Gastroenterology — MCQs

A 30-year-old man with a BMI of 33.7 kg/m2 presents with severe pain in his right great toe that began this morning. He had a few beers last night at a friend's party but otherwise has had no recent dietary changes. On examination, the right great toe appears swollen, warm, red, and tender to touch. Joint aspiration is performed. What will examination of the fluid most likely reveal?

A 41-year-old male presents to his primary care provider after seeing bright red blood in the toilet bowl after his last two bowel movements. He reports that the second time he also noticed some blood mixed with his stool. The patient denies abdominal pain and any changes in his stool habits. He notes a weight loss of eight pounds in the last two months. His past medical history is significant for an episode of pancreatitis two years ago for which he was hospitalized for several days. He drinks 2-3 beers on the weekend, and he has never smoked. He has no family history of colon cancer. His temperature is 97.6°F (36.4°C), blood pressure is 135/78 mmHg, pulse is 88/min, and respirations are 14/min. On physical exam, his abdomen is soft and nontender to palpation. Bowel sounds are present, and there is no hepatomegaly. Which of the following is the best next step in diagnosis?

A 32-year-old man with a history of chronic alcoholism presents to the emergency department with vomiting and diarrhea for 1 week. He states he feels weak and has had poor oral intake during this time. The patient is a current smoker and has presented many times to the emergency department for alcohol intoxication. His temperature is 97.5°F (36.4°C), blood pressure is 102/62 mmHg, pulse is 135/min, respirations are 25/min, and oxygen saturation is 99% on room air. On physical exam, he is found to have orthostatic hypotension and dry mucus membranes. Laboratory studies are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 3.9 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 9.8 mg/dL The patient is given normal saline, oral potassium, dextrose, thiamine, and folic acid. The following day, the patient seems confused and complains of diffuse weakness and muscle/bone pain. An ECG and head CT are performed and are unremarkable. Which of the following is the most likely explanation for this patient's new symptoms?

A 49-year-old woman comes to the physician because of a 1-year history of bloating and constipation alternating with diarrhea. She eats a balanced diet, and there are no associations between her symptoms and specific foods. She had been a competitive swimmer since high school but stopped going to training 4 months ago because her fingers hurt and turned blue as soon as she got into the cold water. She drinks one to two glasses of wine daily. Physical examination shows swollen hands and fingers with wax-like thickening of the skin. There are numerous small, superficial, dilated blood vessels at the tips of the fingers. The abdomen is distended and mildly tender with no guarding or rebound. Further evaluation is most likely to show which of the following findings?

A 72-year-old male is brought from his nursing home to the emergency department for fever, chills, dyspnea, productive cough, and oliguria over the past 72 hours. He was in his normal state of health and slowly developed breathing problems and fever. His past medical history is significant for hepatitis C, hypertension, and hypercholesterolemia. His medications include bisoprolol, hydrochlorothiazide, and atorvastatin. Upon arrival to the ED, his blood pressure is 80/48 mm Hg, pulse is 120/min, a respiratory rate of 28/min, and body temperature of 39.0°C (102.2°F). Physical examination reveals decreased breathing sounds in the base of the left lung, along with increased vocal resonance, and pan-inspiratory crackles. The abdomen is mildly distended with a positive fluid wave. The patient's level of consciousness ranges from disoriented to drowsiness. He is transferred immediately to the ICU where vasoactive support is initiated. Laboratory tests show leukocytosis, neutrophilia with bands. Since admission 6 hours ago, the patient has remained anuric. Which of the following additional findings would you expect in this patient?

A 48-year-old man presents to his primary care physician with diarrhea and weight loss. He states he has had diarrhea for the past several months that has been worsening steadily. The patient recently went on a camping trip and drank unfiltered stream water. Otherwise, the patient endorses a warm and flushed feeling in his face that occurs sporadically. His temperature is 97.2°F (36.2°C), blood pressure is 137/68 mmHg, pulse is 110/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a murmur heard best over the left lower sternal border and bilateral wheezing on pulmonary exam. Which of the following is the best initial step in management?

A 35-year-old woman presents to an outpatient clinic during winter for persistent rhinorrhea. She states it is persistent and seems to be worse when she goes outside. Otherwise, she states she is generally healthy and only has a history of constipation. Her temperature is 98.7°F (37.1°C), blood pressure is 144/91 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Nasal cytology reveals eosinophilia and boggy turbinates. Which of the following is the most likely diagnosis?

A 60-year-old woman presents to the physician because of shortness of breath and easy fatigability over the past 3 months. Her symptoms become worse with physical activity. She notes no chest pain, cough, or wheezing. Her last menstrual period was 10 years ago. She currently takes calcium and vitamin D supplements as well as a vaginal estrogen cream. For several years, her diet has been poor, as she often does not feel like eating. The patient’s medical history is otherwise unremarkable. She works as a piano teacher at the local community center. She does not use tobacco or illicit drugs and enjoys an occasional glass of red wine with dinner. Her vital signs include: pulse 100/min, respiratory rate 16/min, and blood pressure 140/84 mm Hg. Physical examination reveals impaired vibratory sensation in the legs. Pallor is evident on her hands. Which of the following laboratory tests is expected to be abnormal in this patient?

A 51-year-old man comes to the physician because of a 3-month history of diffuse perineal and scrotal pain. On a 10-point scale, he rates the pain as a 5 to 6. He reports that during this time he also has pain during ejaculation and dysuria. He did not have fever. The pain is persistent despite taking over-the-counter analgesics. He has smoked one pack of cigarettes daily for 20 years. He appears healthy and well nourished. Vital signs are within normal limits. Abdominal and scrotal examination shows no abnormalities. Rectal examination shows a mildly tender prostate without asymmetry or induration. Laboratory studies show: Hemoglobin 13.2 g/dL Leukocyte count 5000/mm3 Platelet count 320,000/mm3 Urine RBC none WBC 4-5/hpf A urine culture is negative. Analysis of expressed prostatic secretions shows 6 WBCs/hpf (N <10). Scrotal ultrasonography shows no abnormalities. Which of the following is the most likely diagnosis?

A 25-year-old woman presents to her primary care provider for fatigue. She states that she has felt fatigued for the past 6 months and has tried multiple diets and sleep schedules to improve her condition, but none have succeeded. She has no significant past medical history. She is currently taking a multivitamin, folate, B12, iron, fish oil, whey protein, baby aspirin, copper, and krill oil. Her temperature is 98.8°F (37.1°C), blood pressure is 107/58 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air. Laboratory values are as seen below. Hemoglobin: 8 g/dL Hematocrit: 24% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 147,000/mm^3 Physical exam is notable for decreased proprioception in the lower extremities and 4/5 strength in the patient's upper and lower extremities. Which of the following is the best next step in management to confirm the diagnosis?