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Quiz for Students
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1

A 35-year-old alcoholic male is admitted for nausea, vomiting, and abdominal pain that radiates to the back. The laboratory value that suggests a poor prognosis in this patient is
A)Elevated serum lipase
B)Elevated serum amylase
C)Leukocytosis of 20,000/?m
D)Diastolic blood pressure greater than 90 mmHg
2

A 50-year-old black male with a history of alcohol and tobacco abuse has complained of difficulty swallowing solid food for the past 2 months. More recently, swallowing fluids has also become a problem. He has noted black, tarry stools on occasion. The patient has lost 10 lb. Which of the following statements is correct?
A)The patient’s prognosis is good
B)Barium contrast study is indicated
C)The most likely diagnosis is peptic ulcer disease
D)The patient has achalasia
3

A 34-year-old male presents with substernal discomfort. The symptoms are worse after meals, particularly a heavy evening meal, and are sometimes associated with hot/sour fluid in the back of the throat and nocturnal awakening. The patient denies difficulty swallowing, pain on swallowing, or weight loss. The symptoms have been present for 6 weeks; the patient has gained 20 lb in the past 2 years. Your initial approach is
A)A therapeutic trial of ranitidine
B)Exercise test with thallium imaging
C)Esophagogastroduodenoscopy
D)CT scan of the chest
4

A 48-year-old woman presents with a change in bowel habits and 10-lb weight loss despite preservation of appetite. She notices increased abdominal gas, particularly after fatty meals. The stools are malodorous and occur 2 to 3 times per day; no rectal bleeding is noticed. The symptoms are less prominent when the patient follows a clear liquid diet. The most likely histological abnormality associated with this patient’s symptoms is
A)Signet ring cells on gastric biopsy
B)Mucosal inflammation and crypt abscesses on sigmoidoscopy
C)Villous atrophy and increased lymphocytes in the lamina propria on small bowel biopsy
D)Small, curved gram-negative bacteria in areas of intestinal metaplasia on gastric biopsy
5

A nursing student has just completed her hepatitis B vaccine series. On reviewing her laboratory studies (assuming she has no prior exposure to hepatitis B), you expect
A)Positive test for hepatitis B surface antigen
B)Antibody against hepatitis B surface antigen (anti-HBS) alone
C)Antibody against hepatitis core antigen (anti-HBC)
D)Antibody against both surface and core antigen
E)Antibody against hepatitis E antigen
6

A 40-year-old male has a history of three duodenal ulcers with prompt recurrence. Symptoms have been associated with severe diarrhea. One of the ulcers occurred close to the jejunum. Serum gastrin levels have been 200 pg/mL. The most useful test in this patient is
A)Colonoscopy
B)Endoscopic retrograde cholangiogram
C)CT scan of abdomen
D)Secretin injection test
E)Upper gastrointestinal series
7

A 40-year-old white male complains of weakness, weight loss, and abdominal pain. On examination, the patient has diffuse hyperpigmentation and a palpable liver edge. Polyarthritis of the wrists and hips is also noted. Fasting blood sugar is 185 mg/dL. The most likely diagnosis is
A)Insulin-dependent diabetes mellitus
B)Pancreatic carcinoma
C)Addison’s disease
D)Hemochromatosis
8

A 32-year-old white woman complains of abdominal pain off and on since the age of 17. She notices abdominal bloating relieved by defecation as well as alternating diarrhea and constipation. She has no weight loss, GI bleeding, or nocturnal diarrhea. On examination, she has slight LLQ tenderness and gaseous abdominal distension. Laboratory studies, including CBC, are normal. Your initial approach should be
A)Recommend increased dietary fiber, prn antispasmodics, and follow-up exam in 2 months
B)Refer to gastroenterologist for colonoscopy
C)Obtain antiendomysial antibodies
D)Order UGI series with small bowel follow-through
9

A 55-year-old white woman has had recurrent episodes of alcohol-induced pancreatitis. Despite abstinence, the patient develops postprandial abdominal pain, bloating, weight loss despite good appetite, and bulky, foul-smelling stools. KUB shows pancreatic calcifications. In this patient, you expect
A)Diabetes mellitus
B)Malabsorption of fat-soluble vitamins D and K
C)Guaiac-positive stool
D)Courvoisier’s sign
10

A 34-year-old white woman is treated for a UTI with amoxicillin. Initially she improves, but 5 days after beginning treatment, she develops recurrent fever, abdominal bloating, and diarrhea with six to eight loose stools per day. You suspect antibiotic-associated colitis. The best diagnostic test is
A)Identification of Clostridium difficile toxin in the stool
B)Isolation of C. difficile in a stool culture
C)Stool positive for white blood cells
D)Detection of IgG antibodies against C. difficile in the serum







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