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A 40 year old woman has mild abdominal pain and nausea for several months. Upper GI endoscopy is performed which reveals an irregular 3 x 5 cm area of loss of rugal folds near the antrum. Biopsies from this area show extensive mucosal and submucosal infiltration by a monoclonal population of B lymphocytes. She is given antibiotic therapy and the lesion resolves. Which of the following infectious agents is most likely to be associated with these findings:
A Human immunodeficiency virus
B Salmonella typhi
C Human papillomavirus
D Aspergillus fumigatus
E Helicobacter pylori
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Question 89 A 57 year old woman is moderately obese and has diabetes mellitus type II. She has increasing malaise for several months. A chemistry panels is performed and reveals: total protein 6.1 g/dL, albumin 4.0 g/dL, alkaline phosphatase 31 U/L, AST 67 U/L, ALT 59 U/L, total bilirubin 1.2 mg/dL, and direct bilirubin 0.3 mg/dL. These findings persist for 9 months. An abdominal CT scan reveals decreased attenuation of the entire liver. No mass lesions are noted, but the liver is diffusely enlarged. A liver biopsy is performed. What is the biopsy most likely to show:
A Hepatocellular carcinoma
B Intracanalicular bile stasis
C Macrovesicular steatosis
D Centrilobular congestion
E Piecemeal necrosis
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Questions 90 and 91: Click on the checkbox first, then the lettered item: (90) Liver biopsy reveals that there are varying degrees of liver cell swelling and necrosis with cholestasis and portal inflammation. Giant multinucleated hepatocytes are also present.
(91) Liver biopsy reveals that there are small round red globules that stain strongly with PAS in hepatocytes near the portal tracts. The patient goes on to develop cirrhosis.
A Hemochromatosis
B Alpha-1-antitrypsin deficiency
C Primary biliary cirrhosis
D Veno-occlusive disease
E Neonatal hepatitis
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Question 92 and 93: Click on the checkbox first, then the lettered item: (92) A liver transplant recipient develops a serum AST of 195 U/L with ALT of 276 U/L.
(93) A 41 year old male has had a chronic illness with malaise and nausea for over a year. He now becomes severely ill with generalized icterus.
A Hepatitis A virus
B Hepatitis B virus
C Hepatitis C virus
D Hepatitis D virus
E Cytomegalovirus
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Questions 94 and 95: Click on the checkbox first, then the lettered item: (94) After a potluck meal with pastries, sliced meats, and salad, several members of the office staff develop an explosive diarrhea several hours later.
(95) After eating undercooked thanksgiving turkey at a family dinner, several persons develop diarrhea with cramping abdominal pain two days later.
A Giardia lamblia
B Salmonella
C Entameba histolytica
D Staphylococcal enterotoxin
E Vibrio parahemolyticus
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Questions 96 and 97: Click on the checkbox first, then the lettered item: (96) A perirectal fistula is the cause for severe perianal pain in a 28-year-old male.
(97) Terminal ileal longitudinal ulcers are present in a 30-year-old female with fever and leukopenia.
A Shigellosis
B Crohn's disease
C Diverticulosis
D Ulcerative colitis
E Typhoid fever
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Questions 98 and 99: Click on the checkbox first, then the lettered item: (98) Gardner's syndrome.
(99) Peutz-Jehgers syndrome.
A Pseudopolyp
B Adenomatous polyp
C Hamartomatous polyp
D Inflammatory fibroid polyp
E Hyperplastic polyp
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Questions 100 and 101: Click on the checkbox first, then the lettered item: (100) A neonate in the second week of life is noted to be increasingly icteric. Physical examination reveals no abdominal distension or masses. There is no tenderness. Bowel sounds are present. Laboratory findings reveal a neonatal bilirubin of 12.2 mg/dL.
(101) A neonate in the first week of life is noted by his mother not to have passed any stool for several days' time. The baby is not feeding well. Physical examination reveals a tender abdomen with mild distension, but no masses are noted. The baby has an elevated sweat chloride test.
A Biliary atresia
B Acute pancreatitis
C Meconium ileus
D Choledocholithiasis
E Pyloric stenosis
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Questions 102 and 103: Click on the checkbox first, then the lettered item: (102) Several weeks after the appearance of a markedly elevated serum amylase in a 40 year old male with a history of chronic alcoholism, the following complication occurs:
(103) A cystadenoma of the appendix is present in a middle aged female. Which of the following complications is most likely to occur:
A Pseudopolyposis
B Hemoperitoneum
C Pseudocyst
D Mucocele
E Fibrous adhesions
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Questions 104 and 105: Click on the checkbox first, then the lettered item: (104) A 67 year old male has abdominal pain. The serum calcium is 15.2 mg/dL with a serum albumin of 4.1 g/dL and serum phosphorus of 2.1 mg/dL. The most likely diagnosis is:
(105) A 55 year old male with a long history of chronic alcoholism is admitted with severe mid abdominal pain. Laboratory findings include: slightly elevated AST and ALT, normal alkaline phosphatase, elevated LDH, and markedly elevated amylase. The most likely diagnosis is:
A Chronic hepatitis B
B Acute pancreatitis
C Hemochromatosis
D Hepatocellular carcinoma
E Small intestinal obstruction
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Questions 106 and 107: Click on the checkbox first, then the lettered item: (106) During the exam
abdominal discomfort:
students then pass on.
(107) In the springtime runs
a mild diarrheal illness:
but children get well.
A Duodenal peptic ulcer
B Celiac sprue
C Irritable bowel syndrome
D Menetrier's disease
E Rotavirus infection
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Questions 108 and 109: Click on the checkbox first, then the lettered item: (108) The ALT is 330 U/L and the AST is 287 U/L in a jaundiced 32-year-old male.
(109) A 66-year-old female who noted pale, clay-colored stools is found to have a total bilirubin of 15.4 mg/dL with a direct bilirubin of 12.8 mg/dL.
A Chronic alcoholism with cirrhosis
B Hemoglobinopathy with hemolysis
C Multiple hepatic metastases
D Acute hepatitis A
E Adenocarcinoma of the head of the pancreas
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Questions 110 and 111: Click on the checkbox first, then the lettered item: (110) A 54-year-old male is found to have a positive hepatitis B surface antigen and positive hepatitis B core antibody.
(111) A 32-year-old female has a history of oral contraceptive use for the past 15 years.
A Islet cell adenoma
B Hepatic adenoma
C Focal nodular hyperplasia
D Veno-occlusive disease
E Hepatocellular carcinoma
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Questions 112 and 113: Click on the checkbox first, then the lettered item: (112) A 38-year-old male intravenous drug user has the recent onset of jaundice.
(113) A 25-year-old male has a history of ulcerative colitis.
A Acute viral hepatitis
B Biliary atresia
C Primary biliary cirrhosis
D Adenocarcinoma of ampulla of Vater
E Sclerosing cholangitis
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Question 114 A 58 year old male is admitted to hospital because of hematemesis. He dies following massive upper gastrointestinal hemorrhage that cannot be controlled, despite 10 units of packed red blood cells. The gross and microscopic appearances of his liver at autopsy demonstrate micronodular cirrhosis with macrovesicular steatosis. Which of the following conditions was LEAST likely to have been present at the time of his death:
A Encephalopathy
B Ascites
C Jaundice
D Coagulopathy
E Hemoperitoneum
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Question 115 A 55 year old male has the acute onset of abdominal pain over a days' time. He had an appendectomy for acute appendicitis in his 20's, but no other major medical problems since then. On physical examination, he has abdominal distension, and high-pitched tinkling bowel sounds are heard. A stool guaiac is negative. There is no fluid wave and no masses are felt. He is afebrile. His WBC count is 10,140/microliter with differential count of 68 segs, 3 bands, 20 lymphs, and 9 monos. The etiology for his condition is most likely to be:
A Intussusception
B Entameba histolytica infection
C Tropical sprue
D Peritoneal fibrous adhesions
E Ileal adenocarcinoma
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Question 116 A 71 year old female has vague upper abdominal pain with nausea and a feeling of fullness after eating very little food. Upper endoscopy reveals an ill-defined 6 cm mass on the lesser curve in the body of the stomach. Biopsy of the lesion shows numerous signet ring cells infiltrating into the muscularis. Which of the following conditions is most likely to have contributed most to the development of her disease:
A Inflammatory bowel disease
B Atrophic gastritis
C Ibuprofen use for arthritis
D Drinking coffee
E Chronic alcoholism
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Question 117 A 37 year old female has periodic fainting episodes that are preceded by periods of mental confusion and a feeling of weakness. These have occurred for the past year. She is otherwise healthy. The most likely explanation for these findings, among the following conditions, is:
A Hepatitis C infection
B Colonic adenocarcinoma
C Scleroderma
D Crohn's disease
E Islet cell adenoma
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Question 118 A 48 year old male has worsening congestive heart failure over several years, along with diabetes mellitus and worsening arthritis. He also has cirrhosis with portal hypertension. Which of the following diseases would best account for all of these findings:
A Hereditary hemochromatosis
B Cystic fibrosis
C Wilson's disease
D Alpha-1-antitrypsin deficiency
E Galactosemia
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Question 119 A 39 year old female presents with the sudden onset of marked abdominal pain. Which of the following conditions that could cause this pain is LEAST likely to require prompt surgical intervention:
A Volvulus
B Intussusception
C Acute pancreatitis
D Incarcerated hernia
E Perforated duodenal ulcer
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Question 120 A 41 year old male complains of some cramping abdominal pain with bloating, occasional diarrhea, and increased flatus. During a workup, a radiographic imaging study reveals a 2 cm rounded gallstone. This gallstone is most likely:
A Asymptomatic
B Composed of calcium salts of bilirubin
C Found along with a carcinoma
D Caused by Crohn's disease
E Associated with jaundice
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Question 121 A 68 year old female noted a change in the caliber of her stool over a period of several weeks. Her physician could not palpate a mass by digital rectal examination, but the stool was positive for occult blood. A sigmoidoscopy was performed and revealed an ulcerated 7 cm mass that partially encircled the sigmoid colon at 19 cm above the anal verge, narrowing the lumen. This lesion most likely resulted from:
A Diverticulosis
B Clostridium dificile infection
C Collagenous colitis
D Ischemic colitis
E Mutations in an adenoma
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Question 122 A 22 year old male appears icteric. The total serum bilirubin is 4.3 mg/dL (normal 0 - 1.0 mg/dl) with direct serum bilirubin 0.4 mg/dL (normal 0 - 0.4 mg/dL). The best explanation for these findings is:
A Ulcerative colitis
B Hemolytic anemia
C Hepatitis A infection
D Ampullary adenocarcinoma
E Choledocholithiasis
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Question 123 A 34 year old female has had nausea, vomiting, and fatigue for several months. Serum chemistries reveal that both the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are moderately elevated. The hepatitis B surface antigen is negative, hepatitis B surface antibody negative, hepatitis B core antibody negative, hepatitis A antibody-IgM negative, and the hepatitis C antibody is positive. These findings most strongly suggest that:
A She will recover in a few weeks with no sequelae
B The patient is at risk for development of chronic hepatitis
C There is no risk for development of hepatocellular carcinoma
D Infection could not have come from a blood transfusion
E She was infected via unprotected sexual intercourse a week ago
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Question 124 A 32 year old female with an acute abdomen is taken to surgery and the appendix is removed. The next day, you get a surgical pathology report that describes serosal acute vasculitis with neutrophils and fibrinoid necrosis, but no neutrophils are present in the mucosa or muscular wall of the appendix. Which of the following laboratory tests is most likely to be positive in this situation:
A Peripheral anti-neutrophil cytoplasmic autoantibody (P-ANCA)
B Anti-centromere antibody
C Anti-mitochondrial antibody (AMA)
D Anti-parietal cell antibody (APCA)
E Anti-DNA topoisomerase I antibody
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Question 125 A 44 year old female has experienced a few episodes of sudden abdominal pain over the last few months. Late one afternoon at work, she has another attack, and this time the pain is severe. She feels light-headed and severely nauseated. She goes to the emergency room. The examining physician determines that her abdominal pain is worst in the right upper quadrant. Bowel sounds are present, and her abdomen is non-distended. A stool guaiac is negative. An abdominal radiograph reveals no free air. What additional radiographic finding is most likely to be present:
A Lithiasis of the gallbladder by ultrasound
B Hepatic cirrhosis by MRI scan
C Superior mesenteric arterial occlusion by angiography
D Intussusception by CT scan
E Cecal mass on barium enema
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Question 126 A 30 year old man experiences an episode of hematemesis. Upper endoscopy is performed which reveals a diffusely hyperemic gastric mucosa. Biopsies show mucosal hemorrhage. Which of the following etiologies is most likely to have led to these findings:
A CREST syndrdome
B Use of NSAIDS
C Diabetes mellitus, type I
D Helicobacter pylori infection
E Zollinger-Ellison syndrome
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