Gastroenterology — MCQs

A 20-year-old woman is brought to the emergency department by her parents after finding her seizing in her room at home. She has no known medical condition and this is her first witnessed seizure. She is stabilized in the emergency department. A detailed history reveals that the patient has been progressively calorie restricting for the past few years. Based on her last known height and weight, her body mass index (BMI) is 16.5 kg/m2. Which of the following electrolyte abnormalities would be of the most concern when this patient is reintroduced to food?

An 80-year-old woman presents with general malaise and low-grade fever. Physical examination reveals several retinal hemorrhages with pale centers, painless erythematous macules on palms and soles, and splinter hemorrhages under her fingernails. Echocardiogram shows vegetations on the mitral valve. Blood culture indicates gram-positive bacteria which are catalase negative and able to grow in 40% bile; however, not in 6.5% NaCl. In addition to endocarditis, the doctor is concerned that the patient may also be suffering from which of the following medical conditions?

A 26-year-old woman presents to the clinic today complaining of weakness and fatigue. She is a vegetarian and often struggles to maintain an adequate intake of non-animal based protein. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and she currently denies any illicit drug use. Her past medical history is non-contributory. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 16/min. On physical examination, her pulses are bounding, the complexion is pale, the breath sounds are clear, and the heart sounds are normal. The spleen is mildly enlarged. She is at a healthy body mass index (BMI) of 22 kg/m2. The laboratory results indicate: mean corpuscular volume MCV: 71 fL, Hgb: 11.0, total iron-binding capacity (TIBC): 412 mcg/dL, transferrin saturation (TSAT): 11%. What is the most appropriate treatment for this patient?

A 74-year-old man is brought to the emergency department because of increasing abdominal pain and distention for 3 days. The pain is diffuse and colicky, and he describes it as 4 out of 10 in intensity. His last bowel movement was 5 days ago. He has not undergone any previous abdominal surgeries. He has hypertension, chronic lower back pain, coronary artery disease, and hypercholesterolemia. Prior to admission, his medications were enalapril, gabapentin, oxycodone, metoprolol, aspirin, and simvastatin. He appears uncomfortable. His temperature is 37.3°C (99.1°F), pulse is 93/min, and blood pressure is 118/76 mm Hg. Examination shows a distended and tympanitic abdomen; bowel sounds are reduced. There is mild tenderness to palpation in the lower abdomen with no guarding or rebound. Rectal examination shows an empty rectum. Laboratory studies show: Hemoglobin 13.1 g/dL Serum Na+ 134 mEq/L K+ 2.7 mEq/L Cl- 98 mEq/L Urea nitrogen 32 mg/dL Creatinine 1 mg/dL An x-ray of the abdomen shows a dilated cecum and right colon and preservation of the haustrae. A CT scan of the abdomen and pelvis with contrast shows a cecal diameter of 11 cm. The patient is kept NPO and intravenous fluids with electrolytes are administered. A nasogastric tube and rectal tube are inserted. Thirty-six hours later, he still has abdominal pain. Examination shows a distended and tympanitic abdomen. Serum concentrations of electrolytes are within the reference range. Which of the following is the most appropriate next step in management?

A 26-year-old woman comes to the physician because of intermittent episodes of cramping lower abdominal pain and bloating over the past 3 months. These episodes are often associated with non-bloody, watery, frothy stools, and excessive flatulence. The cramping does not subside after defecation. She reports that her symptoms typically begin an hour or two after eating ice cream, cheese, or pudding. She is otherwise healthy. Her only medication is an iron supplement and an oral contraceptive pill. The patient's height is 158 cm (5 ft 2 in) and her weight is 59 kg (130 lb); her BMI is 23.6 kg/m2. Abdominal examination is normal. Which of the following is the most appropriate next step in management?

A 35-year-old woman comes to your office with a variety of complaints. As part of her evaluation, she undergoes laboratory testing which reveals the presence of anti-centromere antibodies. All of the following symptoms and signs would be expected to be present EXCEPT:

A 15-year-old girl is brought to her pediatrician's office complaining of frequent diarrhea, fatigue, and inability to gain weight. Her vital signs are within normal limits, and her BMI is 17. She describes her stools as pale, malodorous, and bulky. She often has abdominal bloating. Her symptoms are most prominent after breakfast when she typically consumes cereal. After several weeks of careful evaluation and symptomatic treatment, the pediatrician recommends an esophagogastroduodenoscopy. A diagnostic biopsy shows blunting of intestinal villi and flat mucosa with multiple intraepithelial lymphocytes. This patient's condition is most commonly associated with deficiency of which immunoglobulin?

A 66-year-old man presents to the office complaining of abdominal pain. He reports that the pain is mid-epigastric and "gnawing." It worsens after meals but improves "somewhat" with antacids. The patient's medical history is significant for hypertension, hyperlipidemia, and gout. He takes aspirin, lisinopril, atorvastatin, and allopurinol. He uses ibuprofen during acute gout attacks and takes over the counter multivitamins. He also started drinking ginkgo tea once a week after his wife saw a news story on its potential benefits. The patient has a glass of whiskey after work 2 nights a week but denies tobacco or illicit drug use. An upper endoscopy is performed that reveals a gastric ulcer. A urease breath test is positive for Helicobacter pylori. The patient is prescribed bismuth subsalicylate, omeprazole, metronidazole, and tetracycline for 2 weeks. At follow-up, the patient continues to complain of abdominal pain. He has taken all his medications as prescribed along with 10-12 tablets of antacids a day. He denies hematemesis, hematochezia, or melena. Biopsy from the previous upper endoscopy was negative for malignancy. A repeat urease breath test is positive. Which of the following is the most likely cause for the patient's poor treatment response?

A 31-year-old African American woman with a history of Addison's disease presents with widespread, symmetric hypopigmented patches and macules overlying her face and shoulders. After a thorough interview and using a Wood’s lamp to exclude fungal etiology, vitiligo is suspected. Complete blood count shows leukocytes 6,300, Hct 48.3%, Hgb 16.2 g/dL, mean corpuscular volume (MCV) 90 fL, and platelets 292. Which of the statements below about this patient’s suspected disease is correct?

A 35-year-old man comes to the physician because of a 2-month history of upper abdominal pain that occurs immediately after eating. The pain is sharp, localized to the epigastrium, and does not radiate. He reports that he has been eating less frequently to avoid the pain and has had a 4-kg (8.8-lb) weight loss during this time. He has smoked a pack of cigarettes daily for 20 years and drinks 3 beers daily. His vital signs are within normal limits. He is 165 cm (5 ft 5 in) tall and weighs 76.6 kg (169 lb); BMI is 28 kg/m2. Physical examination shows mild upper abdominal tenderness with no guarding or rebound. Bowel sounds are normal. Laboratory studies are within the reference range. This patient is at greatest risk for which of the following conditions?