Gastroenterology 9

Phototherapy is initiated in a newborn infant in treatment of physiologic jaundice. The parents should be counseled that which of the following is the most likely adverse effect?

Despite careful attentiveness to his diet and activity, a 57-year-old man with type 1 diabetes mellitus has frequent hypoglycemic episodes. Which of the following is the most likely cause?

What is the most common cause of small bowel obstruction in an adult?

A 31-year-old man who has hereditary spherocytosis with chronic hemolysis is most likely to develop which of the following?

An 11-year-old boy who has sickle cell disease has the acute onset of right upper quadrant abdominal pain, nausea, and vomiting. Blood pressure 90/72 mm Hg, pulse 106/min, respirations 22/min, oral temperature 99.6 degrees F. The patient is in moderate distress without icterus. Examination of the lungs and heart is normal. The abdomen is flat and soft. Right upper quadrant tenderness without rebound is noted. Bowel sounds are generally hypoactive. Which of the following is the most likely diagnosis?

A 42-year-old woman has a 4 week history of fatigue and, now, diffuse itching. Examination shows diffuse hyperpigmentation, scratches on the skin, and hepatomegaly. Serum alkaline phosphatase is 322 units/L, total bilirubin 1.0 mg/dL, and hemoglobin is 12 g.dL. Which of the following is the most likely diagnosis?

In addition to having chronic bloating and gas, a 34-year-old woman now has a compression fracture of a vertebra caused by osteoporosis. Vital signs are normal. Complete blood count and fasting plasma glucose level are normal. Which of the following is the most likely underlying disorder?

A 68 year old male with a history of PVD and CAD, presents complaining of diffuse, dull aching abdominal pain which occurs within an hour of eating. The patient has stable vital signs and in afebrile. Which of the following is the most likely cause of his symptoms?

A 33-year-old woman has a 4 month history of recurrent abdominal bloating, cramping abdominal pain, but without nausea, vomiting, or weight loss. Which of the following is most consistent with a diagnosis of irritable bowel syndrome?

A 71-year-old man has diarrhea that is thought related to antibiotic therapy. Which of the following is the preferred initial diagnostic test for Clostridium difficile infection?

A 77-year-old man has left lower quadrant pain, tenesmus, and new onset fever. What is the imaging modality of choice for his condition?

A 26-year-old female comes to see you 10 days after returning home from an Asian tour that included visits to India, Thailand and China. About three days ago, she began experiencing fatigue and general malaise followed over the next two days by low-grade fever, nausea and vomiting and right upper quadrant abdominal pain. This morning her roommate said that her eyes looked yellow and told her to see you. The patient does not smoke or drink alcohol, is on no medication and does not use illicit drugs. On exam, her temperature is 100.4 F; she has scleral icterus and a tender enlarged liver. Which of the following would you consider most likely?

Methotrexate therapy is initiated in a 40-year-old woman in treatment of rheumatoid arthritis. Which of the following is proper counseling for the patient?

Six hours after ingestion of excess alcohol, a 56-year-old woman has acute, severe, abdominal pain, nausea, and vomiting. Serum amylase and lipase levels are increased. Which of the following is the radiographic abnormality on plain film of the abdomen that is most likely to be noted?

A 47-year-old female patient with a history of gallstones presents to the emergency department with an acute onset of right upper quadrant abdominal pain and vomiting. Vital signs are stable and she is afebrile. Physical examination reveals hyperactive bowel sounds and tenderness on palpation, Murphy’s sign is equivocal. Her lipase is found to be grossly elevated. Which of the following is the primary objective of treatment?

A 20-year-old female college student gives you a history of recurrent bouts of crampy abdominal pain that are relieved with defecation. During these periods, stools are loose and frequent. She denies fever, weight loss, and blood or mucus in her stools. The rest of her history is unremarkable. Physical exam, including abdominal exam, is normal. Stool Hemoccult test is negative. Which of the following is the best next step in the evaluation and management of this patient?

The presence of which of the following differentiates obstructive jaundice from jaundice caused by hemolysis?

The primary use of focused abdominal sonography in trauma (FAST) after blunt abdominal trauma is to identify which one of the following?

Administration of which of the following to a 2-week-old infant is most likely to increase the risk of infantile hypertrophic pyloric stenosis?

A 67-year-old woman who suffers from chronic alcohol abuse has a 3 month history of recurrent upper abdominal pain, nausea, vomiting, and 8 pound weight loss. Examination shows a thin, non-icteric patient who has a normal lung, heart, and abdominal examination. Which of the following is the expected radiographic sign to be noted on a plain film of the abdomen?

A 46-year-old man with Crohn’s disease has the onset of severe right upper quadrant pain, nausea, and vomiting. Vital signs are normal. Examination of the heart and lungs is normal. The abdomen is flat and soft. Right upper quadrant tenderness without mass is noted. Which of the following is the most likely diagnosis?

A 41-year-old intoxicated male presents to the ED with severe epigastric pain that began acutely 2 hours ago. He has had similar episodes 4-5 times in the past year but never this bad. He is taking prednisone for his psoriasis, lisinopril for his hypertension, protonix for GERD, and wellbutrin as part of a smoking cessation program. Vital signs are stable. Bowel sounds are hyperactive and he has severe epigastric tenderness with guarding and rebound tenderness. Which of the following is the most likely cause of his symptoms?

Ten days after having completed a course of quinolone therapy, a 41-year-old woman has abdominal cramps, low grade fever, and watery diarrhea. Pseudomembranous colitis is diagnosed. Which of the following is the preferred therapy?

A 38-year-old male patient was involved in an alcohol-induced altercation which resulted in blunt trauma to the abdomen. He currently complains of left side abdominal pain. Vital signs reveals BP: 97/40 mmHg; pulse: 116 bpm, regular; respirations: 24 breaths/minute. Abdominal exam reveals hypoactive bowel sounds on the left side with diffuse tenderness and guarding. Plain film chest and abdominal X-rays show an elevated left hemidiaphragm, fractures of ribs 11 and 12, and loss of the psoas shadow. CT of the abdomen is shown. Which of the following is the most likely diagnosis?

A 55-year-old man who suffers from a long history of alcohol abuse has cirrhosis with portal hypertension. Which of the following is the least likely sign to be noted upon examination?

A 55-year-old man has a gastric ulcer related to Helicobacter pylori infection. In selecting treatment, the clinician should note that 50 percent of H. pylori strains are resistant to which of the following medicines?

A 23-year-old male presents with a 9-hour history of worsening generalized, “crampy” lower abdominal pain with associated nausea, vomiting, fever, and chills. Blood pressure = 92/62 mmHg (right arm; supine); pulse = 114 beats/min (regular); respirations = 28 breaths/min; temp = 103° F (oral). On physical exam he is noted to have moderate right lower quadrant tenderness with guarding and rebound tenderness. Which of the following tests would be the most useful in establishing your diagnosis?

A 29-year-old male ate at a seafood buffet dinner last night; he ate a lot of shrimp and scallops. Current symptoms include numbness or tingling around the mouth, abdominal cramps, nausea, vomiting, and diarrhea, All of the following are common pathogens of shellfish poisoning except:

Oral prednisone is not a primary medication in treatment of which of the following conditions?

You are called to examine a 24-year-old male patient who had several episodes of bright red hematemesis 30 minutes prior to arrival. He appears pale. It is estimated that the patient lost 18% of his total blood volume. Which of the following tests or procedures is most sensitive in determining the degree of blood loss within this time frame?