stones is most likely true?

(A) all originate in the gallbladder

(B) always produce jaundice

(C) produce constant level of jaundice

(D) can be painless

(E) indicate anomalies of the bile duct

24. A 53-year-old man presents with diarrhea. He also complains of facial flushing lasting minutes at a time. Physical examination reveals facial telangiectasias and a heart murmur not present 2 years before. This murmur is accentuated by deep breathing. Which of the following is the most appropriate initial diagnostic test?

(A) urinary vanillylmandelic acid (VMA)

(B) serum noradrenaline levels

(C) barium enema

(D) serum serotonin levels

(E) urinary 5-hydroxyindolacetic acid

(5-HIAA)

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