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Gastro Flashcards

1
Q
  1. What is the most important cause of gastric and duodenal erosions?

a. H. pylori infection
b. Alcohol intake
c. NSAID use
d. Stress-related mucosal injury

A

NSAID use

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2
Q

Which of the following medications will most benefit a patient with bleeding esophageal varices from cirrhosis?

a. Omeprazole twice a day

b.Omeprazole once a day

c.Somatostatin

d.Ondansetron

A

Somatostatin

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3
Q

Which of the following is LEAST likely to be the cause of obscure GI bleeding in a 50-year-old patient?

a. GI stromal tumor

b. Vascular ectasia

c. NSAID-induced erosion

d. Meckel’s diverticulum

A

Meckel’s diverticulum

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4
Q

A patient diagnosed with peptic ulcer disease, stable after endoscopy, can be discharged already if he/she has this endoscopic feature?

a.Adherent clot

b.Clean base

c.Flat pigmented spot

d. Visible vessel

A

Clean base

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5
Q

Which of the following is the correct management of an ulcer visible as an adherent clot during endoscopy?

a.Endoscopic therapy + intensive PPI therapy + clear liquids for 2 days

b.Endoscopic therapy + once daily PPI therapy + clear liquids for 1 day

c.No endoscopic therapy + once daily PPI therapy + clear liquids for 1 day

d.No endoscopic therapy + once daily PPI therapy + regular diet

A

Endoscopic therapy + intensive PPI therapy + clear liquids for 2 days

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6
Q

Which of the following clinical presentations likely signifies a massive upper GI bleeding?

a.Low hemoglobin level with low MCH and MCV on initial CBC determination

b.Hematochezia with hemodynamic instability

c.Hyperactive bowel sound with elevated BUN

d.Bile-stained appearance of bleeding

A

Hematochezia with hemodynamic instability

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7
Q

Which of the following patients presenting with GI bleeding will most likely have esophageal varices on endoscopy?

a.74/M, normotensive, with painless passage of bright red blood

b.62/F, with multiple tophi, presenting with melena

c.55/M, heavy alcoholic beverage drinker, presenting with melena and jaundice

d.36/M, presenting with hematemesis after an alcoholic binge

A

55/M, heavy alcoholic beverage drinker, presenting with melena and jaundice

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8
Q

A 72/F with osteoarthritis and chronic NSAID use came in at the emergency department due to hematochezia. Initial vital signs were BP 80/50, HR 121, RR 22. Hypotension was unresponsive to fluid resuscitation hence an inotrope was started. Her BP remains labile while on inotropes. What is the best course of management?

a.Upper endoscopy

b.Flexible sigmoidoscopy

c.Colonoscopy

d.Angiography

A

Angiography

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9
Q

A 35/F presented at the ER due to melena. She was already treated for peptic ulcer disease 6 months ago with proton pump inhibitors. Review of systems also revealed intermittent diarrhea, sometimes steatorrhea. Review of the endoscopic report revealed multiple ulcers, involving the antrum, and the first and second part of the duodenum. H. pylori test was negative. Which of the following should be considered in this patient?

a.Dieulafoy lesion

b.Heyde’s syndrome

c.Zollinger-Ellison syndrome

d.MEN2 syndrome

A

Zollinger-Ellison syndrome

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10
Q

A 72/M was admitted due to bleeding peptic ulcer disease from H. pylori infection. He was admitted 1 month ago for pneumonia and was given aztreonam and azithromycin. During that admission, he had difficulty breathing after receiving an unrecalled IV antibiotic. What is the best treatment for H. pylori for this case?

a.Omeprazole 20 mg BID + Clarithromycin 500 mg BID + Metronidazole 500 mg BID

b.Omeprazole 20 mg BID + Clarithromycin 500 mg BID + Amoxicillin 1 g BID

c.Omeprazole 20 mg BID + Amoxicillin 1 g BID + Levofloxacin 500 mg BID

d.Omeprazole 20 mg BID + Bismuth subsalicylate 2 tabs QID + Tetracycline 500 mg QID + Metronidazole 500 mg TID

A

Omeprazole 20 mg BID + Bismuth subsalicylate 2 tabs QID + Tetracycline 500 mg QID + Metronidazole 500 mg TID

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11
Q

What is the best test to document H. pylori eradication?

a.Rapid urease

b.Urea breath test

c.Histology

d.Serology

A

Urea breath test

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12
Q

Which of the following is associated with the formation of pigment stones?

a.Pregnancy

b.Rapid weight loss

c.Infections of the gallbladder and biliary tree

d. Total parenteral nutrition

A

Infections of the gallbladder and biliary tree

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13
Q

Medical dissolution of gallstone with UDCA is reasonable for which scenario?

a.50/M, asymptomatic with radiolucent stones <10 mm

b.42/F, with frequent right upper quadrant pain from radiolucent stones <10 mm

c.45/F, with epigastric pain radiating to the back, with radiolucent stones <5 mm

d.48/M, with intermittent mild right upper quadrant pain and radiopaque stones <5 mm

A

50/M, asymptomatic with radiolucent stones <10 mm

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14
Q

What is the single best enzyme to measure for the diagnosis of acute pancreatitis?

a.Amylase

b.Macroamylase

c.Isoamylase

d.Lipase

A

Lipase

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15
Q

Which of the following common causes of acute pancreatitis can present with normal amylase and lipase levels?

a.Gallstones

b.Alcohol

c.Hypertriglyceridemia

d.Anti-HIV medications

A

Hypertriglyceridemia

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16
Q

A 45/F is consulting at the ER due to severe epigastric pain, described as steady and boring, radiating to the back, with associated loss of appetite. Vital signs are as follows: BP 100/60, HR 112, RR 21, Temp 37.8°C. Bowel sounds are diminished. She is not jaundiced. Murphy’s, psoas, obturator, Cullen and Turner signs are also negative. Which of the following should be part of the initial management plan for this patient?

a.Low-fat solid diet

b.Initial bolus of 1L of plain normal saline

c.Abdominal CT scan to look for necrosis

d.ERCP within 24 hours of diagnosis

A

Initial bolus of 1L of plain normal saline

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17
Q

A 35/F experiences chest pain described as substernal warmth that moves to the neck, with associated dysphagia and occasional nonproductive cough. She has weight loss of 1 kg over the last 2 months after taking diet pills. Her mother died of breast cancer. Which of the following is a concerning feature of her dyspepsia?

a.Dysphagia

b.Nonproductive cough

c.Weight loss

d.Family history of malignancy

A

Dysphagia

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18
Q

Which of the following patients can be diagnosed with functional dyspepsia in the absence of organic cause?

a.2-week history of bothersome postprandial fullness

b.4-week history of early satiety

c.3-month history of vague epigastric pain

d.6-month history of epigastric burning pain

A

6-month history of epigastric burning pain

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19
Q

Which of the following is a rare gastropathy characterized by large, tortuous mucosal folds most prominent in the body and fundus, sparing the antrum, eventually developing protein-losing gastropathy accompanied by hypoalbuminemia and edema?

a.Menetrier’s disease

b.Russel body gastritis

c.Zollinger-Ellison syndrome

d.Afferent loop syndrome

A

Menetrier’s disease

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20
Q

Which of the following patients has a disease traditionally associated with type A gastritis?

a. Patient who tested positive for urea breath test

b. Patient with friable, ulcerated mass with irregular, thickened margins on the stomach

c. Patient with impaired production of intrinsic factor

d. Patient with colicky abdominal pain, transmural inflammation of the ileum, with fistula formation

A

Patient with impaired production of intrinsic factor

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21
Q

Which of the following should be highly considered in a patient admitted in the ICU suddenly experiencing severe, acute, unremitting abdominal pain, with minimal tenderness on palpation, and hypoactive bowel sounds on auscultation?

a. Acute intestinal obstruction

b. Acute peritonitis

c. Acute appendicitis

d. Acute mesenteric ischemia

A

Acute mesenteric ischemia

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22
Q

What is considered the gold standard for the diagnosis of acute arterial occlusive disease?

a. Duplex imaging

b. Angiography

c. Laparotomy

d. Colonoscopy

A

Angiography

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23
Q

Which of the following hepatitis profiles is consistent with acute hepatitis B infection?

a. HBsAg negative, anti-HBs negative, anti-HBc IgG positive, anti-HBe positive

b. HBsAg negative, anti-HBs positive, anti-HBc negative, anti-HBe negative

c. HBsAg positive, anti-HBs negative, anti-HBc IgM positive, HBeAg positive

d. HBsAg positive, anti-HBs negative, anti-HBc IgG positive, HBeAg positive

A

HBsAg positive, anti-HBs negative, anti-HBc IgM positive, HBeAg positive

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24
Q

Which of the following is TRUE of hepatitis B infection in adults?

a. Can be transmitted thru orofecal route

b. Neonatal transmission is related to breastfeeding from infected mothers

c. Does not usually progress to a chronic infection

d. Not documented to cause hepatocellular cancer

A

Does not usually progress to a chronic infection

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25
Q

A 26/F was referred to you by a company physician. She just had her routine annual physical examination and check-up and laboratory results showed anti-HBc IgM was positive, but HBsAg, anti-HBs, HBeAg, and anti-Hbe were negative. Which of the following is a correct interpretation of this hepatitis profile?

a. Low level hepatitis B carrier

b. Immunized (after vaccination)

c. HBeAg-negative “precure mutant”

d. Anti-HBc “window”

A

Anti-HBc “window”

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26
Q

Which of the following laboratory findings is most compatible with alcoholic hepatitis?

a.ALT > 400 IU/L

b. AST/ALT ratio <1

c. Elevated GGTP

d. Hyperbilirubinemia with marked increase in alkaline phosphatase

A

Elevated GGTP

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27
Q

53/M came to the ER due to hematemesis for 2 days. He had fever, jaundice, and abdominal pain starting 1 week prior. Upon probing, he drinks 3 to 4 bottles of beer a day, with occasional binge drinking with friends during weekends. Physical examination showed spider nevi on his chest and abdominal enlargement without tenderness on palpation. Laboratory results showed AST 312 IU/L, ALT 285 IU/L, alkaline phosphatase 150 IU/L, total bilirubin 8 mg/dL, albumin 26 g/L, creatinine 92 µmol/L, Protime 20 seconds (reference value 13 seconds). Which of the following will most benefit this patient?

a. Aspirin

b. Prednisone

c. Pentoxifylline

d. Abstinence from alcohol

A

Abstinence from alcohol

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28
Q

Which risk assessment score predicts failure of glucocorticoid treatment in alcoholic liver disease?

a. Discriminant function ≥ 32

b. Model for end-stage liver disease (MELD) score ≥ 21

c. MELD-Na score ≥ 21

d. Lille score > 0.45

A

Lille score > 0.45

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29
Q

What is the most common agent implicated as causing drug-induced liver injury?

a. Amoxicillin-clavulanate

b. Acetaminophen (Paracetamol)

c. Ciprofloxacin

d. Steroids

A

Amoxicillin-clavulanate

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30
Q

Which of the following drugs likely caused drug-induced hepatitis with the following laboratory findings: ALT 376 IU/L (upper limit of normal 45 IU/L), Alk phos 182 IU/L (upper limit of normal 147 IU/L)?

a. Amoxicillin-clavulanate

b. Isoniazid

c. Simvastatin

d. Oral contraceptives

A

Isoniazid

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31
Q

Which of the following diseases will most likely test positive for antimitochondrial antibodies?

a. Primary biliary cholangitis

b. Primary sclerosing cholangitis

c. Autoimmune cholangitis

d. Idiopathic adulthood ductopenia

A

Primary biliary cholangitis

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32
Q

Which of the following clinical manifestations is a sign of portal hypertension?

a. Jaundice

b. Ascites

c. Spider angioma

d. Hepatic encephalopathy

A

Ascites

33
Q

A 48/M, heavy alcoholic drinker, presented at the ER due to a 1-month history of jaundice and abdominal enlargement. He does not have any other comorbidities or previous hospitalizations. Physical examination revealed bitemporal wasting, parotid enlargement, palmar erythema, and bipedal edema. Fluid wave was present. His liver edge was not palpable and Traube’s space was obliterated. Digital rectal exam was unremarkable. Which of the following is the next best course of management?

a. Send for fecalysis with occult blood testing

b. Abdominal X-ray upright and supine

c. Diagnostic paracentesis

d. Start Ceftriaxone

A

Diagnostic paracentesis

34
Q

A 55/M with known chronic hepatitis B infection presents at the ER due to altered sensorium. He is awake but disoriented. He can follow commands and is positive for asterixis. Physical examination shows icteric sclerae, abdominal enlargement, caput medusae, spider nevi and bipedal edema. Which of the following is the correct management step in this case?

a. Restrict dietary proteins

b. Start lactulose to target at least one soft stool per day

c. Start octreotide drip and maintain for 2 to 5 days until sensorium normalizes

d. Start rifaximin 550 mg BID

A

Start rifaximin 550 mg BID

35
Q

Which of the following clinical manifestations is more consistent with ulcerative colitis than in Crohn’s disease?

a.Gross blood and mucus in stool

b. May present with an abdominal mass

c. Frequently associated with significant perineal disease

d. Associated with fistula formation

A

Gross blood and mucus in stool

36
Q

What is the most common site of inflammation in Crohn’s disease?

a. Second part of duodenum

b. Terminal ileum

c. Jejunum

d. Colon and rectum

A

Terminal ileum

37
Q

Portal areas of the liver consist of small veins, arteries, bile ducts and lymphatics. Secreted bile flows: a. From the hepatocytes to the sinusoids
b. From the portal areas to the sinusoids to the terminal hepatic areas
c. In a counter-current pattern
d. From zone 1 to zone 3

A

c. In a counter-current pattern

38
Q

. A 68-year-old male is evaluated for hematemesis. He reports history of smoking, hypertension, weight loss for the last 3 months, abdominal fullness, and fatigue. On PE BP 90/60, CR 120s, RR 24, T37.2C. He has pale palpebral conjunctivae, icterisia, abdominal shifting dullness, tender right upper quadrant area, and grade 2 bipedal edema. His intial serologies showed Hg 8.7g/dL, platelet 122, BUN 32mg/dL, creatinine 1.3mg/dL, PT INR 1.8, ALT 278, AST 322 and high biliribuin levels; with (+) HBsAg, (+) IgG anti-HBc. What is the ideal management along with upper endoscopy:

a. CT angiography
b. CT enterography
c. Once daily PPI therapy
d. Vasoactive drug like octreotide

A

d. Vasoactive drug like octreotide

39
Q

A 62-year-old female with no previous therapy for the liver came for follow up for fatigue and occasional itchiness with her lab results: SGPT 74, SGOT 79, (+) HBsAg, (-) HBeAg, (+) anti-HBe, (-) anti-HBc and HBV DNA < 20 IU/mL. What does she have:

a. Acute hepatitis B, replicative phase
b. Acute hepatitis B, non-replicative phase
c. Chronic hepatitis B, replicative phase
d. Chronic hepatitis B, non-replicative phase

A

d. Chronic hepatitis B, non-replicative phase

40
Q

A 28-year-old male complained of 2-month history of hematochezia with frequent soft to watery stools of about 4 episodes per day, accompanied by weight loss and anorexia. Distal colon biopsy showed diffuse mucosal disease with no ulceration and no cobblestoning. Management for this condition:

a. Cyclophosphamide
b. Metronidazole
c. Rituximab
d. Sulfasalazine

A

d. Sulfasalazine

41
Q

66-year-old diabetic male was admitted for debridement of cellulitis on the right foot. However on his 22nd hospital day, he developed watery stools occurring 4 episodes per day for the last 2 days, fever Tmax 38.9C, with CBC WBC 18,000, N88; The most sensitive and specific test for the isolation of this organism is:

a. Cell culture cytotoxin test on stool
b. Colonoscopy
c. Enzyme immunoassay for toxins A and B in stool
d. Nucleic acid amplification tests for toxins A and B in stool

A

d. Nucleic acid amplification tests for toxins A and B in stool

42
Q

A 26-year-old female with 8 days of flu-like symptoms with anorexia came in for evaluation. She is sexually active with multiple partners. On PE BP 132/84, CR 98, RR 19, T 37.9C, icteric sclerae, clear breath sounds, no active skin lesions, with palpable liver at mid clavicular line, measuring 17cm by percussion. Her serologies showed: HbsAg (+), IgG anti-HBs (-), HBe Ag (+), IgM anti-HBc (+)

a. Active hepatitis B infection
b. Active protection against the hepatitis B virus
c. No active hepatitis B infection
d. Previous hepatitis B infection

A

a. Active hepatitis B infection

43
Q

A 42-year-old female seeking clearance for work came in with hepatitis panel results: anti-HAV IgG (+), anti HAV IgM (-), HBsAg (-), anti-HBs (+), anti-HBc (-), HBeAg (-), anti-HBe (-). What is the assessment:

a. Acute Hepatitis A infection with immunization from vaccination with Hepatitis B
b. Acute hepatitis A and B infection
c. Previous hepatitis A infection with immunization from vaccination with Hepatitis B
d. Previous hepatitis A infection with chronic hepatitis B infection

A

c. Previous hepatitis A infection with immunization from vaccination with Hepatitis B

44
Q

A 26-year-old male came in for occasional frequent bowel movement of about 3 episodes, with passage of small volumes of stool amounting to about less than 1 cup, often associated with urgency, tenesmus and feeling of incomplete evacuation. He remembers having the same episodes 3 years ago which lasted for a few weeks and spontaneously improved. Most likely he has:

a. Chronic diarrhea
b. Irritable bowel syndrome
c. Malabsorption syndrome
d. Overflow diarrhea

A

b. Irritable bowel syndrome

45
Q

A 43-year-old female came for evaluation of gradual abdominal enlargement for the last 3 weeks, accompanied by bilateral leg swelling. On PE BP 160/100, CR 110, RR 22, T 36.8C. She has multiple cervical lymphadenopathy, neck veins not distended, decreased breath sounds bibasal; abdominal enlargement, with normoactive bowel sounds, negative hepatojugular reflux, non tender abdomen and grade 2 bipedal edema. Her SAAG was noted at <1.1g/dL. Possible differential would include:

a. Budd-Chiari syndrome
b. Congestive heart failure
c. Nephrotic syndrome
d. Sinusoidal obstruction syndrome

A

c. Nephrotic syndrome

46
Q

A 35 year old female with no known comorbidities sought consult due to chronic epigastric pain accompanied by diarrhea. EGD was done which showed hypertrophic gastric folds and prepyloric and duodenal scars, as well as duodenitis. At the second portion of the duodenum a sessile hemispheric polyp was seen close to the papilla of Vater. Biopsy of the polyp showed an abundance of cells immunoreactive for gastrin. What will be the next diagnostic test for the patient?

a. Endoscopic ultrasound
b. Fasting gastrin level
c. Measurement of gastric fluid pH
d. Trial of high dose PPI 60 mg/24H

A

b. Fasting gastrin level

47
Q

A 68-year-old male, chronic alcohol beverage drinker, was seen at the ER with complaints of abdominal discomfort. On PE, the following were noted: BP120/74, CR 82, RR 20, T 36.9C, icteric sclerae, jaundice, liver span 14cm, tender right upper quadrant, and flapping tremors. His ALT 47U/L, AST 158 U/L, albumin 2.3, PT INR 1.20, RBS 132. Which among the following treatment options would result to better survival for his condition:

a. Alcohol intake cessation
b. Anti-TNF like infliximab or etanercept
c. Penicillamine
d. Pentoxyfilline

A

a. Alcohol intake cessation

48
Q

A 40-year-old female came in for EGD due to 4 months of epigastric pain worst between meals, occasionally relieved by Sodium alginate + Sodium bicarbonate + Calcium carbonate sachet, and now advised for EGD due to melena. She has no comorbidity, with no intake of medications. Her PE is normal except for epigastric tenderness. Her EGD which showed a well- circumscribed 2-cm duodenal ulcer that is positive for H.pylori. Which of the following is the recommended initial therapy given these findings?

a. A. Esomeprazole plus bismuth subsalicylate plus tetracycline plus metronidazole for 5-7 days
b. Lansoprazole plus clarithromycin plus amoxicillin for 14 days
c. Omeprazole plus Clarithromycin plus Amoxicillin plus Metronidazole for 5-7 days
d. Omeprazole plus rifabutin plus amoxicillin for 10 days

A

b. Lansoprazole plus clarithromycin plus amoxicillin for 14 days

49
Q

58-year-old alcoholic male, presented with 3-days of hematemesis. His BP 100/70, CR 108bpm, pale palpebral conjunctivae with slight icterisia. He had tender epigastric and RUQ areas. Liver was firm with palpable nodular edge at mid clavicular line. His BUN was 20mg/dL, Hgb 11g/dL, with no signs of heart failure. Aside from PPI infusion at presentation, what will be the next management?

a. Antibiotic therapy with quinolone or ceftriaxone
b. Blood transfusion
c. Early endoscopy within 12 hours
d. Surgery

A

a. Antibiotic therapy with quinolone or ceftriaxone

50
Q

A 46-year-old male, came in due to 2 days hematochezia. He is hemodynamically stable. Upon colonoscopy, there is active bleeding mass on the sigmoid area. Base on the findings, what is your next immediate management?

a. CT angiography
b. Flexible sigmoidoscopy
c. Intraoperative colonoscopy and surgery
d. Surgery alone

A

b. Flexible sigmoidoscopy

51
Q

A 65 year old male with liver cirrhosis came in for follow up for his liver function tests: ALT 158U/L, AST 172U/L, INR 1.0, albumin 3.2; HBsAg (+), HBe Ag (-) , HBV DNA <2000 IU/mL. What will be the next step:

a. Consider liver biopsy
b. Consider liver transplant
c. Start chemotherapy
d. Start Lamivudine +/- adefovir

A

d. Start Lamivudine +/- adefovir

52
Q

A 32-year-old female with 3 month history of fatigue was referred for hepatomegaly 17cm by ultrasound, elevated ALT 198mg/dL and AST 221mg/dL, viral hepatitis tests negative, ANA 1:320 homogenous. IgG (+), and anti-LKM1 (+). Liver biopsy showed: interface hepatitis. Management for this case would include:

a. Azathioprine
b. Glucocorticoid therapy + Azathioprine
c. Glucocorticoid + Hydroxychloroquine therapy
d. Hydroxychloroquine therapy

A

b. Glucocorticoid therapy + Azathioprine

53
Q

A unique form of hemolytic anemia with spurs and acanthocytes that occur among patients with severe alcoholic liver disease.

a. Beck’s triad
b. Laennec’s syndrome
c. Wernicke’s syndrome
d. Zieve’s syndrome

A

d. Zieve’s syndrome

54
Q

28/F, PU36 weeks AOG came to the ER due to RUQ pain with radiation to the scapula accompanied by vomiting. PE was unremarkable. Ultrasound of the gall bladder showed bile sludge.
Factors that may contribute to gallstone formation during pregnancy:

a. Decrease in bile salt secretions
b. Gallbladder hypomotility
c. Decreased enterohepatic circulation of bile acids
d. Decreased size of bile acid pools

A

b. Gallbladder hypomotility

55
Q

A 39-year-old male with no known co-morbidities sought consult for a 3-year history of recurrent epigastric pains with nausea and vomiting. He took PPI for 1 month, but symptoms persisted. He underwent gastroscopy with biopsy which showed: inflammatory infiltrate extending deeper into the mucosa with progressive distortion and destruction of the glands. Based on these findings, what phase of chronic gastritis does he belong to?

a. Atrophic gastritis
b. Gastric atrophy
c. Gastric metaplasia
d. Superficial gastritis

A

a. Atrophic gastritis

56
Q

A 65-year-old male admitted for syncope due to cardiomyopathy-associated ventricular tachycardia and had been on amiodarone drip for 3 days then oral amiodarone for 10 days developed jaundice and vomiting and later encephalopathy just when discharge was being planned. Which therapy provides a higher transplant-free survival?

a. Glucocorticoids
b. N-Acetylcysteine
c. Silymarin
d. Ursodeoxcholic acid

A

b. N-Acetylcysteine

57
Q

Congestive splenomegaly with hypersplenism is common in patients with portal hypertension and is usually the first indication of portal hypertension in liver cirrhosis. They are characterized with the development of

a. Thrombocytosis and leukocytosis
b. Thrombocytosis and leukopenia
c. Thrombocytopenia and leukocytosis
d. Thrombocytopenia and leukopenia

A

d. Thrombocytopenia and leukopenia

58
Q

A 52-year-old male diagnosed was diagnosed with gastric ulcer. What is true of its pathology:

a. Intake of Paracetamol increases the risk
b. NSAIDs induce increase in prostaglandin secretion
c. The organism associated is a gram-positive microaerophilic rod
d. The organism associated is S-shaped with multiple sheathed flagella

A

d. The organism associated is S-shaped with multiple sheathed flagella

59
Q

A 57 year old male with duodenal ulcer experienced transient improvement with H.pylori eradication. Three months later, symptoms recur despite suppressing therapy. He has no NSAID intake. Stool test for H.pylori is negative. EGD reveals prominent gastric folds together with persistent ulceration in the duodenal bulb previously detected and the beginning of a new ulcer 4cm proximal to the initial ulcer. What is the likely diagnosis

a. H.pylori associated PUD
b. Malignancy
c. NSAID induced gastropathy
d. Zollinger Ellison Syndrome

A

d. Zollinger Ellison Syndrome

60
Q

A 67 year old male presenting with melena at the ward developed orthostatic hypotension. His current BP is 90/50, HR 128. His hemoglobin is 6.9g/dL, BUN of

What will be your next initial management?

a. Admit to ICU
b. Blood transfusion
c. PPI therapy
d. Urgent endoscopy

A

b. Blood transfusion

61
Q

A 38-year old female who was previously well, developed a 3 month history of progressive body weakness, body malaise, and fatigue. She has no history of illicit drug use, an occasional alcoholic drinker and a non-smoker. She is married with only one sexual partner, her husband who admits to having multiple partners in the last 3 years, prior to his marriage. The last 2 weeks patient has anorexia, nausea and occasional vomiting. Upon PE she has right upper quadrant tenderness. Her lab results showed: CBC: 12/0.39/WBC 14/N50, L45, M3, E2/plt 250; RBC 88, Creatinine 1.0, BUN 14, ALT 235, AST 100, TB 2.0 mg/dl, IgM anti HAV – Negative; IgM Anti-HBc-Positive; anti
Hbs – Negative; HBsAg – Positive; HBeAg-Negative; anti HCV Negative; HBV DNA >2 x104 IU/mL How will you manage this patient?

a. Anti-viral therapy is not recommended, suggest liver biopsy
b. Close monitoring of viral load every 3 months
c. Interferon therapy 5M units subcutaneously daily
d. Tenofovir 300mg OD PO

A

d. Tenofovir 300mg OD PO

62
Q

A 62-year-old female came in due to epigastric pain radiating to the back. PMH: s/p cholecystectomy a year ago. Ultrasound showed absent gall bladder with dilated common bile duct. The present of choledocholithiasis should be suspected if

a. Elevation of aminotransferases 2-10 fold
b. Intrahepatic biliary dilatation
c. Presence of pruritus and acholic stools
d. Serum bilirubin levels > 20mg/dL

A

a. Elevation of aminotransferases 2-10 fold

63
Q

A 53-year-old female with T2DM came in with epigastric fullness and eructation. Ultrasound showed a 7mm gallstone. The best management advice would be:
a. Choleresis to increase biliary secretion
b. Expectant management
c. Gallstone dissolution with UDCA at 10-15 mg/kg/day.
d. Prophylactic cholecystectomy

A

b. Expectant management

64
Q

A 20-year-old female consulted for itchiness of 2 weeks, bloatedness and periods of tiredness. Initial aminotransferases are elevated. What diagnostic imaging study would be valuable in evaluation of the patient’s condition?
a. CT scan of the abdomen
b. ERCP
c. MRCP
d. Ultrasound of the abdomen

A

b. ERCP

65
Q

A 39 year old male with history of 2 CVD infarcts when he was 19 years old and later when he was 25 years old, is admitted for severe generalized abdominal pains since 2 days now. He has no nausea/vomiting but with last bowel movement 4 days ago. On PE he has hypoactive bowel sounds, tender on light percussion on all quadrants, no ascites, no organomegaly, tender on all quadrants. DRE was negative. Abdominal X-ray showed “thumbprinting” on the bowel wall. The next diagnostic step for this condition:
a. Angiography with venous phase
b. Colonoscopy
c. Duplex scan
d. Ultrasound of the whole abdomen

A

a. Angiography with venous phase

66
Q

A 38-year-old female comes in for recurrent bloody diarrhea. Fecalysis showed WBCs and RBCs, fecal lactoferrin is elevated. ESR and CRP are elevated. Ultrasound of the whole abdomen was unremarkable. The colonoscopy shows diffuse continuous inflammation of the bowel across the rectosigmoid. What key diagnostic test can confirm her likely condition?

a. CT scan of the whole abdomen with triphasic contrast
b. Endoscopic ultrasound of the rectum
c. Immune markers such as ANA and AMA
d. There is no key / definitive test for her condition.

A

d. There is no key / definitive test for her condition.

67
Q

Which is the most commonly affected portion of the GI system in patients with Crohn’s disease? a. The cecum
b. The rectum
c. The stomach
d. The terminal ileum

A

d. The terminal ileum

68
Q

A 41-year-old female Crohn’s disease patient comes in for severe abdominal pain. She has been maintained on sulfasalazine and azathioprine for the last 10 years but was lost to follow up for the last 3 years. She now has difficulty defecating for over 1 week. Her Xray shows evidence of bowel obstruction and CT scan confirms multiple strictures. Her ideal management would be:

a. Perform a colonoscopy to dilate the strictured segments
b. Refer for surgical intervention
c. Start bowel rest and steroids
d. Step up management to use infliximab

A

b. Refer for surgical intervention

69
Q

A 52 year old female, recently diagnosed with Rheumatoid arthritis was referred for clearance prior to Rituximab infusion. She denies history of any liver disease, abdominal pains and problems in defecation. On work up she has: IgM anti HAV (-); HBsAg (+),IgM anti-HBc (-),IgG anti HBc (+),HBeAg (-), anti-HBe(-), anti-HCV (-). What is the patient’s hepatitis status?

a. Acute hepatitis B infection
b. Chronic hepatitis B infection
c. Process of seroconversion to antiHBs
d. No hepatitis infection

A

d. No hepatitis infection

70
Q

A 44-year-old male, smoker, alcoholic was rushed to the ER for progressive, severe abdominal pain for the last 8 days. Initially described as burning, epigastric pain radiating to the back. On PE BP 60/40, CR 130s, RR 24, T 38.7C, dry mucosa, decreased breath sounds bibasal, faint blue discoloration on the periumbilicus, hypoactive bowel sounds, tender on all quadrants. The patient is currently in which phase of this condition?

a. First phase
b. Second phase
c. Third phase
d. Fourth phase

A

c. Third phase

71
Q

A 66-year-old female, previously alcoholic came in for work up for weight loss abdominal pains and chronic diarrhea. She noticed that fecal matter is frothy and floats every bowel movement which occurs about 3-4 times daily. Initial work up for this condition would include:

a. CT scan of the pancreas
b. Endoscopic ultrasound
c. Fecal elastase measurement
d. Pancreas function test with secretin

A

c. Fecal elastase measurement

72
Q

A 43-year-old female came in from India with 2-week fever, abdominal pains, anorexia, weight loss and nausea and vomiting. She remembers having salmon colored rash that lasted for 3 days during the first week of fever. On PE BP 130/90, CR 80s, T39C. She has tender abdomen and hepatosplenomegaly. If she will be left untreated and develop chronic carriage, this will increase the risk for:

a. Coma vigil
b. Gallbladder cancer
c. Hemophagocytic syndrome
d. Osteomyelitis

A

b. Gallbladder cancer

73
Q

A 48/F with a 5-month history of intermittent colicky abdominal pain presented at the ER due to severe, boring, epigastric pain. Labs are as ff: Amylase 2675, Lipase 2734, Crea 0.5, BUN 20, CXR normal. The patient is classified as having: (p.838)

a. Mild acute pancreatitis
b. Moderately severe acute pancreatitis
c. Severe acute pancreatitis
d. Fulminant pancreatitis

A

a. Mild acute pancreatitis

74
Q

On Day 3 of hospital stay, patient denies abdominal pain and is requesting if he can start eating. How should you progress her diet: (p.838)

a. Clear Liquids
b. General liquids
c. Soft diet
d. Low fat solid diet

A

d. Low fat solid diet

75
Q

Which of the following is a marker of severity of acute pancreatitis (p.837)

a. Age >55
b. Hemoconcentration (Hct >44%)
c. BUN >20
d. WBC >10

A

b. Hemoconcentration (Hct >44%)

76
Q

Predisposing factors of gallstone formation include the ff EXCEPT: (p.828)

a. Age
b. Pregnancy
c. Cirrhosis
d. Weight gain

A

d. Weight gain

77
Q

A 56/F consults at the OPD due to incidental finding of cholelithiasis 3.5cm on routine WAUTZ. She has no comorbids and denies having abdominal pain. Your management would be: (p.832)

a. Assurance
b. Oral dissolution therapy
c. Elective surgery
d. Emergency surgery

A

c. Elective surgery

78
Q

A 67/M presents at the ER with crampy LLQ pain and tenderness, fever, leukocytosis WBC 15,000, and altered bowel movement. What would be the best initial diagnostic test to confirm your suspicion: (p.826)

a. Fecalysis
b. Colonoscopy
c. WAUTZ
d. WACT

A

d. WACT

79
Q

A 34/F presents with jaundice, malaise, ALT 1745 AST 1675 HbsAg(R) anti-Hbc IgM(R) anti-Hbs (NR) HbeAg(R). What would you advise:

a. Observe
b. Start Silymarin
c. Start Entecavir
d. Start Prednisone

A

a. Observe

I (12 decks)

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