Gastroenterology — MCQs

A 63-year-old man presents to the emergency department complaining of sudden-onset severe dyspnea and right-sided chest pain. The patient has a history of chronic obstructive pulmonary disease, hypertension, peptic ulcer disease, and hyperthyroidism. He has smoked a pack of cigarettes daily for 20 years, drinks socially, and does not take illicit drugs. The blood pressure is 130/80 mm Hg, the pulse is 98/min and regular, and the respiratory rate is 20/min. Pulse oximetry shows 90% on room air. On physical examination, he is in mild respiratory distress. Tactile fremitus and breath sounds are decreased on the right, with hyperresonance on percussion. The trachea is midline and no heart murmurs are heard. Which of the following is the most likely underlying mechanism of this patient's current condition?

A 57-year-old man presents with an ongoing asymptomatic rash for 2 weeks. A similar rash is seen in both axillae. He has a medical history of diabetes mellitus for 5 years and dyspepsia for 6 months. His medications include metformin and aspirin. His vital signs are within normal limits. His BMI is 29 kg/m2. The physical examination shows conjunctival pallor. The cardiopulmonary examination reveals no abnormalities. The laboratory test results are as follows: Hemoglobin 9 g/dL Mean corpuscular volume 72 μm3 Platelet count 469,000/mm3 Red cell distribution width 18% HbA1C 6.5% Which of the following is the most likely underlying cause of this patient’s condition?

A 65-year-old patient presents with acute left lower quadrant abdominal pain and is diagnosed with diverticulitis. Which of the following is most likely to have prevented this patient's condition?

A 47-year-old woman comes to the physician because of progressive pain and stiffness in her hands and wrists for the past several months. Her hands are stiff in the morning; the stiffness improves as she starts her chores. Physical examination shows bilateral swelling and tenderness of the wrists, metacarpophalangeal joints, and proximal interphalangeal joints. Her range of motion is limited by pain. Laboratory studies show an increased erythrocyte sedimentation rate. This patient's condition is most likely associated with which of the following findings?

A 69-year-old man presents with progressive dysphagia and a 5-kg weight loss over 3 months. Initially, he had difficulty swallowing solids, which progressed to include liquids in the past week. Endoscopy reveals a mass 3 cm proximal to the esophagogastric junction. Biopsy shows significant distortion of glandular architecture, consistent with adenocarcinoma. Which of the following is the strongest risk factor for this patient's likely diagnosis?

A 6-year-old girl with no significant past medical, surgical, social, or family history presents to urgent care for a new itchy rash on the fingers of her right hand. When questioned, the patient notes that she recently received a pair of beloved silver rings from her aunt as a birthday present. She denies any history of similar rashes. The patient's blood pressure is 123/76 mm Hg, pulse is 67/min, respiratory rate is 16/min, and temperature is 37.3°C (99.1°F). Physical examination reveals erythematous scaly plaques at the base of her right middle and ring finger. What metal alloy is most likely contained within the patient’s new rings?

A 33-year-old female presents with recent onset of painful urination, fever, and right flank pain. Urinary sediment analysis is positive for the presence of white blood cell casts and Gram-negative bacteria. She has not recently started any new medications. What is the most likely diagnosis in this patient?

A 34-year-old woman with no significant prior medical history presents to the clinic with several days of bloody stool. She also complains of constipation and straining, but she has no other symptoms. She has no family history of colorectal cancer or inflammatory bowel disease. She does not smoke or drink alcohol. Her vital signs are as follows: blood pressure is 121/81 mm Hg, heart rate is 77/min, and respiratory rate is 15/min. There is no abdominal discomfort on physical exam, and a digital rectal exam reveals bright red blood. Of the following, which is the most likely diagnosis?

A 54-year-old man is brought to the emergency department by his wife because of high fever and confusion for the past 10 hours. His wife reports that 1 week ago during a trip to Guatemala he underwent an emergency appendectomy. His temperature is 40.1°C (104.2°F), pulse is 132/min, and blood pressure is 74/46 mm Hg. He is oriented only to person. Physical examination shows a surgical wound in the right lower quadrant with purulent discharge. The skin is warm and dry. Serum studies show a sodium concentration of 138 mEq/L, potassium concentration of 3.7 mEq/L, and lactate concentration of 3.5 mEq/L (N = 0.5–2.2 mEq/L). Arterial blood gas analysis on room air shows: pH 7.21 pCO2 36 HCO3- 12 O2 saturation 87% Which of the following is the most likely explanation for these laboratory changes?

A 50-year-old man visits his primary care practitioner for a general health check-up. He was recently hired as a fitness instructor at a local fitness center. His father died of advanced colorectal cancer, however, his personal medical history is significant for the use of performance-enhancing drugs during his 20’s when he competed in bodybuilding and powerlifting competitions. As part of the paperwork associated with his new position, he received an order for a hemoglobin and hematocrit, occult blood in stool, and serum iron and ferritin level, shown below: Hemoglobin 11.8 g/dL Hematocrit 35% Iron 40 µg/dL Ferritin 8 ng/mL His fecal occult blood test was positive. Which of the following is the most recommended follow-up action?