GI and hepatic disorders questions Flashcards
Which of the following is unlikely to be reported by Mr. Kane, a 45-year-old man with a BMI=41 kg/m2 who presents with typical GERD symptoms?
Unintended weight loss
Hoarseness
A recurrent cough
Chronic pharyngitis
uninteded weight loss
the others are non redflag findings
Mr. Lam, a 78-year-old man with longstanding GERD, presents with a 1-month history of “feeling like the food gets stuck way down in my throat.” This sensation occurs with meats and other solid food types and less likely with softer or liquid foods. He denies nausea, vomiting, constipation, diarrhea, aspiration, or melena. His physical examination is unremarkable. A hemogram today reveals a microcytic hypochromic anemia with an elevated RDW.
The most likely etiology of this anemia is:
Anemia of chronic disease
Vitamin B12 deficiency
Iron deficiency
Acute blood loss
Iron deficiency
Mr. Lam, a 78-year-old man with longstanding GERD, presents with a 1-month history of “feeling like the food gets stuck way down in my throat.” This sensation occurs with meats and other solid food types and less likely with softer or liquid foods. He denies nausea, vomiting, constipation, diarrhea, aspiration, or melena. His physical examination is unremarkable. A hemogram today reveals a microcytic hypochromic anemia with an elevated RDW.
All of the following diagnostic studies are available as part of Mr. Lam’s evaluation. Rank from 1 (most helpful) to 3 (least helpful) as these tests pertain to the evaluation of Mr. Lam’s symptoms.
Barium swallow
Upper endoscopy
Abdominal ultrasound
Upper endoscopy is the only one that can get the confirmatory biopsy
Then the barium swallow to visualize the mass
Abdominal ultrasound has no use here
When choosing a pharmacologic intervention to prevent recurrence of duodenal ulcer, you prescribe:
A proton pump inhibitor
Timed antacid use
Antimicrobial therapy
A H2-receptor antagonist
ABX therapy
Anticipated clinical findings in acute appendicitis for Jordan, an otherwise well 24-year-old man with a BMI=32 kg/m2 include all of the following except:
Leukocytosis with neutrophilia and bandemia
Positive obturator and psoas signs
A 2-hour history of sudden onset of vomiting and generalized abdominal pain accompanied by fever
A 12-hour history of epigastric discomfort and anorexia that gradually shifts to nausea and right lower quadrant abdominal pain
A 2-hour history of sudden onset of vomiting and generalized abdominal pain accompanied by fever
In evaluating Jordon, the most helpful imaging study to support the diagnosis of appendicitis is an abdominal:
Please refer to this question: “Anticipated clinical findings in acute appendicitis for Jordan, an otherwise well 24-year-old man with a BMI=32 kg/m2 include all of the following except”
Flat plate
CT with contrast
MRI
Radionuclide scan
CT with constrast
A 45-year-old man who drinks 8–10 beers/day with a 12-hour history of acute-onset epigastric pain radiating into the back with bloating, nausea, vomiting. Objective: Epigastric tenderness, hypoactive bowel sounds, abdomen distended and hypertympanic. Laboratory evaluation reveals elevated lipase and amylase Likely has: A. Erosive gastritis B. Acute pancreatitis C. Duodenal ulcer D. Cholecystitis E. Diverticulitis
B. Acute pancreatitis
A 64-year-old woman with a 3-day history of intermittent left lower quadrant (LLQ) abdominal pain accompanied by fever, cramping, nausea, and 4–5 loose stools per day. Objective: Abdomen soft, +bowel sounds, tenderness to LLQ abdominal palpation, negative Blumberg’s sign. Laboratory evaluation reveals leukocytosis with neutrophilia Likely has: A. Erosive gastritis B. Acute pancreatitis C. Duodenal ulcer D. Cholecystitis E. Diverticulitis
E. Diverticulitis
A 34-year-old man w/ 3-month history of intermittent upper abdominal pain described as epigastric burning, gnawing pain about 2–3 h PC. Relief with foods, antacids. Awakening at 1–2 AM with symptoms. Objective: Tender at the epigastrium, LUQ, slightly hyperactive bowel sounds Likely has: A. Erosive gastritis B. Acute pancreatitis C. Duodenal ulcer D. Cholecystitis E. Diverticulitis
C. Duodenal ulcer
A 52-year-old woman who was recently laid off from her job, taking 3–4 doses of ibuprofen/day for the past 2–3 months to help with headaches; 1-month history of intermittent nausea, burning, and pain, limited to upper abdomen, often worse with eating. Objective: Tender at the epigastrium, LUQ, slightly hyperactive bowel sounds Likely has: A. Erosive gastritis B. Acute pancreatitis C. Duodenal ulcer D. Cholecystitis E. Diverticulitis
A. Erosive gastritis
A 54-year-old woman who presents with a 24-h history of significant epigastric and RUQ abdominal pain that is constant with 2‒3-minute periods of increased pain, accompanied by nausea, 2 episodes of vomiting, and intermittent fever. Objective: Tenderness at the epigastrium and abdominal RUQ, positive Murphy’s sign, moderately elevated AST, ALT, and ALP Likely has: A. Erosive gastritis B. Acute pancreatitis C. Duodenal ulcer D. Cholecystitis E. Diverticulitis
D. Cholecystitis
Janet, a 47-year-old well woman who is 64” (163 cm) tall with BMI=25 kg/m2, presents for a periodic health evaluation and to establish care in your practice. She reports drinking approximately 1 to 2 mixed drinks containing 1.5 oz (44.4 mL) 80-proof liquor per week and takes approximately 1 to 2 doses of acetaminophen per month. Her last visit with a healthcare provider was more than 5 years ago; she was told that her “liver tests were a bit higher than normal.” She felt well and decided not to return for follow-up. She denies history of injection drug use and has no tattoos. Her last vaccines were administered more than 10 years ago. She is without complaint. Abdominal examination is WNL.
LAbs:
HBsAG positive
Anti-HAV positive
Anti-HCV negative
These findings are most consistent with which of the following? Choose two that apply.
Chronic hepatitis B Evidence of hepatitis B infection immunity Evidence of hepatitis A immunity Acute hepatitis B infection Evidence of hepatitis C infection
Chronic hepatitis B
Evidence of hepatitis A immunity
Choosing all that apply, you offer Janet the following immunizations against:
Hepatitis B
Hepatitis A
Seasonal influenza
Tetanus, diphtheria, and acellular pertussis
Seasonal influenza
Tetanus, diphtheria, and acellular pertussis
Adults born from 1945 through 1965 should be encouraged to be screened for HCV regardless of HCV risk factors. 5 times more likely to have hepatitis C than other adults.
True
False
true
