GIT

Question 1

A 43-year-old man with a 20-year history of ulcerative colitis presents to the
physician with complaints of worsening bloody diarrhea, progressive fatigue,
pruritus, visual disturbances, and arthralgias. On physical examination, he is
found to have icteric sclera, finger clubbing, and several small ulcerations with
necrotic edges on both legs. Endoscopic retrograde cholangiopancreatography
(ERCP) shows alternating strictures and dilations of the bile ducts.
Which of the following conditions is consistent with these ERCP findings?
(A) Cholelithiasis
(B) Pancreatic carcinoma
(C) Primary biliary cirrhosis
(D) Primary hemochromatosis
(E) Primary sclerosing cholangitis

Answer 1

(E) Primary sclerosing cholangitis

Question 2

A 41-year-old man has a history of drinking 1 to 2 liters of whisky per day for the
past 20 years. He has had numerous episodes of nausea and vomiting in the past 5
years. He now experiences a bout of prolonged vomiting, followed by massive
hematemesis. On physical examination his vital signs are: T 36.9°C, P 110/min,
RR 26/min, and BP 80/40 mm Hg lying down. His heart has a regular rate and
rhythm with no murmurs and his lungs are clear to auscultation. There is no
abdominal tenderness or distension, and bowel sounds are present. His stool is
negative for occult blood. Which of the following is the most likely diagnosis?
A Hiatal hernia
B Esophageal laceration (Mallory-Weiss syndrome)
C Esophageal pulsion diverticulum
D Barrett esophagus
E Esophageal squamous cell carcinoma

Answer 2

B Esophageal laceration (Mallory-Weiss syndrome)

Question 3

A 50-year-old man has had persistent nausea for 5 years with occasional
vomiting. On physical examination there are no abnormal findings. He
undergoes upper GI endoscopy, and a small area of gastric fundal mucosa has
loss of rugal folds. Biopsies are taken and microscopically reveal welldifferentiated adenocarcinoma confined to the mucosa. An upper GI endoscopy
performed 5 years previously showed a pattern of gastritis and microscopically
there was chronic inflammation, Which of the following is the most likely risk
factor for his neoplasm?
A Inherited APC gene mutation
B Chronic alcohol abuse
C Helicobacter pylori infection
D Use of non-steroidal anti-inflammatory drugs
E Vitamin B12 deficiency

Answer 3

C Helicobacter pylori infection

Question 4

A 58-year-old man has had increasing difficulty swallowing for the past 6
months and has lost 5 kg. No abnormal physical examination findings are noted.
Upper GI endoscopy reveals a nearly circumferential mass with overlying
ulceration in the mid esophageal region. Biopsy of the mass reveals pink
polygonal cells with marked hyperchromatism and pleomorphism. Which of
the following is the most likely risk factor for development of his disease?
A Iron deficiency
B Helicobacter pylori infection
C Chronic alcohol abuse
D High fruit diet
E Zenker diverticulum

Answer 4

C Chronic alcohol abuse