The Quizzes about Gastroenterology diseases – Part 3 (27 test)

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The Quizzes about Gastroenterology diseases – Part 3 (27 test)
5 (100%) 1 vote

Select the ONE answer that is BEST in each case.

A 28-year-old man presents with symptoms of frequent bowel movements, crampy abdominal pain, and the passage of mucus. There is no history of any bloody diarrhea, but recently, he developed joint discomfort in his hands, knees, and back. On examination he is thin, and his abdomen is soft with voluntary guarding in the left lower quadrant. His joints are not actively inflamed and there is an asymmetric distribution. Which of the following is the most likely diagnosis?

Joint involvement in inflammatory bowel disease may involve sacroiliitis or specific large joint peripheral arthritis. The latter type of arthritis parallels the course of the bowel disease. The sacroiliitis (spondylitic) variety follows an independent course.

 

See all quizzes of  the Gastroenterology diseases at here:

Part 1Part 2 | Part 3 |

 

50. A 28-year-old man presents with symptoms of frequent bowel movements, crampy abdominal pain, and the passage of mucus. There is no history of any bloody diarrhea, but recently, he developed joint discomfort in his hands, knees, and back. On examination he is thin, and his abdomen is soft with voluntary guarding in the left lower quadrant. His joints are not actively inflamed and there is an asymmetric distribution. Which of the following is the most likely diagnosis?

(A) lymphoma of the bowel

(B) amyloid infiltration

(C) chronic pancreatitis

(D) ulcerative colitis

(E) tropical sprue

51. A 57-year-old man, recently discharged from the hospital, develops severe diarrhea and abdominal pain. Sigmoidoscopy reveals a granular friable mucosa. Which of the following is the most common cause of this syndrome?

(A) ischemic colitis

(B) rotavirus

(C) Clostridium perfringensinfection

(D) cephalosporin therapy

(E) bacterial invasion of the bowel wall

52. A 42-year-old previously well woman presents with pruritus. She is not taking any medications, and only drinks alcohol on a social basis. Her physical examination is entirely normal with no signs of chronic liver disease or jaundice. Laboratory evaluation reveals an alkaline phosphatase level of three times normal, and an ultrasound of the liver and gallbladder is normal. Which of the following is the most appropriate next step in diagnosis?

(A) INR or prothrombin time

(B) antinuclear antibodies

(C) protein immunoelectrophoresis

(D) abdominal ultrasound

(E) antimitochondrial antibodies

53. A 53-year-old man has weight loss, chronic diarrhea, and steatorrhea. He undergoes diagnostic investigations including small bowel biopsies. The biopsy report reveals normal small bowel mucosa. Which of the following is the most likely diagnosis?

(A) tropical sprue

(B) postgastrectomy steatorrhea

(C) Whipple’s disease

(D) nontropical sprue

(E) abetalipoproteinemia

54. A 22-year-old man with inflammatory bowel disease is noted to have a “string sign” in the ileal area on barium enema. In which of the following conditions is this sign most often seen? (See Fig. 4–4.)

(A) in the stenotic or nonstenotic phase of the disease

(B) in the stenotic phase only

(C) as a rigid, nondistensible phenomenon

(D) with gastric involvement

(E) with rectal involvement

55. A 22-year-old woman presents with chronic diarrhea. She has no abdominal discomfort, feels well, and reports no weight loss or systemic symptoms. Physical examination reveals a healthy young woman who is 5’7” tall and weighs 150 lb. The complete physical examination is normal. Which of the following is the most likely cause of a secretory diarrhea in this young woman?

(A) surreptitious use of stimulant laxatives

(B) carcinoid tumor

(C) ulcerative colitis

(D) lactose deficiency

(E) celiac disease

56. A 59-year-old man presents with abdominal distention and a decrease in bowel movements. He has had previous abdominal surgery. Which of the following findings is most likely to favor large bowel obstruction over small bowel obstruction?

(A) milder degree of pain

(B) temperature 103.1°F

(C) stepladder pattern and air-fluid levels on abdominal films

(D) bile in the vomitus

(E) hiccups

57. A 57-year old man comes to the office with a complaint of food “sticking on the way down.” Which of the following characteristics suggests a benign problem is causing the dysphagia?

(A) severe weight loss in comparison to the degree of dysphagia

(B) hoarseness following the onset of dysphagia

(C) episodic dysphagia for several years

(D) difficulty only with solids

(E) hiccups

58. A 70-year-old man is investigated for symptoms of dysphagia with solids, but not with liquids. There is no history of weight loss, and his physical examination is normal. Investigations reveal a Zenker’s diverticulum of the esophagus. Which of the following historical characteristics suggests a Zenker’s diverticulum?

(A) severe weight loss

(B) greater problems with liquids than solids

(C) hoarseness

(D) worse in semirecumbent position

(E) aspiration unrelated to swallowing

59. A 27-year-old man with HIV complains of pain every time he swallows (odynophagia). He is not on any antiretroviral therapy and otherwise feels well. Examination of the mouth and pharynx are normal. Which of the following is the most likely diagnosis?

(A) midesophageal cancer

(B) distal esophageal cancer

(C) peptic stricture

(D) candida infection

(E) bacterial esophagitis

60. A 33-year-old woman is recently diagnosed with primary biliary cirrhosis (PBC). She is inquiring about available treatments for this condition, including if there is a cure for the disease. Which of the following treatments is most likely to “cure” her PBC?

(A) ursodiol

(B) methotrexate

(C) azathioprine

(D) liver transplantation

(E) glucocorticoids

61. A 47-year-old woman complains of food sticking every time she eats anything solid. She has lost 10 lb since the symptoms started, and points to her midthorax as the site where she feels the food is sticking. If this is due to mechanical obstruction, this historical information suggests which of the following locations?

(A) at the location the patient points to

(B) at or above the location the patient points to

(C) below the location the patient points to

(D) at or below the location the patient points to

(E) the historical information is unhelpful in suggesting a location

62. A 52-year-old man has episodes of severe chest pain associated with dysphagia. He has been seen twice in the emergency room, and both times the symptoms responded to sublingual nitroglycerin. He then had a full cardiac evaluation including electrocardiogram (ECG), cardiac biomarkers, and an exercise stress test, which were all normal. Which of the following is the most likely diagnosis?

(A) herpetic infection

(B) a motor disorder

(C) midesophageal cancer

(D) peptic stricture

(E) external esophageal compression

63. A 16-year old girl has recently been referred to your family practice. She is a recent immigrant from Southeast Asia, and has been taking isoniazid (INH) and rifampin for uncomplicated tuberculosis. Routine blood tests are unremarkable, except for an elevated direct bilirubin. Other liver enzymes and function tests are completely normal. Which of the following is the most likely diagnosis?

(A) hemolytic anemia

(B) INH toxicity

(C) Crigler-Najjar syndrome type I

(D) rifampin toxicity

(E) Rotor’s syndrome

64. A 45-year-old woman presents with a 1-week history of jaundice, anorexia, and right upper quadrant discomfort. On examination she is icteric, with a tender right upper quadrant and liver span of 14 cm. There is no shifting dullness or pedal edema and the heart and lungs are normal. On further inquiry, she reports consuming one bottle of wine a day for the past 6 months. Which of the following laboratory tests is most likely to be characteristic of a patient with jaundice secondary to alcoholic hepatitis?

(A) ratio of AST:ALT is 3:1 and the AST is 500 U/L

(B) ratio of AST:ALT is 2:1 and the AST is 250 U/L

(C) ratio of AST:ALT is 1:1 and the AST is 500 U/L

(D) ratio of AST:ALT is 1:1 and the AST is 250 U/L

(E) ratio of AST:ALT is 1:3 and the AST is 750

65. Which of the following medications causes predictable, dose-dependent hepatocellular injury?

(A) morphine

(B) INH

(C) gold

(D) acetaminophen

(E) acetylsalicyclic acid (ASA)

66. Which of the following is the mostly likely mechanism of acetaminophen hepatotoxicity toxicity?

(A) an allergic mechanism

(B) an active metabolite

(C) a reaction with hepatic glycogen stores

(D) direct toxicity of the parent compound

(E) circulating immune complexes

67. Blood-filled lesions in the liver (peliosis hepatis) are most likely to be seen with which of the following medications?

(A) methyltestosterone

(B) oral contraceptives

(C) trimethoprim-sulfamethoxazole

(D) chlorpromazine

(E) erythromycin

68. A 24-year-old man with a history of depression is brought to the emergency room because of a drug overdose. He is experiencing some nausea and vomiting, but no other symptoms. Physical examination and vital signs are normal. Six hours prior to presentation, he intentionally took 40 tablets of acetaminophen (500 mg/tablet). Which of the following is the most appropriate next step in management?

(A) give ethanol to compete with the parent drug for metabolism, therefore preventing formation of toxic metabolites

(B) give Narcan to block its actions directly

(C) give intravenous prostacyclins to maintain cellular integrity

(D) give N-acetylcysteine to allow binding of the toxic metabolite

(E) give glucocorticoids to block the immune cascade

69. A 16-year-old girl is referred to the office because of chronic diarrhea and weight loss. She is experiencing large-volume watery diarrhea that is painless. The symptoms persist even when she is fasting, and there is no relationship to foods or liquids. She is not on any medications, and there is no travel history or other constitutional symptoms. Her physical examination is normal. Which of the following is the most likely diagnosis?

(A) partial small bowel obstruction

(B) partial large bowel obstruction

(C) osmotic diarrhea

(D) secretory diarrhea

(E) inflammatory bowel disease

70. A 52-year-old man has suffered with chronic diarrhea for several years, but has refused to see a doctor. He finally comes because he is having trouble driving at night, because of difficulty seeing. Physical examination reveals a slender, pale, unwell-looking man. He has a microcytic anemia, low calcium, and albumin levels. Which of the following is the most likely cause for his diarrhea?

(A) malabsorption

(B) osmotic diarrhea

(C) secretory diarrhea

(D) inflammatory bowel disease

(E) colonic tumor

71. A 49-year-old woman is being investigated for chronic diarrhea and weight loss. Malabsorption is suspected. Which of the following investigations is most likely to make a definitive diagnosis?

(A) presence of fecal osmotic gap

(B) D-xylose test

(C) stool fat measurements

(D) Schilling test

(E) mucosal biopsy

72. A 67-year-old man is admitted to the intensive care unit (ICU) because of respiratory failure from pneumonia. He requires artificial ventilation and inotropic support. On the third day in the ICU, he develops melena and a drop in his hemoglobin. Urgent upper endoscopy is performed and it reveals three gastric ulcers in the fundus and body of the stomach. Appropriate treatment is started. (SELECT ONE)

(A) bile acid reflux implicated in pathogenesis

(B) immune or autoimmune pathogenesis Suspected

(C) ischemia of the gastric mucosa implicated in the pathogenesis

(D) associated with Helicobacter pyloriinfection

(E) unknown mechanism

(F) interruption of prostaglandin synthesis

73. A 70-year-old man has a long history of heartburn and dyspepsia. He has tried many medications but the symptoms always return. His upper endoscopy is normal with no ulcers. Routine biopsies of the gastric mucosa report “gastritis.” (SELECT ONE)

A) bile acid reflux implicated in pathogenesis

(B) immune or autoimmune pathogenesis Suspected

(C) ischemia of the gastric mucosa implicated in the pathogenesis

(D) associated with Helicobacter pyloriinfection

(E) unknown mechanism

(F) interruption of prostaglandin synthesis

74. A 57-year-old woman experiences frequent symptoms of heartburn. She reports no weight loss, diarrhea, or dysphagia symptoms. Past medical history is significant for B12 deficiency treated with monthly injections. She appears well, and the examination is normal, except for some patches on her arms where she has lost all the skin pigmentation. Her upper endoscopy is normal, except for gastric biopsies commenting on gastritis. (SELECT ONE)

A) bile acid reflux implicated in pathogenesis

(B) immune or autoimmune pathogenesis Suspected

(C) ischemia of the gastric mucosa implicated

in the pathogenesis

(D) associated with Helicobacter pyloriinfection

(E) unknown mechanism

(F) interruption of prostaglandin synthesis

75. A 54-year-old man is investigated for weight loss, epigastric pain, nausea, and vomiting. He appears ill; on examination, there is epigastric tenderness and marked peripheral edema. Upper endoscopy reveals large mucosal folds in the body and fundus of the stomach. Biopsies are consistent with a diagnosis of Ménétrier’s disease. (SELECT ONE)

A) bile acid reflux implicated in pathogenesis

(B) immune or autoimmune pathogenesis Suspected

(C) ischemia of the gastric mucosa implicated in the pathogenesis

(D) associated with Helicobacter pyloriinfection

(E) unknown mechanism

(F) interruption of prostaglandin synthesis

76. A 65-year-old man has developed abdominal pain, early satiety, nausea, and vomiting. He reports no weight loss or change in bowel habits. He had a partial gastrectomy 30 years ago for a bleeding gastric ulcer. Upper endoscopy finds erythema of the gastric remnant, and biopsies report epithelial injury and minimal inflammation (gastritis). (SELECT ONE)

A) bile acid reflux implicated in pathogenesis

(B) immune or autoimmune pathogenesis Suspected

(C) ischemia of the gastric mucosa implicated in the pathogenesis

(D) associated with Helicobacter pyloriinfection

(E) unknown mechanism

(F) interruption of prostaglandin synthesis

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