Gastroenterology — MCQs

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?

A 42-year-old woman presents complaining of pain in her hands. She reports that the pain is in both hands, and that it is usually worse in the morning. She reports that her hands are also stiff in the morning, but that this gradually improves throughout the morning. She notes, however, that her symptoms seem to be getting worse over the last three months. What is the most likely pathogenesis of her disease process?

A 24-year-old African American college student comes to the office for a scheduled visit. He has been healthy, although he reports occasional flank discomfort which comes and goes. He denies any fever, chills, dysuria, or polyuria in the past year. His vaccinations are up to date. His family history is unknown, as he was adopted. He smokes 1 pack of cigarettes every 3 days, drinks socially, and denies any current illicit drug use, although he endorses a history of injection drug use. He currently works as a waiter to afford his college tuition. His physical examination shows a young man with a lean build, normal heart sounds, clear breath sounds, bowel sounds within normal limits, and no lower extremity edema. You order a urinalysis which shows 8 red blood cells (RBCs) per high-power field (HPF). The test is repeated several weeks later and shows 6 RBCs/HPF. What is the most appropriate next step in management?

A 24-year-old man comes to the physician for the evaluation of a severely pruritic skin rash. Physical examination shows a symmetrical rash over the knees and elbows with tense, grouped vesicles, and several excoriation marks. Microabscesses in the papillary dermis are seen on light microscopy. Immunofluorescence shows deposits of immunoglobulin A at the tips of dermal papillae. This patient's skin findings are most likely associated with which of the following?

A 33-year-old woman comes to the physician because of a 14-hour history of left flank pain associated with dark urine. Her temperature is 37.2°C (99°F). The abdomen is soft with normal bowel sounds. There is guarding on the left lateral side and tenderness to palpation over the left costophrenic angle. An x-ray of the abdomen shows an 8-mm kidney stone. Stone analysis reveals a calcium oxalate stone. In addition to adequate hydration, which of the following diets should be advised for this patient?

A 45-year-old woman presents with fever, chills, nausea, and dysuria. She says her symptoms started 4 days ago and have progressively worsened. Her past medical history is significant for recurrent UTIs for the past 6 months and for diabetes mellitus type 2, diagnosed 5 years ago and treated with metformin. Her vital signs include: temperature 39.5°C (103.1°F), blood pressure 100/70 mm Hg, pulse 90/min, and respiratory rate 23/min. On physical examination, moderate right costovertebral angle tenderness is noted. Laboratory findings are significant for the following: WBC 9,500/mm3 RBC 4.20 x 106/mm3 Hematocrit 41.5% Hemoglobin 13.0 g/dL Platelet count 225,000/mm3 Urinalysis: Color Dark yellow Clarity Turbid pH 5.5 Specific gravity 1.021 Glucose None Ketones None Nitrites Positive Leukocyte esterase Positive Bilirubin Negative Urobilirubin 0.6 mg/dL Protein Trace Blood None WBC 25/hpf Bacteria Many Urine culture and sensitivities are pending. Which of the following is the best next step in the management of this patient?

A 36-year-old woman comes to the physician because of a 12-month history of upper abdominal pain. The pain is worse after eating, which she reports as 7 out of 10 in intensity. Over the last year, she has also had nausea, heartburn, and multiple episodes of diarrhea with no blood or mucus. Eight months ago, she underwent an upper endoscopy, which showed several ulcers in the gastric antrum, the pylorus, and the duodenum, as well as thick gastric folds. The biopsies from these ulcers were negative for H. pylori. Current medications include pantoprazole and over-the-counter antacids. She appears anxious. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and there is tenderness to palpation in the epigastric and umbilical areas. Test of the stool for occult blood is positive. A repeat upper endoscopy shows persistent gastric and duodenal ulceration with minimal bleeding. Which of the following is the most appropriate next step in diagnosis?