Gastroenterology — MCQs

A 71-year-old man presents to his primary care physician with complaints of fatigue, weight loss, and early satiety for 3 weeks. Before this, he felt well overall. He is a former smoker, but otherwise has no past medical history. On examination, the patient appears fatigued and thin; his stool is guaiac positive. He is referred to a gastroenterologist who performs an esophagogastroduodonoscopy that reveals a mass in the antrum of the stomach. Pathology consistent with adenocarcinoma. Which of the following is the most appropriate next step in management?

A 19-year-old recent ROTC male recruit presents to the university clinic with left foot pain. He reports that the pain started a week ago while running morning drills. The pain will improve with rest but will occur again during exercises or during long periods of standing. He denies any recent trauma. His medical history is significant for partial color blindness. He has no other chronic medical conditions and takes no medications. He denies any surgical history. His family history is significant for schizophrenia in his father and breast cancer in his mother. He denies tobacco, alcohol, or illicit drug use. On physical examination, there is tenderness to palpation of the second metatarsal of the left foot. A radiograph of the left foot shows no abnormalities. Which of the following is the best next step in management?

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

A 26-year-old female with AIDS (CD4 count: 47) presents to the emergency department in severe pain. She states that over the past week she has been fatigued and has had a progressively worse headache and fever. These symptoms have failed to remit leading her to seek care in the ED. A lumbar puncture is performed which demonstrates an opening pressure of 285 mm H2O, increased lymphocytes, elevated protein, and decreased glucose. The emergency physician subsequently initiates treatment with IV amphotericin B and PO flucytosine. What additional treatment in the acute setting may be warranted in this patient?

A 28-year-old African American woman presents to her primary care physician with two weeks of nausea, abdominal pain, and increased urination. She states she has had kidney stones in the past and is concerned because her current pain is different in character from what she had experienced then. In addition she reports increasing weakness and fatigue over the past several months as well as mild shortness of breath. Chest radiography shows bilateral hilar adenopathy. Which of the following processes is most likely responsible for her current symptoms?

A 65-year-old man presents to the emergency department due to an episode of lightheadedness. The patient was working at his garage workbench when he felt like he was going to faint. His temperature is 98.8°F (37.1°C), blood pressure is 125/62 mmHg, pulse is 117/min, respirations are 14/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below. Hemoglobin: 7 g/dL Hematocrit: 22% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 197,000/mm^3 The patient is started on blood products and a CT scan is ordered. Several minutes later, his temperature is 99.5°F (37.5°C), blood pressure is 87/48 mmHg, and pulse is 180/min. The patient's breathing is labored. Which of the following is also likely to be true?

A 55-year-old woman with poorly controlled type 2 diabetes mellitus comes to the emergency department because of a 5-day history of a severely painful, blistering rash. The rash began over the right forehead, and spread to the chest, back, and bilateral upper extremities over the next 2 days. She is diagnosed with disseminated cutaneous herpes zoster and hospitalized for further management. Prior to admission, her only medication was insulin. On the second day of her stay, she develops bilateral episodic, cramping flank pain and nausea. Her temperature is 36.7°C (98°F), pulse is 80/min, and blood pressure is 128/76 mm Hg. Examination shows a healing rash over the forehead, chest, and extremities, with no evidence of new blisters. Her serum blood urea nitrogen is 33 mg/dL and serum creatinine is 3.5 mg/dL. On admission, her serum urea nitrogen was 18 mg/dL and her serum creatinine was 1.1 mg/dL. Which of the following is the most likely cause of this patient's laboratory findings?

A 43-year-old man comes to the physician because of nasal congestion and fatigue for 12 days. During this period, he has had fevers and severe pain over his cheeks. His nasal discharge was initially clear, but it has turned yellowish over the last couple of days. He has no visual complaints. He has been taking an over-the-counter nasal decongestant and acetaminophen without much relief. He has type 2 diabetes mellitus and hypertension. He underwent an appendectomy 23 years ago. He does not smoke or drink alcohol. His current medications include metformin, sitagliptin, and enalapril. He appears tired. His temperature is 38.5°C (101.3°F), pulse is 96/min, and blood pressure is 138/86 mm Hg. Examination shows purulent discharge in the nose and pharynx and normal appearing ears. The left maxillary sinus is tender to palpation. Laboratory studies show: Hemoglobin 14.6 g/dL Leukocyte count 10,800/mm3 Platelet count 263,000/mm3 ESR 22 mm/hr Serum Glucose 112 mg/dL Which of the following is the most appropriate next step in management?

A 50-year-old man presents to the emergency department complaining of blood in his stool. He reports that this morning he saw bright red blood in the toilet bowl. He denies fatigue, headache, weight loss, palpitations, constipation, or diarrhea. He has well-controlled hypertension and takes hydrochlorothiazide. His father has rheumatoid arthritis, and his mother has Graves disease. The patient’s temperature is 98°F (36.7°C), blood pressure is 128/78 mmHg, and pulse is 70/min. He appears well. No source for the bleeding is appreciated upon physical examination, including a digital rectal exam. A fecal occult blood test is positive. Which of the following is the most appropriate initial diagnostic test to rule out malignancy?

A 48-year-old woman is brought to the emergency department by police because of confusion and agitation. Her medical record indicates that she has peptic ulcer disease that is treated with omeprazole. The patient's brother arrives shortly after. He reports that she drinks around 17 oz. of vodka daily. Neurological examination shows horizontal nystagmus. Her gait is wide-based with small steps. Her hemoglobin concentration is 9.1 g/dL. A peripheral blood smear shows hypersegmented neutrophils. Homocysteine levels are elevated. Methylmalonic acid levels are within normal limits. Which of the following is the most likely direct cause of this patient's anemia?