Gastroenterology 2

A 29-year-old woman who gave birth to a healthy baby six months ago presents to your office complaining of rectal bleeding and perianal pruritus which began four days ago after a large bowel movement. She states she seen small amounts of bright red blood on the toilet tissue, but has seen no bleeding in the toilet bowl. The patient denies any other complaints and overall is a healthy individual. On physical exam you find a fluctuant rectal mass is mildly painful on palpation. Which of the following is the most likely diagnosis?

A patient presents to your office with a school physical form for entrance into the local college. The patient reports she has received all three of her hepatitis B vaccinations however, she is unable to produce her vaccination record. Which of the following could be ordered to determine if this patient is immune to hepatitis B?

A 49-year-old woman who has a long history of alcohol abuse has cirrhosis with portal hypertension. She now has massive upper gastrointestinal bleeding. Which of the following is the preferred initial management?

A 36-year-old female presents with a complaint of food getting stuck in her esophagus while she’s eating and drinking. She has no past medical history that she is aware of, but has had difficulty with her skin in the last two years. Which of the following is the most likely related to this patient symptoms?

A 34-year-old male who is treated five months ago by his primary care for cholelithiasis, however refused surgical treatment, presents to the emergency room with severe epigastric pain. The patient states the pain radiates to his left upper quadrant and to his left scapula. The pain increases and worsens when he lies supine and becomes severe when he tries to eat. The patient has been unable to eat for the last three days. Physical exam finds hyperactive bowel sounds and epigastric and left upper quadrant tenderness and guarding. The patient’s stool guaiac test is negative for blood and he is afebrile. Which of the following is the most likely diagnosis?

A 45-year-old female with a history of multiple prior abdominal surgeries, and no significant medical history, presents to the emergency room complaining of diffusive abdominal pain, nausea and loss of appetite. The patient states her last bowel movement was five days ago. Physical exam finds the patient with hypoactive bowel sounds in a diffuse the tender abdomen. Flat and upright abdominal series x-rays are obtained and showed dilated loops of bowel with air fluid levels. Which of the following is the most likely cause of this patient’s disorder?

A 21-year-old daycare worker presents to the emergency room with malaise, nausea, anorexia and arthralgias. She has noted a low grade fever throughout the last five days as well as a tea color to her urine. On physical exam you find some mild right upper quadrant tenderness, jaundice and scleral icterus. The patient has a negative Murphy’s sign. Lab work is unremarkable except for elevated AST and ALT. Which of the following is the most likely diagnosis?

What is the most likely diagnosis in a patient who initially presents with forceful vomiting followed by sudden onset of chest pain and the development of subcutaneous emphysema?

A concerned mother presents with her three-year-old daughter who is had four days of watery diarrhea. The mother reports that 7 of the 13 children in her daycare are also out with similar symptoms. Which of the following is the most likely agent causing her symptoms?

A 54-year-old male with a long-term history of alcohol abuse presents with severe pain in the epigastric region which radiates to his left scapula. Physical exam reveals a positive Cullen’s sign. Which of the following would be most useful in the diagnosis of this patient?

A 39-year-old man with a history of PUD arrives at the emergency department complaining of an abrupt onset of severe, epigastric pain that radiates to his back for 1 hour. The pain is aggravated by body movement. On physical examination, the patient looks ill, the abdomen is rigid, bowel sounds are absent, and generalized rebound tenderness is present. Which of the following is the initial diagnostic study to evaluate this patient’s complaints?

A 43-year-old man presents to your office for a routine physical exam. He tells you that his 55-year-old brother was recently diagnosed with colon cancer. Using the standards recommended by the American College of Gastroenterology, which of the following is the most appropriate colon cancer screening advice for your patient?

Which of the following nonsteroidal anti-inflammatory drugs (NSAID) is the most ulcerogenic?

Which of the following is considered the major pathogenesis of gastroesophageal reflux disease (GERD)?

Which of the following is the test of choice to confirm the diagnosis of achalasia?

Where is the anatomic location of a Zenker’s diverticulum?

Which of the following is the most common cause of upper gastrointestinal bleeding?

All of the following symptoms or signs may be noted in a patient with malabsorption following a terminal ileal resection of approximately 100 cm except?

A 21-year-old woman arrives at the office complaining of a 5-month history of intermittent, crampy lower abdominal pain that is relieved with defecation. Abdominal cramping is frequently worse approximately 2 hours after eating and does not interfere with sleep. The patient states that her stools alternate from formed to explosive and watery. On physical examination, the patient is afebrile. Her abdomen is soft and nontender, and stool is without occult blood. Which of the following is the most likely diagnosis?

A 30-year-old woman arrives at the office complaining of a 6-month history of intermittent, crampy lower abdominal pain that is relieved with defecation. Abdominal cramping is frequently worse with stress and does not interfere with sleep. The patient states that her stools alternate from formed to explosive and watery. Which of the following is an appropriate diagnostic study?

A 53-year-old patient is brought to the emergency room after an abrupt and severe illness has lasted for several hours. He is experiencing abdominal pain, diarrhea, and tenesmus. He has a 102.3°F fever and his stool contains some blood and mucus and his abdomen is tender to the touch. His blood culture does not show any sign of Salmonella entrica. Which of the following diagnoses is most likely to be correct?

A 64-year-old male patient arrives at the clinic complaining of frequent post prandial epigastric pain, indigestion, weight loss, and oily, odorous stools which he states “float in the toilet”. He says he has had these symptoms on and off for years. Which of the following is most likely to be the cause of this condition?

A 45-year-old businessman comes to the clinic for his routine physical. He states that he is traveling to India in six weeks and asks you if he needs a hepatitis A vaccination. What do you tell him?

A 65-year-old male patient arrives at the clinic complaining of gastrointestinal discomfort. Which of the following symptoms would be most likely to indicate that the patient is suffering from ulcerative colitis?

Which of the following symptoms would suggest a B6 pyridoxine deficiency?

A baker’s yeast allergy would be a contraindication for immunization with which of the following vaccines?

An 18-year-old male awoke early and experienced intermittent periumbilical pain throughout the morning. By evening, the pain had become constant and is centered toward the right lower quadrant of the patient’s abdomen. Movement increases the pain. The patient also feels nauseated and has a low-grade fever. The diagnosis is appendicitis. Which of the following is the recommended treatment for appendicitis?

A 30-year-old woman comes to the office complaining of abdominal bloating and pain. She also complains of chronic diarrhea with pale, foul- smelling, oily stool and weight loss (5 pounds in 2 months). She reports fatigue, numbness and tingling in the hands and feet, and feeling “down in the dumps.” She also has a “really itchy rash” on her hands, which appears as small red dots with blisters. What is the most likely diagnosis?

A 70-year-old female patient comes to the office complaining of abdominal pain. She states she has had heartburn for several weeks, but it is usually relieved with chewable antacid tablets. The pain appears to be worse when she is hungry or at night. When asked about the color of her stools, the patient said sometimes they are “dark.” She denies any frank blood in her stools. She has had no vomiting, but some nausea. She also complains of fatigue. Her medications are lisinopril for high blood pressure and Cosopt eye drops for glaucoma. She has osteoarthritis, for which she takes over-the-counter naproxen. When asked how much naproxen she takes, the patient states she takes “two or three every few hours when the pain is bad.” She doesn’t know the dosage she is taking. She states she has had more pain than usual in the last few weeks. What diagnosis do you suspect in this patient?

A 65-year-old woman comes to the clinic with a 101°F fever, diarrhea of three days’ duration, and abdominal cramps. The patient takes simvastatin, 20 mg daily; metoprolol, 50 mg daily; and a daily aspirin. What is the most likely diagnosis?