Your-Doctor Multiple Choice Questions (MCQ)

Category: Medicine--->Gastroenterology
Page: 1

Question 1#Print Question

A 65-year-old man is admitted with rectal bleeding. He noticed a significant amount of blood in the toilet after going to the bathroom this morning and had some mild cramping just before that bowel movement. His past medical history is positive for coronary artery disease (has had stents placed and is on aspirin and clopidogrel) and osteoarthritis for which he has been taking ibuprofen. He denies weight loss and has no previous history of bleeding. On examination he is slightly diaphoretic. Vital signs are BP 124/72 and pulse 88 with the patient supine, BP 94/52 and pulse 110 with the patient standing. Abdomen is nontender and nondistended. NG aspirate is negative for occult blood. After establishing two large-bore intravenous lines, administering an IV fluid bolus and otherwise stabilizing the patient, what will be the most important study to perform?

a. Upper endoscopy
b. Air-contrast barium enema
c. Colonoscopy
d. X-ray of the abdomen—flat and upright
e. CT scan of the abdomen


Question 2#Print Question

A 60-year-old woman with depression and poorly controlled type 2 diabetes mellitus complains of episodic vomiting over the last 3 months. She has constant nausea and early satiety. She vomits once or twice almost every day. In addition, she reports several months of mild abdominal discomfort localized to the upper abdomen. The pain sometimes awakens her at night. She has lost 5 lb of weight. Her diabetes has been poorly controlled (glycosylated hemoglobin recently was 9.5). Current medications are glyburide, metformin, and amitriptyline.

Her physical examination is normal except for mild abdominal distention and evidence of a peripheral sensory neuropathy. Complete blood count, serum electrolytes, BUN, creatinine, and liver function tests are all normal. Gallbladder sonogram is negative for gallstones. Upper GI series and CT scan of the abdomen are normal.

What is the best next step in the evaluation of this patient’s symptoms?

a. Barium esophagram
b. Scintigraphic gastric emptying study
c. Colonoscopy
d. Liver biopsy
e. Small bowel biopsy


Question 3#Print Question

 A 56-year-old woman becomes the chief financial officer of a large company and, several months thereafter, develops upper abdominal pain that she ascribes to stress. She takes an over-the-counter antacid with temporary benefit. She uses no other medications. One night she awakens with nausea and vomits a large volume of coffee grounds-like material; she becomes weak and diaphoretic. Upon hospitalization, she is found to have an actively bleeding duodenal ulcer. Which of the following statements is true?

a. The most likely etiology is adenocarcinoma of the duodenum
b. The etiology of duodenal ulcer is different in women than in men
c. The likelihood that she harbors Helicobacter pylori is greater than 50%
d. Lifetime residence in the United States makes H pylori unlikely as an etiologic agent
e. Organisms consistent with H pylori are rarely seen on biopsy in patients with duodenal ulcer


Question 4#Print Question

A 40-year-old woman complains of mid-abdominal pain that began several hours ago. She has vomited once, and the ride to the hospital was very uncomfortable for her. She has felt hot but has not checked her temperature. She denies any diarrhea or blood in her stools. She has a history of diabetes and hypertension and is on metformin, lisinopril, and hydro-chlorothiazide. She denies trauma or dysuria, and she is currently on her menstrual period. Her surgical history is positive only for a laparoscopic cholecystectomy and tubal ligation. On examination she has a temperature of 38.3°C (101°F), a pulse of 96, clear lungs, normal heart, some right flank tenderness, decreased bowel sounds with voluntary guarding diffusely, and more exquisite tenderness in the right lower quadrant. Her white blood cell count is 16,000 with a left shift. A urinalysis and a pregnancy test are both negative.

What would be the next best step?

a. Obtain an abdominal CT scan
b. Obtain an intravenous pyelogram (IVP)
c. Obtain flat and upright x-rays of the abdomen
d. Obtain abdominal ultrasound
e. Consult surgery


Question 5#Print Question

A 70-year-old man presents with a complaint of fatigue. There is no history of alcohol abuse or liver disease; the patient is taking no medications. Scleral icterus is noted on physical examination; the liver and spleen are nonpalpable. The patient has a normocytic, normochromic anemia. Urinalysis shows bilirubinuria with absent urine urobilinogen. Serum bilirubin is 12 mg/dL, AST and ALT are normal, and alkaline phosphatase is 300 U/L (three times normal). Which of the following is the best next step in evaluation?

a. Ultrasound or CT scan of the abdomen
b. Viral hepatitis profile
c. Reticulocyte count
d. Serum ferritin
e. Antimitochondrial antibodies




Category: Medicine--->Gastroenterology
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