Im - Gastroenterology Set 1

IM � GASTROENTEROLOGY SET 1 1. A 43-year-old 43-year-old man comes to to the clinic because of black black stools. He denies abdominal pain. Rectal examination reveals black stool that is strongly guaiac positive. a. Is this most likely an upper GI bleed or a lower GI bleed? b. What anatomical structure struct ure marks the boundary boundar y between the upper and lower GI GI tract? c. What is the most important aspect in management of an acute, large volume GI bleed?

I    M �   G  A   S  T  R   O  E  N  T  E  R   O  L    O   G  Y   S  E  T  1 

2. Based on the following following serological serological markers, what is the status of each of the following following patients? HBsAg

HBsAb

HBcAb

HBeAg

-

-

+

-

+

-

+

+

-

+

+

-

-

+

-

-

Status

3. A 22-year-old 22-year-old woman comes comes to the clinic because of intermittently intermittently bloody diarrhea that began one month ago. She also complains of colicky abdominal pain and fatigue. Colonoscopy Colonoscopy shows continuous circumferential inflammation in flammation of the rectum rect um and sigmoid colon. a. What serology would suggest a diagnosis of ulcerative colitis (UC)? b. What is the most most appropriate initial therapy for mild cases of UC?

[ 29 ]

I    N  T  E  R  N  A  L   M E   D  I     C  I    N  E 

    1     T     E     S     Y     G     O     L     O     R     E     T     N     E     O     R     T     S     A     G   �     M     I

4. What is the most likely cause of diarrhea in each of the following patients? a. b. c. d. e.

HIV-positive patient with < 100 CD4 cells Vomiting and diarrhea after eating reheated Chinese fried rice Vomiting and diarrhea after eating raw oysters Diarrhea began after backpacking in the mountains Patient recently treated for UTI

5. You are asked to evaluate a 45-year-old man on the inpatient ward for elevated liver function tests. He complains of epigastric and right upper quadrant abdominal pain that began 8 hours ago. He has also had fever, nausea and vomiting. a. What type of hepatitis would most likely cause the AST to be twice as high as the ALT? b. In a patient with acute hepatitis, what type of bilirubin would you expect to be elevated?

6. A 65-year-old woman was diagnosed with inflammatory bowel disease 5 years ago. She complains of colicky right lower quadrant abdominal pain and occasional low-grade fevers. A colonoscopy reveals cobblestoning and sk ip lesions. a. What would the colon biopsy most likely reveal? b. Under what clinical circumstances would you refer this patient for a curative colectomy?

7. A 23-year-old woman comes to the clinic for intermittent abdominal bloating and crampy lower abdominal pain over the last 6 weeks. Tere is no nausea or vomiting. She alternates between diarrhea and constipation, and defecation often relieves the abdominal pain.  Tere is no blood or mucus in the stools. She has had no weight loss. She recently broke up  with her fiancé and is staying with friends. Te physical examination, labs, imaging and colonoscopy are all normal. a. What is the most likely diagnosis? b. What initial management should be considered for this patient?

[ 30 ]

8. A 21-year-old woman comes to the clinic with 6 months of chronic diarrhea. She complains of occasional nausea/vomiting and abdominal pain. Analysis of the stool shows steatorrhea. Serum anti-endomysial antibody and anti-tissue transglutaminase antibodies are positive. a. What test should be performed to confirm the diagnosis? b. How should this condition be managed?

I    M �   G  A   S  T  R   O  E  N  T  E  R   O  L    O   G  Y   S  E  T  1 

9. A 56-year-old woman has routine labwork done to evaluate her chronic type 2 diabetes. Her AS and AL are moderately elevated (245 U/L and 278 U/L, respectively). Further studies show that she is negative for hepatitis B and hepatitis C. Serum ferritin is 540 ng/dL (normal 12-150 ng/dL in women), and transferrin saturation is 72% (normal 20-50%). a. What further tests would help confirm the diagnosis of hereditary hemochromatosis? b. What is the most appropriate treatment?

10. A 63-year-old man is intubated and admitted to the intensive care unit (ICU) for an acute exacerbation of COPD. a. In what situations is prophylaxis against stress ulcers in the ICU indicated? b. What stress ulcer prophylaxis treatment or treatments are linked with an increase risk of Clostridium difficile  infection?

[ 31 ]

I    N  T  E  R  N  A  L   M E   D  I     C  I    N  E