Gastroenterology — MCQs

A 47-year-old man presents with recurrent epigastric pain and diarrhea. He has had these symptoms for the last year or so and has been to the clinic several times with similar complaints. His current dosage of omeprazole has been steadily increasing to combat his symptoms. The pain seems to be related to food intake. He describes his diarrhea as watery and unrelated to his meals. Blood pressure is 115/80 mm Hg, pulse is 76/min, and respiratory rate is 19/min. He denies tobacco or alcohol use. An upper endoscopy is performed due to his unexplained and recurrent dyspepsia and reveals thickened gastric folds with three ulcers in the first part of the duodenum, all of which are negative for H. pylori. Which of the following is the best next step in this patient's management?

A 29-year-old man comes to the physician for a routine health maintenance examination. He has no history of serious illness. His mother has hypertension and his father died of testicular cancer at the age of 51 years. He does not smoke or drink. He is sexually active and uses condoms consistently. He takes no medications. His immunization records are unavailable. He works as a financial consultant and will go on a business trip to Mexico City in 2 weeks. His temperature is 36.7°C (98.7° F), pulse is 78/min, and blood pressure is 122/78 mm Hg. Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.4 g/dL Leukocyte count 9800/mm3 Platelet count 168,000/mm3 Serum Glucose 113 mg/dL Creatinine 1.1 mg/dL Which of the following recommendations is most appropriate at this time?

A 25-year-old woman is admitted to the intensive care unit (ICU) with hematemesis and shock. Five days ago she had a severe fever 40.0℃ (104.0℉), retro-orbital pain, nausea, and myalgias. The high temperatures decreased over a few days, but she developed severe abdominal pain and bleeding gums. A single episode of hematemesis occurred prior to ICU admission. She travels to Latin America every winter. Two weeks ago, she traveled to Brazil and spent most of her time outdoors. She is restless. The temperature is 38.0℃ (100.4℉), the pulse is 110/min, the respiration rate is 33/min, and the blood pressure is 90/70 mm Hg. Conjunctival suffusion is seen. The extremities are cold. A maculopapular rash covers the trunk and extremities. Ecchymoses are observed on the lower extremities. The lung bases reveal absent sounds with dullness to percussion. The abdomen is distended. The liver edge is palpable and liver span is 15 cm. Shifting dullness is present. The laboratory studies show the following: Laboratory test Hemoglobin 16.5 g/dL Leukocyte count 3500/mm3 Segmented neutrophils 55% Lymphocytes 30% Platelet count 90,000/mm3 Serum Alanine aminotransferase (ALT) 75 U/L Aspartate aminotransferase (AST) 70 U/L Total bilirubin 0.8 mg/dL Direct bilirubin 0.2 mg/dL Which of the following is the most likely diagnosis?

A 63-year-old woman comes to the physician because of diarrhea and weakness after her meals for 2 weeks. She has the urge to defecate 15–20 minutes after a meal and has 3–6 bowel movements a day. She also has palpitations, sweating, and needs to lie down soon after eating. One month ago, she underwent a distal gastrectomy for gastric cancer. She had post-operative pneumonia, which was treated with cefotaxime. She returned from a vacation to Brazil 6 weeks ago. Her immunizations are up-to-date. She is 165 cm (5 ft 5 in) tall and weighs 51 kg (112 lb); BMI is 18.6 kg/m2. Vital signs are within normal limits. Examination shows a well-healed abdominal midline surgical scar. The abdomen is soft and nontender. Bowel sounds are hyperactive. Rectal examination is unremarkable. Which of the following is the most appropriate next step in management?

A 71-year-old woman is brought to the emergency department following a syncopal episode. Earlier in the day, the patient had multiple bowel movements that filled the toilet bowl with copious amounts of bright red blood. Minutes later, she felt dizzy and lightheaded and collapsed into her daughter's arms. The patient has a medical history of diabetes mellitus and hypertension. Her temperature is 99.0°F (37.2°C), blood pressure is 155/94 mmHg, pulse is 82/min, respirations are 15/min, and oxygen saturation is 99% on room air. The patient's exam is notable for fecal occult blood positivity on rectal exam; however, the patient is no longer having bloody bowel movements. The patient's lungs are clear to auscultation and her abdomen is soft and nontender. Labs are ordered as seen below. Hemoglobin: 7.1 g/dL Hematocrit: 25% Leukocyte count: 5,300/mm^3 with normal differential Platelet count: 182,500/mm^3 Two large bore IV's are placed and the patient is given normal saline. What is the best next step in management?

A 50-year-old overweight woman presents to her physician with complaints of recurrent episodes of right upper abdominal discomfort and cramping. She says that the pain is mild and occasionally brought on by the ingestion of fatty foods. The pain radiates to the right shoulder and around to the back, and it is accompanied by nausea and occasional vomiting. She admits to having these episodes over the past several years. Her temperature is 37°C (98.6° F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Her physical examination is unremarkable. Lab reports reveal: Hb% 13 gm/dL Total count (WBC): 11,000/mm3 Differential count: Neutrophils: 70% Lymphocytes: 25% Monocytes: 5% ESR: 10 mm/hr Serum: Albumin: 4.2 gm/dL Alkaline phosphatase: 150 U/L Alanine aminotransferase: 76 U/L Aspartate aminotransferase: 88 U/L What is the most likely diagnosis?

A 52-year-old man comes to the physician because of a 3-month history of upper abdominal pain and nausea that occurs about 3 hours after eating and at night. These symptoms improve with eating. After eating, he often has a feeling of fullness and bloating. He has had several episodes of dark stools over the past month. He has smoked one pack of cigarettes daily for 40 years and drinks 2 alcoholic beverages daily. He takes no medications. His temperature is 36.4°C (97.5°F), pulse is 80/min, and blood pressure is 110/70 mm Hg. Abdominal examination shows epigastric tenderness with no guarding or rebound. Bowel sounds are normal. Which of the following treatments is most appropriate to prevent further complications of the disease in this patient?

A 62-year-old man, a retired oil pipeline engineer, presents to his primary care physician with complaints of headaches, fatigue, and constant ringing in his ears. Recurrently he has developed pruritus, usually after a hot shower. He also noted a constant burning sensation in his fingers and toes, independent of physical activity. On examination, he has a red face and his blood pressure levels are 147/89 mm Hg. A CBC revealed that his Hb is 19.0 g/dL and Hct is 59%. Because of his condition, his physician prescribes him 81 mg of aspirin to be taken daily in addition to therapeutic phlebotomy. Which of the statements below is true about this patient’s condition?

A 32-year-old man presents to his physician with a complaint of pain with urination that has developed and persisted over the past 8 days. Upon awakening today, he also noted a clear discharge from his urethra. The patient states he is otherwise healthy. Social history is notable for the patient working at a local farm with livestock. Review of systems is notable for left knee and ankle pain for the past week and worsening of his seasonal allergies with red and itchy eyes. His temperature is 97.7°F (36.5°C), blood pressure is 122/83 mmHg, pulse is 89/min, respirations are 14/min, and oxygen saturation is 98% on room air. Which of the following is likely to be positive in this patient?

A 59-year-old female presents to your office with complaints of progressive numbness and tingling in her fingers and toes over the last several months. She also reports "feeling weak" in her arms and legs. The patient's past medical history is significant for hypertension and Crohn's disease, which has been well-controlled since undergoing an ileocolectomy 7 years ago. Physical examination is significant for the following findings: decreased sensation to light touch, temperature, and vibration in the bilateral lower extremities; ataxia; positive Romberg sign. Deficiency of which of the following is most likely responsible for this patient's symptoms?