GI - entire block 2 (Q46-87)

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Question 46 A 40 year old female notes that her fingers turn blue with exposure to cold. She has difficulty with fine movement of her fingers, because the skin is taut. Her face is mask-like because of skin that is taut and non-wrinkled. She has been gradually losing weight for the past 5 years. Laboratory findings include a positive anti-centromere antibody with negative antinuclear antibody and negative rheumatoid factor. Which of the following pathologic findings is she most likely to have:
A Chronic cholecystitis
B Micronodular cirrhosis
C Acute pancreatitis
D Ischemic enteritis
E Esophageal stricture
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Question 47 A 42 year old woman has noted generalized pruritis, but no rash, for several months. This pruritis is not relieved by application of topical corticosteroid containing creams. She is also bothered by dry eyes and a dry mouth. Laboratory findings include: total bilirubin 1.8 mg/dL, direct bilirubin 1.2 mg/dL, AST 55 U/L, ALT 58 U/L, alkaline phosphatase 289 U/L, total protein 6.8 g/dL, albumin 3.4 g/dL, and total cholesterol 344 mg/dL. A liver biopsy reveals destruction of intrahepatic bile ducts with associated lymphoplasmacytic inflammatory infiltrates of the portal tracts that extend into the adjacent parenchyma. Which additional serologic laboratory test finding is most likely to be positive:
A Anti-mitochondrial antibody
B Anti-parietal cell antibody
C Anti-centromere antibody
D Anti-ribonucleoprotein
E Anti-double stranded DNA
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Question 48 A 47-year-old male has increasing abdominal enlargement. Physical examination reveals the presence of no abdominal tenderness, but a fluid wave is present. A paracentesis is performed with removal of 2000 cc of clear, yellow ascitic fluid. This fluid has a protein of 2.1 g/dL. Cytologically, the fluid contains a few mesothelial cells and a few mononuclear cells. Which of the following underlying conditions is he is most likely to have:
A Perforated gastric ulcer
B Acute pancreatitis
C Micronodular cirrhosis
D Crohn's disease
E Colonic adenocarcinoma
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Question 49 A 23 year old male has been feeling tired for several weeks. He is found to have a hemoglobin of 9 g/dL with hematocrit 26.3%, MCV 72 fL, platelet count 189,000/microliter, and WBC count 7500/microliter. On physical examination, there is no evidence for trauma. His stool is positive for occult blood. A small bowel series with barium enema reveals no masses or perforations, only a solitary 2 cm outpouching in the ileum. The presence of which of the following conditions has most likely led to these findings:
A Inheritance of a faulty APC gene
B Ulceration of mucosa by ectopic gastric tissue
C Proliferation of abnormal submucosal veins
D Elaboration of enterotoxin by Escherichia coli
E Antiphospholipid antibody
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Question 50 A 29-year-old female has lost 10% of her body weight in the past three months. She has no pets at home. For several weeks, she has had a high-volume watery diarrhea with over 10 non-bloody stools per day. She has generalized lymphadenopathy. Her fingernails show onychomycosis. Abdominal examination reveals no masses or organomegaly and no areas of tenderness. Bowel sounds are very active. A stool sample for ova and parasites is negative. Her current CD4 lymphocyte count is 150/microliter. Which of the following organisms is most likely responsible for these findings:
A Campylobacter jejuni
B Cryptosporidium parvum
C Helicobacter pylori
D Staphylococcus aureus
E Pneumocystis carinii
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Question 51 A 50 year old male has the onset over one day's time of increasing abdominal pain. He notes abdominal distension. In the emergency room, the examing physician's assistant finds that he has diffuse abdominal pain. An old right lower quadrant 8 cm transverse scar is noted. Bowel sounds are high-pitched, faint, and sporadic. A stool guaiac is negative. An abdominal radiograph reveals dilated loops of bowel with air-fluid levels. Which of the following conditions predisposed this patient to development of his current problem:
A Chronic persistent hepatitis
B Ileal adenocarcinoma
C Entameba histolytica infection
D Adhesions from prior surgery
E Meckel's diverticulum
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Question 52 A 30-year-old female goes on a crash diet to lose weight, eating less than 500 calories per day. After two weeks, she notices scleral icterus and sees her physician. Laboratory testing reveals total bilirubin 3.5 mg/dl with direct bilirubin 0.3 mg/dl. The most likely cause for these findings is:
A Fatty metamorphosis of liver
B Biliary atresia
C Rotor syndrome
D Choledocholithiasis
E Gilbert's syndrome
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Question 53 Ischemia with infarction of the small intestine is LEAST likely to occur with which of the following conditions:
A Intussusception
B Volvulus
C Regional enteritis
D Incarcerated hernia
E Superior mesenteric artery thrombosis
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Question 54 A 27 year old previously healthy male feels nauseated one morning and does not eat breakfast. By mid-morning, he feels worse, with periumbilical abdominal pain. He goes to the emergency room, where physical examination reveals a normal head, neck, and chest exam, but he has a temperature of 38.7 C. However, he has right lower quadrant abdominal pain with rebound tenderness. Bowel sounds are present. His abdomen is not distended. His stool is negative for occult blood. An abdominal radiograph reveals no free air. Laboratory findings show a WBC count of 10,600/uL with differential of 70 segs, 8 bands, 17 lymphs, and 5 monos. Which of the following laboratory tests will be most useful to you in this situation:
A White blood cell count
B Sedimentation rate
C Serum amylase
D Stool culture
E Urinalysis
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Question 55 All of the following findings are possible consequences of portal hypertension from cirrhosis of the liver in a 49-year-old male EXCEPT:
A Hemorrhoids
B Ascites
C Splenomegaly
D Vasculitis
E Hepatic encephalopathy
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Question 56 Although he made 8 seconds for a score of 78, a cowboy is kicked in the abdomen just below the xyphoid process after being tossed from the rankest bull in the pen for the rodeo that night. What injury is he most likely to have received:
A Ileal rupture
B Duodenal hematoma
C Gastric laceration
D Cecal perforation
E Gallbladder rupture
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Question 57 A 65 year old woman has increasing dyspnea along with peripheral edema. She is bothered by a chronic arthritis involving both large and small joints. She is found to have a random serum glucose of 168 mg/dL. Two additional fasting serum glucose values are obtained which are 152 mg/dL and 168 mg/dL respectively. A serum ferritin is 6320 ng/mL. Which of the following approaches is most appropriate for you to take:
A Put the patient on corticosteroid therapy
B Tell her to stop using NSAIDS
C Give her interferon therapy
D Get her serum glucose under control
E Screen family members for the same condition
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Question 58 A 30 year old male suffers through occasional bouts of bloating and diarrhea. These transient episodes last a few hours and then subside. He has experienced such episodes since childhood. You recommend that he abstain from milk products in his diet for a month, and he experiences no episodes during that time. What is the probable cause for these findings:
A Cystic fibrosis
B Crohn's disease
C Celiac disease
D Short bowel syndrome
E Lactase deficiency
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Question 59 A 30-year-old male suffers from bloating and diarrhea. His quantitative stool fat is abnormally increased. He also has an elevated sweat chloride. However, his major illnesses over the years have been bouts of pneumonia with Pseudomonas aeruginosa. Which of the following findings is most likely to be present:
A Meconium ileus
B Mesenteric artery atherosclerosis
C Pancreatic acinar atrophy
D Zollinger-Ellison syndrome
E Periampullary adenocarcinoma
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Question 60 A 31 year old male has complained of burning substernal chest pain following meals. He has no nausea or vomiting. A stool sample is negative for occult blood. An upper endoscopy reveals some erythema of the lower esophagus. Esophageal biopsies from this area demonstrate neutrophils infiltrating a hyperplastic squamous epithelium. This biopsy finding by itself is most consistent with:
A Barrett's esophagus
B Scleroderma
C Mild reflux esophagitis
D Herpes simplex infection
E Congenital atresia
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Question 61 Which of the following pathologic conditions is LEAST likely to be associated with a positive stool guaiac test:
A Sigmoid diverticular disease
B Acute appendicitis
C Meckel's diverticulum
D Pseudomembranous colitis
E Adenomatous polyp
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Question 62 A 44 year old female has developed worsening pruritis over the past three months. Laboratory findings include: total protein 5.9 g/dL, albumin 3.4 g/dL, alkaline phosphatase 487 U/L, AST 66 U/L, ALT 55 U/L, total bilirubin 0.9 mg/dL, and direct bilirubin 0.7 mg/dL. A liver biopsy reveals destruction of intrahepatic bile ducts with associated lymphoplasmacytic inflammatory infiltrates of the portal tracts that extend into the adjacent parenchyma. Which of the following disease processes best explains these findings:
A Pancreatic adenocarcinoma
B Viral hepatitis C infection
C Chronic alcoholism
D Congestive heart failure
E Primary biliary cirrhosis
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Question 63 A cachectic-appearing 29-year-old female has been plagued by diarrhea for many years along with abdominal distension and bloating. She has no nausea, vomiting, or abdominal pain. Malabsorption is demonstrated by finding steatorreha and impaired absorption. A stool guaiac is negative. Upper GI endoscopy and biopsy of the duodenum is performed. The biopsy reveals the absence of villi, increased surface intraepithelial lymphocytes, and hyperplastic appearing crypts. Which of the following therapies is indicated for this case:
A Omeprazole
B Fat-free diet
C Gluten-free diet
D Vagotomy
E Segmental duodenal resection
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Question 64 A neonate has failure to thrive and increasing jaundice. The baby has not had vomiting or diarrhea, however. A liver biopsy demonstrates giant multinucleated hepatocytes and portal tract infiltrates of chronic inflammatory cells. These findings are most consistent with:
A Biliary atresia
B Neonatal hepatitis
C Alpha-1-antitrypsin deficiency
D Primary biliary cirrhosis
E Sclerosing cholangitis
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Question 65 A 45-year-old female has noted increasing bronze pigmentation of the skin even though she has not been out in the sun. She is found to have a fasting serum glucose of 160 mg/dl. Physical examination reveals a palpable spleen tip and a firm liver edge. Arrhythmias are noted on electrocardiogram. The best explanation for these findings is:
A Chronic alcoholism
B Wilson's disease
C Budd-Chiari syndrome
D Hemochromatosis
E Gilbert's disease
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Question 66 Bone marrow transplantation for acute leukemia was performed in a 23-year-old female. She received total body radiation with busulfan and cyclophosphamide therapy. Three weeks after transplantation, she had sudden weight gain with hepatic enlargement, ascites, and markedly elevated serum bilirubin. These findings most strongly suggest:
A Acute viral hepatitis B
B Micronodular cirrhosis
C Focal nodular hyperplasia
D Extrahepatic biliary obstruction
E Hepatic veno-occlusive disease
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Question 67 Which of the following statements regarding carcinoma of the gallbladder and extrahepatic bile ducts is INCORRECT:
A There is an increased risk for bile duct carcinoma in patients with sclerosing cholangitis
B Gallstones are present along with most carcinomas of the gallbladder
C The five year survival rate is greater than 90%
D Histologically, most of these cancers are adenocarcinomas
E Carcinoma of the gallbladder is uncommon in patients with acute cholecystitis
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Question 68 Following heart transplantation for idiopathic dilated cardiomyopathy, a 40 year old female had an endomyocardial biopsy that showed acute cellular rejection. Her immunosuppressive therapy was increased. She then developed bacterial and fungal sepsis. She was treated with antimicrobial therapy, including clindamycin. She patient then developed a marked diarrhea. A colonoscopy was performed that showed diffuse colonic erythema with an overlying friable tan-green exudate. Which of the following findings is most likely to be present:
A Positive Clostridium difficile toxin assay
B Stool specimen containing Entameba histolytica cysts
C Numerous crypt abscesses on colonic mucosal biopsy
D Blood culture positive for Salmonella typhi
E Abdominal CT scan showing an aortic aneurysm
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Question 69 It is traditional for the person making a batch of chocolate chip cookies to be unable to resist sampling the batter prior to baking the cookies. A 30 year old woman follows this dictum. A couple of days later, she has cramping abdominal pain with diarrhea and a low grade fever. She is most likely to have:
A Giardiasis
B Shigellosis
C Salmonellosis
D Cryptosporidiosis
E Gluten enteropathy
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Question 70 After an episode of hematemesis, a 48 year old male undergoes upper endoscopy, and a 1.5 cm sharply demarcated ulceration is noted in the gastric antrum. A biopsy of the adjacent gastric mucosa shows many organisms with the appearance of short, curved rods in the overlying mucus of gastric pits. Which of the following additional problems is he most likely to develop:
A Duodenal ulceration
B Gastrointestinal stromal tumor
C Megaloblastic anemia
D Malabsorption with weight loss
E Gastroesophageal reflux disease
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Question 71 A 33 year old male has odynophagia, and endoscopy reveals several 0.5 cm "punched out" ulcerations of the lower esophagus. Microscopically, there are multinucleated cells and cells with intranuclear inclusions seen in epithelium at the ulcer margin. Based upon these findings, his underlying risk for development of this disease process is most likely:
A Chronic reflux esophagitis
B Ingestion of a caustic substance
C Chronic alcoholism
D Acquired immunodeficiency syndrome
E Scleroderma
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Question 72 The mother of a one month old baby boy brings him in to you because the baby has had forceful vomiting for several days' time and has begun to lose weight. She states that he was a term infant with no complications of pregnancy, delivery, or perinatal period. The most likely diagnosis is:
A Tracheo-esophageal fistula
B Cystic fibrosis
C Pyloric stenosis
D Meckel's diverticulum
E H. pylori gastritis
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Question 73 The colon in a 45 year old patient who has been hospitalized for several weeks for treatment of bronchopneumonia demonstrates a tan to green exudate overlying an erythematous but non-ulcerated mucosa. Which of the following laboratory findings will most likely be present:
A Positive stool culture for Shigella flexneri
B Presence of Entamoeba histolytica in the stool
C Positive stool Clostridium dificile toxin assay
D Colonic crypt distortion and dysplasia on biopsy
E Positive stool ELISA assay for rotavirus
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Question 74 The colon of a 31 year old male is seen on colonoscopy to demonstrate marked ulceration with remaining pseudopolyps extending from rectum to splenic flexture. These findings most strongly suggest that he:
A Has a sensitivity to gluten
B Should not have eaten the salad at the office party
C Has a risk for colonic adenocarcinoma
D Does not have enough fiber in his diet
E Has advanced atherosclerosis
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Question 75 A 70 year old woman has had lower abdominal pain for the past week, accompanied by a change in bowel habits, with more frequent stools of narrower caliber. On physical examination there is diffuse but mild left lower quadrant abdominal pain. Bowel sounds are present. The stool is positive for occult blood, but no masses are palpable on digital rectal examination. An abdominal CT scan shows many small small outpouchings with air and stool involving the rectosigmoid region. What is most likely to have contributed to the development of her disease process:
A Inflammatory bowel disease
B Faulty mismatch repair genes
C Decreased dietary fiber
D Hypercholesterolemia
E Infection with Shigella flexneri
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Question 76 A 50 year old male has the onset over one day's time of increasing abdominal pain. He notes abdominal distension. In the emergency room, the examing PA finds that he has diffuse abdominal pain. An old right lower quadrant 8 cm transverse scar is noted. Bowel sounds are high-pitched, faint, and sporadic. A stool guaiac is negative. An abdominal radiograph reveals dilated loops of bowel with air-fluid levels. Which of the following conditions predisposed this patient to development of his current problem:
A Ileal adenocarcinoma
B Scleroderma
C Diabetes mellitus
D Previous laparotomy
E Chronic persistent hepatitis
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Question 77 Malrotation of the small intestine in a neonate born prematurely at 35 weeks gestational age with trisomy 18 is most likely to be associated with which of the following findings:
A Omphalocele
B Oligohydramnios
C Meconium ileus
D Meckel's diverticulum
E Jejunal duplication
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Question 78 An 84 year old female is found at autopsy to have a cirrhotic liver in which the size of the liver nodules averages 2 to 3 mm. Microscopically, the liver shows regenerative nodules with extensive fibrosis between portal regions along with scattered lymphocytes and bile duct proliferation. Which of the following etiologies best explains the appearance of the cirrhosis in this case:
A Alpha-1-antitrypsin deficiency
B Hepatitis B infection
C Biliary atresia
D Veno-occlusive disease
E Chronic alcoholism
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Question 79 At autopsy, the liver grossly shows a "nutmeg" pattern on sectioning. The microscopic appearance of the liver demonstrates centrilobular congestion and necrosis, but no inflammation or fibrosis. The patient was a 63 year old woman who had a 70 pack year history of smoking. She also had a history of chronic arthritis for which she used analgesics. The cause for the liver disease is most likely to be:
A Cor pulmonale
B Uncontrolled diabetes mellitus
C Alpha-1-antritrypsin deficiency
D Chronic hepatitis C
E Acetaminophen ingestion
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Question 80 A 25 year old male presents to the emergency room with abdominal pain of one day's duration. Physical examination reveals that tenderness is most marked in the right lower quadrant, and there is rebound tenderness. He has never had a similar abdominal pain, and he has no history of previous illnesses. Which of the following procedures would be most helpful in determining what to do next:
A Colonoscopy with biopsy
B Stool culture for Shigella and Salmonella
C CBC with WBC differential
D Clostridium dificile toxin assay
E Stool examination for ova and parasites
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Question 81 A 45 year old female is found to have gallstones on ultrasound examination of the abdomen after she complains of some vague upper abdominal pain of several days' duration. Which of the following statements regarding this finding is most correct:
A The presence of gallstones means that cholecystitis is also present
B She has a markedly increased risk for development of adenocarcinoma of the gallbladder
C A hemolytic anemia is probably present
D The gallstones probably contain cholesterol with bile and calcium salts
E Stones are probably also present in the intrahepatic bile ducts
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Question 82 An abdominal CT scan reveals a 10 cm solid mass in the left lobe of a nodular liver in a 56 year old man from Shanghai, China. He has had a 10 kg weight loss over the past three months and has felt tired. Laboratory testing reveals that he is hepatitis B surface antigen positive, hepatitis C antibody negative, and hepatitis A antibody negative. A liver biopsy of the lesion is most likely to show:
A Metastatic adenocarcinoma
B Extensive steatosis
C Focal nodular hyperplasia
D Hepatocellular carcinoma
E Hepatic adenoma
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Question 83 A 25 year old female has had low volume diarrhea for several weeks, but the quality of the stool has been noted to be mucoid and, at times, blood-tinged. The diarrhea is accompanied by tenesmus. These problems are beginning to interfere with her work as a computer networking consultant when she travels to St. George, Provo, and Ogden. Which of the following findings is most likely to be present in this case:
A Ulcerative colitis
B Amebiasis
C Campylobacter infection
D Collagenous colitis
E Irritable bowel syndrome
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Question 84 A 50 year old male has a periampullary mass discovered by endoscopy after he complains of some abdominal pain. He has had a previous total colectomy performed 15 years before because of polyposis. The periampullary mass probably represents:
A A primary adenocarcinoma
B Ectopic pancreatic tissue
C Sclerosing cholangitis
D Metastatic colonic adenocarcinoma
E Pancreatic adenocarcinoma
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Question 85 A 27 year old man has had episodes of abdominal pain with low volume diarrhea for the past few years. He now has persistent pain in the rectal area, particularly with defacation. Examination of the perirectal region reveals erythema of the skin with a deep fissure. There are no palpable masses on digital rectal exam. Stool culture is negative for pathogens. Which of the following diseases is he most likely to have:
A Adenocarcinoma
B Diverticulosis with diverticulitis
C Chronic ulcerative colitis
D Shigellosis
E Crohn's disease
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Question 86 A 26 year old student incurs a needlestick injury while starting an IV on a combative patient in the emergency room. About 25 years later, a mass develops in his liver. This mass is most likely to be a(an):
A Hepatoblastoma
B Hepatocellular carcinoma
C Hepatic angiosarcoma
D Cholangiocarcinoma
E Hepatic adenoma
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Question 87 For as long as his wife can remember, her 60 year old husband has complained of heartburn after eating dinner. He says it is her cooking. She tells him to shut up and take an antacid medication. She says he must like something she cooks, because he keeps gaining weight. He has no significant findings on physical exam. His CBC and serum chemistry panel are normal. Upper gastrointestinal endoscopy is most likely to reveal:
A A circumferential mid-esophageal web
B A large ulcerating mass of the mid-esophagus
C Tongues of columnar epithelium above the Z-line
D Complete lack of gastric rugal folds
E Large dilated submucosal veins just above the gastroesophageal junction
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