GI Rx cond

Question 1

The inferior mesenteric artery branches off the aorta at a site commonly affected by abdominal aortic aneurysms. It can be compromised during AAA repair, potentially leading to?

Answer 1

Ischemia of the distal colon. Despite collateral circulation, the sigmoid colon is susceptible to ischemic events.
The inferior mesenteric artery (IMA) originates from the aorta inferior to the renal arteries and superior to the bifurcation of the aorta into the common iliac arteries. The IMA supplies blood to the distal one-third of the transverse colon, descending colon, and sigmoid colon, and the upper portion of the rectum

Question 2

This young woman presents with abdominal pain and changes in bowel habits that increase with stress (eg, after starting a new job) and are classically relieved with bowel movements. This characterizes?

Answer 2

irritable bowel syndrome (IBS), an idiopathic functional disorder marked by a set of chronic gastrointestinal symptoms. A normal complete blood count, normal erythrocyte sedimentation rate, and normal physical exam findings are consistent with this benign disease

Question 3

Irritable bowel syndrome is a diagnosis of exclusion; it often presents with bloating, chronic abdominal discomfort, altered bowel habits, and relief of abdominal pain with defecation? .

Answer 3

Loperamide (an opioid) may be used as adjunctive pharmacotherapy for diarrhea, along with support, dietary modifications, and physical activity.

Question 4

The patient’s dysphagia for both solids and liquids suggest a motility problem. Barium swallow shows dilation and tapering with concentric distal stenosis, often described ?

Answer 4

as the “bird’s beak” sign. In combination with her regurgitation on eating, these symptoms suggest achalasia.Patients with achalasia often present with difficulty swallowing both solids and liquids. Achalasia can be treated with a calcium channel blocker, nitroglycerin, or botulinum toxin injection. These medications help to relax the lower esophageal sphincter, which can be seen failing to relax on manometry.

Question 5

Peyer patches are lymphoid tissue found in the lamina propria and the submucosa of the small intestine. They play a role in gastrointestinal immunity, as stimulated B cells leave Peyer patches and differentiate into IgA-secreting plasma cells. IgA is found in ?

Answer 5

breast milk, which supports infant immune function.

Question 6

This patient presents with nausea, abdominal cramping, bloating, and watery diarrhea. Although a number of bacterial and viral infections can manifest with such symptoms, the patient’s recent camping trip suggests?

Answer 6

Infected with Giardia lamblia. Colonization of the gut by Giardia trophozoites results in small bowel inflammation and villous atrophy, which reduces absorptive capability.
Giardia infection is diagnosed by duodenal aspiration

Question 7

This patient presents with right upper quadrant pain, nausea and vomiting. There is evidence of a liver cyst on ultrasound. He has a negative history for cirrhosis, hepatitis, fever, and B symptoms. These signs and symptoms, combined with his decades-long history of interaction with dogs, make infection with?

Answer 7

Echinococcus granulosus, also called cystic echinococcosis, a likely diagnosis. Echinococcus granulosus is found in the feces of dogs, and should be suspected in shepherds or in individuals with close contact with the animals. Patients infected with this pathogen develop (slow-growing) cysts in the liver and right upper quadrant pain. Albendazole is the first-line treatment; patients should be closely monitored for possible anaphylaxis if the echinococcal antigen is released from the cysts.

Question 8

1. This patient presents with watery diarrhea and abdominal pain of 3 days’ duration and has been in daycare with children who have the same signs and symptoms. This patient likely has?
2. Rotavirus is part of the reovirus family and is ?

Answer 8

a rotavirus infection, which is a common cause of viral gastroenteritis
2. a double-stranded, nonenveloped, linear-segmented RNA virus

Question 9

This patient presents with a history of chronic alcohol abuse and symptoms of fever and abdominal pain after 4 days of binge drinking. His lab values show AST≥ALT = 2:1. His biopsy demonstrates the presence of fat droplets called steatosis, balloon degeneration of hepatocytes, and eosinophilic cytoplasmic inclusions of damaged keratin called Mallory bodies.
These symptoms, lab values, and biopsy findings are consistent with?

Answer 9

acute alcoholic hepatitis. It is a diffuse liver injury that can manifest with fever, abdominal pain, and jaundice

Question 10

Right upper quadrant pain with nausea, vomiting, and fever in an obese, middle-aged, multiparous woman is a classic presentation of acute cholecystitis. In 90% of the cases, ?

Answer 10

Acute cholecystitis results from acute inflammation of the gallbladder caused by blockage of the gallbladder neck or cystic duct by a stone. Other rare causes include viral infection and severe dehydration.

Question 11

The patient’s symptoms of bloody diarrhea and cramping are consistent with a diagnosis of ulcerative colitis (UC), while the presence of fatigue, pruritus, and scleral icterus are suggestive of?

Answer 11

primary sclerosing cholangitis Alkaline phosphatase is elevated. PSC is associated with positive perinuclear antineutrophil cytoplasmic antibodies, and patients with PSC commonly have underlying ulcerative colitis.

Question 12

This patient presents with abdominal pain, steatorrhea, weight loss, fatigue, and joint pain. The histology results reveal intraepithelial lymphocytes, enterocyte damage, and villous blunting. Together, these findings suggest that the patient most likely has? . The pathogenesis of this condition is driven by an?

Answer 12

1. celiac disease. Patients with celiac disease are at increased risk for IgA deficiency.
2. autoimmune response triggered by gluten.

more likely to have iron-deficiency anemia, autoimmune thyroid disease, and type 1 diabetes.

Question 13

This patient presents with bloody diarrhea, abdominal pain, and mild fever following exposure to presumably undercooked meat. These symptoms are suggestive of infection with ?

Answer 13

Escherichia coli O157:H7.
Hemolytic-uremic syndrome is a life-threatening condition associated with infection with this organism. It is characterized by anemia, thrombocytopenia, and elevated creatinine, indicating renal failure (often manifested by uremia).

Question 14

Petechial rash combined with adrenal gland hemorrhage is caused by?

Answer 14

Neisseria meningitidis.

Question 15

Ascending muscle weakness and hyporeflexia can be caused by?

Answer 15

Guillain-Barré syndrome.

Question 16

Migratory polyarthritis can be caused by?

Answer 16

infectious organisms (bacteria, virus) or via an immunologic response like that in rheumatic fever

Question 17

New murmur and splinter hemorrhages suggest?

Answer 17

infective endocarditis

Question 18

This patient experienced bloody diarrhea on return from Mexico 4 weeks ago. She now presents with a 2-week history of upper right quadrant pain, and an ultrasound shows a large mass in the liver.
This patient most likely has an ?

Answer 18

amebic abscess caused by infection with Entamoeba histolytica. Amebiasis is common in developing countries with poor sanitation. An amebic abscess can develop weeks to months after infection with E histolytica if it goes untreated. Amebiasis causes bloody mucoid diarrhea, fever, and abdominal pain. Liver ultrasound will show a well-circumscribed, hypoechoic mass

Question 19

The treatment of a hepatic abscess caused by E histolytica infection consists of ?

Answer 19

a course of metronidazole, an antibiotic used for protozoan infections. It is also used to treat Giardia and Trichomonas infections. Treatment with metronidazole usually leads to complete resolution of pathology. Additionally, subsequent treatment with paromomycin to eliminate intraluminal cysts is often necessary. Metronidazole can cause adverse effects, including abdominal discomfort, nausea, and a disulfiram-like effect when combined with alcohol.

Question 20

This otherwise healthy teenager has developed jaundice. His family history of a cousin with jaundice that persisted for some time immediately after birth and the presence of abnormally pigmented hepatocytes in a biopsy specimen suggests a diagnosis of?

Answer 20

Dubin-Johnson syndrome

This autosomal recessive inherited form of conjugated (direct) hyperbilirubinemia presents with no other significant clinical symptoms. The disorder is caused by an impairment of the hepatocyte transport system for removal of conjugated anions (eg, bilirubin diglucuronide) into bile. The genetic defect that causes Dubin-Johnson syndrome is a mutation in the multidrug resistance protein 2 (ABCC2) gene

Question 21

The patient presents with fever, right upper quadrant (RUQ) pain, and a positive Murphy sign (inspiratory arrest on palpation), which suggest ?

Answer 21

Acute cholecystitis. In acute cholecystitis, gallstones obstruct the cystic duct, leading to contraction of the gallbladder against resistance.

The next step in diagnosis is an RUQ ultrasound exam. Patients with this condition often have elective cholecystectomy at a later time.

Question 22

This patient presenting with symptoms of bloody diarrhea and abdominal pain, as well as contiguous inflammatory findings on colonoscopy and biopsy (as seen in the image, showing prominent lymphocytic infiltrate), most likely has ?

Answer 22

ulcerative colitis. His physician wants to begin treatment with azathioprine,

Question 23

Azathioprine?

Answer 23

an antimetabolite prodrug, which is converted to 6-mercaptopurine. Azathioprine is an immunosuppressive medication, sometimes used for long-term control of inflammatory bowel disease (IBD). This drug works by inhibiting purine synthesis and metabolism, thus affecting proliferating cells such as white blood cells (WBCs). As a result, patients will have a reduction in the number of WBCs (leukopenia) and thus increased susceptibility to infection.

Question 24

Nephrotoxicity is an adverse effect of ?

Answer 24

calcineurin inhibitors, such as tacrolimus and cyclosporin, sometimes used to treat IBD

Question 25

Cardiotoxicity is an adverse effect of ?

Answer 25

doxorubicin, which is an antitumor antibiotic used in the treatment of multiple malignancies including lymphomas and bladder, breast, and lung cancer

Question 26

Orange discoloration of body fluids is an adverse effect of?

Answer 26

sulfasalazine, a sulfa drug prescribed for long-term control of IBD.

Question 27

Peripheral neuropathy is a side effect of ?

Answer 27

vincristine, which is used in the treatment of acute leukemia, rhabdomyosarcoma, neuroblastoma, Wilms tumor, Hodgkin disease, and other lymphomas.

Question 28

Pneumonitis is a rare adverse effect of ?

Answer 28

methotrexate, which is also used occasionally to treat IBD.

Question 29

This patient presents with a history of end-stage renal disease and symptoms of fatigue, muscle aches, nausea, abdominal pain, and weight loss. She is experiencing symptoms that raise concern for ?

Answer 29

liver disease. In light of her unknown immunization history, hepatitis B (HBV) is a concern for this patient. Positive HBsAg (surface antigen), and the presence of IgM anti-HBcAb (core antibody) are consistent with a diagnosis of hepatitis B. Up to 15 weeks after exposure, patients with HBV infection are positive for HBV DNA, HBsAg, anti-HBcAb, and HBeAg (envelope antigen), but they are negative for anti-HBeAb and anti-HBsAb.

Question 30

Active hepatitis B infection is characterized by ?

Answer 30

the presence of HBsAg without HBsAB. If present, HBeAg indicates actively replicating virus and high infectivity. Hepatitis B virus infection is treated with tenofovir and interferon-α.