Gastroenterology

Question 1

A patient presents with a burning, gnawing epigastric pain consistent with peptic ulcer disease. He is initially treated for H. Pylori without results. The patient denies NSAID use. What would be the best test to perform next in evaluating this patient, and which disorder do you suspect?

Answer 1

Serum gastrin level, Zollinger-Ellison Syndrome

Question 2

A patient presents with stabbing chest pain that is provoked by eating and drinking. Barium swallow study shows a “corkscrew” appearance of the esophagus. What is the most likely diagnosis?

Answer 2

Diffuse esophageal spasm

Question 3

A patient presents with steatorrhea, flatulence, and unintentional weight loss. IgA antiendomysial and tissue transglutaminase antibodies are both positive. What is the most likely diagnosis?

Answer 3

Celiac disease

Question 4

A patient presents with steatorrhea, flatulence, and unintentional weight loss. IgA antiendomysial and tissue transglutaminase antibodies are both positive. What is the most definitive test for diagnosing the patient’s condition?

Answer 4

Small bowel biopsy

Question 5

A 14 year-old patient presents with periumbilical pain that migrated to the RLQ over the course of 12 hours with associated nausea. The patient is febrile, WBC count is elevated, and you elicit a positive psoas sign on exam. What is the most likely etiology of this patient’s illness?

A. Inflammation
B. Obstruction (fecalith)
C. Autoimmune
D. Parasitic

Answer 5

A. Inflammation

Question 6

A patient with a history of chronic constipation presents with LLQ abd pain and fever. The patient has had previous episodes of painless rectal bleeding, but none associated with the current presentation. CT scan shows a structural abnormality of the colon. What is it?

Answer 6

Diverticula

Question 7

A patient with a history of ulcerative colitis presents with fever, abdominal pain, and abdominal distention. WBC is elevated, and there are positive peritoneal signs on exam. KUB shows dilation of the transverse colon. What is the most likely diagnosis?

Answer 7

Toxic megacolon

Question 8

A pediatric patient presents with paroxysms of apparent abdominal pain. During these episodes, the patient is inconsolable and draws his knees to his chest. On exam, a sausage shaped abdominal mass is palpable. What is the most likely diagnosis?

Answer 8

Intussusception

Question 9

A college student returns from a spring break trip to Mexico with diarrhea. Which antibiotic might you prescribe?

Answer 9

ciprofloxacin

Question 10

A patient with a history of ulcerative colitis presents with fatigue, pruritis, and anorexia for the past several months. On exam, you find jaundice and scleral icterus. No gallstones are present on ERCP. Cholangiography shows fibrosis of the bile duct with areas of dilation between strictures. What is the most likely diagnosis?

Answer 10

Primary sclerosing cholangitis

Question 11

A patient presents with abdominal pain, unintentional weight loss, diarrhea, and aphthous oral ulcers. ANCA antibodies are positive, and endoscopy shows cobblestoning and skip lesions. What is the most likely diagnosis?

Answer 11

Chron’s disease

Question 12

A patient presents with abdominal pain, unintentional weight loss, diarrhea, and aphthous oral ulcers. ANCA antibodies are positive, and endoscopy shows cobblestoning and skip lesions. You prescribe corticosteroids for this acute flare and which class of medications for chronic management of the patient’s condition?

Answer 12

5-ASA derivitaves

Question 13

A patient presents with abdominal pain, unintentional weight loss, diarrhea, and aphthous oral ulcers. ANCA antibodies are positive, and endoscopy shows cobblestoning and skip lesions. Which extra-intestinal manifestation of this disease might you find on eye exam?

Answer 13

uveitis

Question 14

You wake up one morning after a wild party to find that someone has left his triad in your apartment. What might you find that would indicate that it was Charcot who left it?

Answer 14

RUQ pain
Fever
Jaundice

Question 15

A 60 year-old male patient presents with painless jaundice and recent unintentional weight loss. ERCP shows a filling defect. Which disease are you most concerned about?

Answer 15

Cholangiocarcinoma

Question 16

Of the two variants of inflammatory bowel disease, which is most associated with perforation, and which is most associated with fistula formation?

Answer 16

Perforation: UC
Fistula: Chron’s

Question 17

A patient presents with fever, bloody diarrhea, defecatory urgency, and LLQ/rectal pain. Colonoscopy would most likely show ______ (continuous/discontinuous) inflammatory lesions.

Answer 17

Continuous

Question 18

A patient presents with fever, bloody diarrhea, defecatory urgency, and LLQ/rectal pain. Colonoscopy shows continuous inflammatory lesions proximally from the rectum. These lesions are most likely ______ (superficial/transmural).

Answer 18

Superficial

Question 19

A patient presents with fever, bloody diarrhea, defecatory urgency, and LLQ/rectal pain. Colonoscopy shows continuous inflammatory lesions proximally from the rectum. Which antibodies are most likely to be positive in this patient?

Answer 19

pANCA

Question 20

An 8 week-old patient presents with projectile vomiting, weight loss, and failure to thrive. On exam, an olive-like mass is palpable in the abdomen. What is the most likely diagnosis?

Answer 20

Pyloric stenosis

Question 21

A patient presents with dysphagia to liquids and solids. Barium swallow shows parrot beak. What is the gold standard test for diagnosing this patient’s condition?

Answer 21

Manometry

Question 22

A patient with a history of poorly managed GERD presents with solid-food dysphagia. The patient denies pain with swallowing liquids. What is the most likely diagnosis?

Answer 22

Esophageal stricture

Question 23

A patient with a history of Chron’s disease undergoes an ileal resection, then develops a macrocytic anemia. What is the most likely cause?

Answer 23

B-12 deficiency

Question 24

A patient with a history of chronic alcoholism develops ataxia and altered mentation. Which vitamin deficiency is most likely to blame?

Answer 24

Thiamine

Question 25

An elderly patient with a history of atrial fibrillation presents with acutely onset severe abdominal pain and rectal bleeding. Though limited by the patient’s pain, abdominal examination is unremarkable. What is the most likely diagnosis?

Answer 25

Ischemic bowel

Question 26

An elderly patient with a history of atrial fibrillation presents with acutely onset severe abdominal pain and rectal bleeding. Though limited by the patient’s pain, abdominal examination is unremarkable. Abdominal x-ray shows “thumb print” sign on colon. What is the gold-standard test in diagnosing this patient’s condition?

Answer 26

Mesenteric angiography