Multiple Choice Questions (MCQ)

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Category: Medicine--->Gastroenterology
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Question 11#Print Question

A 34-year-old man presents with substernal discomfort. The symptoms are worse after meals, particularly a heavy evening meal, and are sometimes associated with hot/sour fluid in the back of the throat and nocturnal awakening. The patient denies difficulty swallowing, pain on swallowing, or weight loss. The symptoms have been present for 6 weeks; the patient has gained 20 lb in the past 2 years. Which of the following is the most appropriate initial approach?

a. Therapeutic trial of ranitidine or omeprazole
b. Exercise test with thallium imaging
c. Esophagogastroduodenoscopy
d. CT scan of the chest
e. Coronary angiography

Question 12#Print Question

A 48-year-old woman presents with a 2-month history of change in bowel habit and 10-lb weight loss despite preservation of appetite. She notices increased abdominal gas, particularly after fatty meals. The stools are malodorous and occur two to three times per day; no rectal bleeding is noticed. The symptoms are less prominent when she follows a clear liquid diet.

Which of the following is the most likely histological abnormality associated with this patient’s symptoms?

a. Signet ring cells on gastric biopsy
b. Mucosal inflammation and crypt abscesses on sigmoidoscopy
c. Villous atrophy and increased lymphocytes in the lamina propria on small bowel biopsy
d. Small, curved gram-negative bacteria in areas of intestinal metaplasia on gastric biopsy
e. Periportal inflammation on liver biopsy

Question 13#Print Question

An otherwise healthy 40-year-old woman sees you because of recurrent abdominal pain. In the past month she has had four episodes of colicky epigastric pain. Each of these episodes has lasted about 30 minutes and has occurred within an hour of eating. Two of the episodes have been associated with sweating and vomiting. None of the episodes have been associated with fever or shortness of breath. She has not lost weight. She does not drink alcohol or take any prescription or over-the-counter medications. Other than three previous uneventful vaginal deliveries, she has never been hospitalized.

Her examination is negative except for mild obesity (BMI = 32). A complete blood count and multichannel chemistry profile that includes liver function tests are normal. A gallbladder sonogram reveals multiple gallstones.

What is the next best step in the treatment of this patient?

a. Omeprazole, 20 mg daily for 8 weeks
b. Ursodeoxycholic acid
c. Observation without specific therapy
d. Laparoscopic cholecystectomy
e. Weight reduction

Question 14#Print Question

A 56-year-old chronic alcoholic has a 1-year history of ascites. He is admitted with a 2-day history of diffuse abdominal pain and fever. Examination reveals scleral icterus, spider angiomas, a distended abdomen with shifting dullness, and diffuse abdominal tenderness. Paracentesis reveals slightly cloudy ascitic fluid with an ascitic fluid PMN cell count of 1000/µL.

Which of the following statements about treatment is true?

a. Antibiotic therapy is unnecessary if the ascitic fluid culture is negative for bacteria
b. The addition of albumin to antibiotic therapy improves survival
c. Repeated paracenteses are required to assess the response to antibiotic treatment
d. After treatment of this acute episode, a second episode of spontaneous bacterial peritonitis would be unlikely
e. Treatment with multiple antibiotics is required because polymicrobial infection is common

Question 15#Print Question

 A 60-year-old man with known hepatitis C and a previous liver biopsy showing cirrhosis requests evaluation for possible liver transplantation. He has never received treatment for hepatitis C. Though previously a heavy user of alcohol, he has been abstinent for over 2 years. He has had two episodes of bleeding esophageal varices. He was hospitalized 6 months ago with acute hepatic encephalopathy. He has a 1-year history of ascites that has required repeated paracentesis despite treatment with diuretics. Medications are spironolactone 200 mg daily and lactulose 30 cc three times daily

On examination he appears thin, with obvious scleral icterus, spider angiomas, palmar erythema, gynecomastia, a large amount of ascitic fluid, and small testicles. There is no asterixis.

Recent laboratory testing revealed the following:

  • Hemoglobin = 12.0 mg/dL (normal 13.5-15.0)
  • MCV = 103 fL (normal 80-100)
  • Creatinine = 2.0 mg/dL (normal 0.7-1.2)
  • Bilirubin = 6.5 mg/dL (normal 0.1-1.2)
  • AST = 25 U/L (normal < 40)
  • ALT = 45 U/L (normal < 40)
  • INR = 3.0 (normal 0.8-1.2)

What is the best next step in the management of this patient’s liver failure?

a. Repeat liver biopsy
b. Start treatment with interferon and ribavirin
c. Refer the patient for hospice care
d. Continue to optimize medical treatment for his ascites and hepatic encephalopathy and tell the patient he is not eligible for liver transplantation because of his previous history of alcohol abuse
e. Refer the patient to a liver transplantation center

Category: Medicine--->Gastroenterology
Page: 3 of 5