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Which of the following statements about cardiac cirrhosis is true?



A 17-year-old girl is commenced on nasogastric feeding due to severe anorexia nervosa. Five days later she becomes increasingly confused. On examination she was afebrile, appeared appropriately hydrated, with a pulse of 98 beats per minute and blood pressure 96/60 mmHg. Which one of the following investigations should be requested forthwith?



A 55 year old, overweight man presents with left lower quadrant tenderness and a one week history of abdominal pain associated with loose non-bloody stools and worsening fever. Leukocytosis with neutrophilia is found on laboratory investigations. What is the diagnostic imaging study of choice?



A 17 year old male presents with history of weight loss, abdominal pain and bloody diarrhea. Investigation shows a normal upper endoscopy and colonoscopy. The most appropriate next step is



A 77 year old man complains of fatigue and a 10 kg weight loss for 3 months. Physical examination reveals jaundice without abdominal tenderness or organ enlargement. The most likely diagnosis is which of the following?



A 24 year old man develops abdominal pain and diarrhea that is liquid containing mucus and blood three days after coming back from a camping trip. Stool studies show Shigella. What is the most appropriate treatment?



The medication that works well to discourage people with alcohol abuse from drinking is



A 22 year old woman presents with a 3 week history of bloody diarrhea and weight loss. She is febrile, dehydrated and has a distended abdomen with left lower quadrant tenderness. You suspect that she has ulcerative colitis. Which of the following would be not an appropriate initial management?



A 32 year old woman with known HIV presents with a 3 month history of watery diarrhea, severe weakness, and a 22 pound weight loss. Multiple stool tests for bacteria, ova, and parasities are repeatedly negative. A colonoscopy is normal. What is the most likely cause of her diarrhea?



A 70 year old female complains of constipation and abdominal pain. Over a period of 48 hours, her symptoms worsen and she is transported to the hospital for laparoscopic evaluation of an acute abdomen. At laparoscopy, a loop of bowel is noted to be twisted and darkly hemorrhagic. The most likely location for the bowel loop is



A patient presents to the emergency room with malaise. He is slightly jaundiced. Serum chemistries reveal marked elevation of both aspartate aminotransferase (AST) and alanine aminotransferase (ALT), with the AST/ALT ratio being 2.5. Alkaline phosphatase is near normal. Serum copper and serum iron are normal. These findings are most likely associated with liver damage caused by which of the following?



An apparently healthy 25 year old man is found to have increased serum levels of unconjugated bilirubin during a routine pre-employment examination. Conjugated bilirubin and transaminases are normal. No evidence of recent illnesses on further questioning. The most appropriate diagnosis is



A 36 year old man who recently returned from a Third World country develops chronic, severe dysentery. Colonoscopy reveals ulceration of the cecum, and a cecal biopsy reveals 15 to 40 micron amoebae with ingested erythrocytes and small nuclei with distinctive tiny central karyosomes. The most likely causative agent is



All of the following are true of infection with hepatitis E EXCEPT



A man of 44 years of age has symptoms of cirrhosis although he has no alcohol intake history. His father also had cirrhosis of the liver. Examination shows hepatomegaly, ascities, brownish pigmentation of the skin, and small testicles. Investigations revealed a transferrin saturation greater than 80% and a serum ferritin level of 1,010 mg/ml. The diagnostic test of choice to make the correct diagnosis is which of the following?



What is the approximate incidence of significant gastrointestinal bleeding as a result of diverticulosis?



A male aged 52 years who is a heavy consumer of alcohol develops nausea and emesis and vomits brownish material. All of the following can be the cause of his symptoms, EXCEPT



Which complication of liver failure is effectively managed by water restriction?



A person presents with recurrent episodic diarrhea, triggered by eating too much or drinking alcohol. According to his wife "he turns as red as a beet, starts wheezing, and looks just ghastly" during these episodes. A lung mass is seen on Chest X-ray. The most likely cause of his symptoms is



A 66 year old male dies of metastatic liver cancer. At autopsy the liver shows a multinodular vascular tumor. Histologically the tumor is composed of anastomosing channels lined by anaplastic endothelial cells. The liver parenchyma between tumor nodules appears normal. The risk factor that is associated with this form of liver cancer is



A 35 year old man has abdominal pain and cramping. He has frequently observed blood in his stools, and has occasionally had fevers. Examination reveals abdominal tenderness, and guaiac positive stool is found in the rectal vault. Colonoscopy reveals ulceration, which biopsy shows to be mucosal and submucosal. The most appropriate pharmacotherapy is which one of the following?



A 57 year old male is brought with severe abdominal pain that began by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198080&Page=22#14174044">SHORTLY after taking a drug for GERD. On exam he almost has total bowel obstruction secondary to the presence of several small bowel tumors. Which drug was likely taken?



A 44 year old jaundiced woman undergoes endoscopic retrograde cholangiopancreatography. Multiple common bile duct stones are imaged and the injected contrast material is retained within dilated common bile duct proximal to the stones. Which finding would be consistent with this case of jaundice?



A 25 year old female presents in the first trimester of her first pregnancy (6 weeks gestation) for an antenatal checkup, she feels well. Labs show a bilirubin of 40µmol/L (1-22); other LFT´s are normal. The likely diagnosis is



A woman aged 28 years develops abdominal pain, jaundice and ascites worsening over a week. She drinks 10 units of alcohol each week and takes the oral contraceptive pill. Which finding would make a diagnosis of hepatic vein thrombosis Budd Chiari syndrome [BCS] most likely?



FALSE statement regarding a patient with ascites due to liver cirrhosis is which one of the following?



True statement regarding spontaneous bacterial peritonitis (SBP) is which one of the following?



A 55 year old obese male has burning retrosternal pain and heartburn that is brought about by bending over, wearing a tight belt, or lying flat in bed at night. He gets symptomatic relief from over the counter antacids or H2 blockers, but has never been formally studied or treated. Problem has been present for many years and seems to be progressing. He drinks alcohol few weekends a year. The most appropriate next step in management is



A 29-year-old woman has severe heartburn with or without meals. She has a history of hypertension, treated with captopril. She also had Raynaud´s disease, multiple facial telangiectasias, and very taut skin on the dorsum of both hands. Antacids, ranitidine, or omeprazole did not help. What will esophageal manometry show?



A 65-year-old has longstanding cirrhosis and portal hypertension due to previous alcohol abuse. He has no history of gastrointestinal bleeding. He had a few inappropriately prescribed drugs. Coadministration of which of the following is likely to cause this patient the greatest harm if not corrected?



A 53-year-old diabetic has hepatomegaly. Albumin =3 g/dL, Total bilirubin=1.29 mg/dL, ALP=134 U/ L, ALT=90 U/ L, GGT=125 U/ L and Ferritin= 1450 µg/L. Which of the following is most suggestive of a diagnosis of Hemochromatosis?



A woman was referred with iron deficiency anemia. She was 54 year old and suffering from rheumatoid arthritis. Endoscopy showed several superficial antral erosions, with small bowel biopsy showing mild villous blunting, apopotic bodies, occasional eosinophils and mild increase in chronic inflammatory cells. Colonoscopy was reported as normal. Which of the following is the most likely cause of these findings?



A 73 year old complains of pain with defection, and loose stools over the last several months. His past medical history includes prostate cancer treated with radiation therapy 5 years ago, hypertension, and osteoarthritis. Medications include hydrochlorothiazide (HydroDIURIL), a Beta-blocker, and acetaminophen. On colonoscopy, no polyps or cancer are found, but the rectal and sigmoid areas show pallor with friability and telangiectasias. The most likely diagnosis is



A 46 year old with a 20 year history of severe Crohn´s disease requiring in patient hospitalization complains of the recent onset of left knee pain on walking. What is the most likely cause of the pain?









A 62 year old man is admitted to the hospital because of acute pancreatitis. Laboratory studies show:

Amylase=1,000 U/L Hematocrit=42%
Calcium=8.4 mg/dlWBC=14000/mm3
BUN=5 mg/dl
Results of serum liver chemistry profile are normal. After 48 hours of fluid therapy and observation, which of the following lab study would indicate poor prognosis?



True statement about celiac diseases (gluten sensitive enteropathy) in adults is



A 52 year old man with a history of Hemochromatosis presents to the ER vomiting up bright red blood. He had his most recent phlebotomy yesterday. His blood pressure is 110/85 mmHg, his pulse 115/min; his face is flushed, and he is diaphoretic. During the physical examination splenomegaly and a venous pattern on his chest and abdomen are noted. He seems somewhat drowsy and confused but has no focal neurologic signs. The probable source of this patient´s confusion is



A 43-year-old smoker and alcoholic has severe epigastric pain, diarrhea, and hematemesis. His father also had similar symptoms. Cimetidine did not relieve him. Milk and food do not relieve these symptoms. Diagnose:



A patient complains of epigastric pain that fails to respond to antacids. Endoscopy demonstrates an ulcerated mass on the greater curvature of the stomach. Genetic studies on the tumor demonstrate an altered DCC gene. The other tumor suppressor genes found on the same chromosome as DCC is



A 56 year old anemic woman is found have a vitamin B12 level of 95 pmol/L (normal is> 150 pmol/L). Antibodies to intrinsic factor are identified. Levels of all other essential vitamins are within normal limits. The most likely associated condition is which of the following?



A 27 year old female gives birth to a baby at term. The newborn infant has the most common type of tracheoesophageal fistula (type C). When and how will this developmental anomaly most likely be discovered?



A 62 year old man presents with complain of progressive dysphagia, first for solids, then for liquids. A large, fungating mass 2 cm above the gastroesophageal junction is found on endoscopy. Biopsy of the mass demonstrates glands that extend into the muscular layer and contain cells with large, hyperchromatic nuclei. The condition most likely associated with development of this mass is



A 44 year old man presents to his physician for a routine checkup. He was found to have mildly elevated liver transaminase levels. No known history of allergy is present and he is taking no medications. Liver biopsy reveals an inflammatory process confined to the portal areas without involvement of the periportal region. He has no constitutional symptoms. The most likely diagnosis is



A 54 year old male has chronic watery diarrhea, weight loss, and hypokalemia. Large pancreatic mass is found by computerized axial tomography. Elevated levels of which of the following would be revealed on serum analysis?



A 74 year old male is admitted to hospital with left lower quadrant abdominal pain, nausea, a low grade fever, and left lower quadrant tenderness. He is diagnosed as acute diverticulitis. Which of the following is not an appropriate treatment option?



Achalasia is NOT characterized by



Gastric ulcer disease has NOT been shown to be aggravated by which one of the following?



Hypoglycemia can be associated with which one of the following?



The disorder of the esophagus that will present with dysphagia to both liquids and solids is which one of the following?



Which of the following is NOT an appropriate initial treatment for the management of peptic ulcer disease?



A woman aged 67 years presents with upper right quadrant abdominal pain. Fever and jaundice exist. The most likely diagnosis is



Fresh frozen plasma is used in management of which complication of liver failure?



According to a patient he sets off the metal detector at the airport, despite removing his by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198092&Page=26#1160069">WATCH, belt buckle, and every other obvious source of metal. Disease that might be responsible for this phenomenon is



A 59-year-old woman has advanced colorectal cancer. Despite aggressive surgery and adjuvant chemotherapy, the disease has spread throughout her pelvis and eroded into her left acetabulum. Her pain control plan involves transitioning her to a long-acting, sustained-release form of fentanyl. Which of the common clinically significant side effect she is likely to experience?



A 44 year old jaundiced woman undergoes endoscopic retrograde cholangiopancreatography. Multiple common bile duct stones are imaged and the injected contrast material is retained within dilated common bile duct proximal to the stones. Which finding would be consistent with this case of jaundice?



A 32 year old man with chronic hepatitis C is admitted with general deterioration. He has missed many of his previous outpatient appointments and currently is not receiving any treatment. His temperature is 37.8°C, BP is 110/72 mmHg and appears jaundiced. Serum urea, creatinine, bilirubin, AST, and ALP are elevated. Albumin is 30 g/L and urine sodium is 15mmol/L. The likely diagnosis is



A student aged 19 years has a 15 week history of diarrhea. He has lost 2 kg in weight, and has no recent travel abroad. Duodenal biopsy smear reveals many trophozoites. The best treatment option is which one of the following?



A man aged 25 years complains of pain in his rectum. A perianal abscess is revealed on examination. Which sign is not characteristic of it?



A boy aged 19 years is suspected to have cystic fibrosis (CF). Which one of the following finding would be most suggestive of this condition?



An 18 year old boy with a history of fever, fatigue, weight loss, and mild diarrhea of 2 months duration is found to have a palpable mass in the right lower quadrant of the abdomen. What is the most likely diagnosis?



A patient who has chronic ulcer asks for the best method for curing this disease. What would you answer?



A 45 year old housewife presents with heartburn, stomach pain and satiety for several weeks. You order an EGD and a gastric ulcer is present. You treat the patient for 12 weeks with ranitidine (H2 blocker). She returns and is asymptomatic now. But a repeat gastroscopy shows that the ulcer is still present. Her biopsies are negative for malignancy and H. Pylori. The appropriate next step is which of the following?



A 66 year old woman presents with evidence of a fecal impaction which you successfully treat. She relates a history of chronic laxative use for most of her adult years. You perform sigmoidoscopy and note that the anal and rectal mucosa contains scattered areas of bluish black discoloration. The most likely explanation for the sigmoidoscopic findings is



A 45 year old woman presents with severe abdominal pain that radiates to her back and she is found to have high amylase and lipase. Which does not form part of the treatment of this illness?



The type of hemorrhoids that is particularly suitable for treatment by elastic-band ligation is



A 46-year old has hepatocellular carcinoma. He was previously diagnosed with allergic bronchopulmonary eosinophilia when he also had wheezing and a CXR revealed pulmonary infiltrates. Corticosteroids were affective in contrast to anti-fungal agents. What agent is responsible?



A patient is admitted with severe upper abdominal pain that radiates to the back. He describes the pain as steady, but notes that it is more severe when he lies down on his back. His blood pressure starts to drop, but no source of bleeding is identified. When questioned about what he had been doing before the pain started, he reports having been at a friend´s cabin, and spending the weekend "smoking cigarettes, using a little cocaine, and drinking beer." The patient´s white blood cell count is within normal limits. Of the following serum laboratory tests, which will most likely be diagnostic?



A 25 year old female gives birth to an apparently normal male. He begins feeding well by the second day, then at 6 months, suddenly develops colicky abdominal pain and vomiting. It is determined that he has gastrointestinal obstruction. The most likely cause of this presentation is



A 24 year old man has the gradual onset of intermittent diarrhea which, over year, progresses to severe diarrhea, alternating with constipation, rectal bleeding, and passage of mucus. The abdomen is tender over the colon on examination. Stool examination does not show parasites. Colonoscopy demonstrates inflammation limited to the rectum, with no higher lesions. The disease that would most likely be seen in a close relative of the patient is



A middle aged woman presents with fatigue, pruritus, and steatorrhea. Further evaluation demonstrates the presence of antimitochondrial antibodies. This patient if not treated is also at increased risk of developing which of the following?



In which of the following scenarios of a patient with GI bleed is a red cell radionuclide scan is indicated as the next step in evaluation?



A 55 year old male with a history of glomerulonephritis is diagnosed with renal failure. He subsequently complains of heartburn and nausea, and states that he has been vomiting each morning for the last few days. The type of gastritis that would most likely be found in his patient is which of the following?





A 22 year old student is brought to the emergency room after an episode of binge drinking. He complains of epigastric pain and is vomiting. Increased amylase and lipase levels are revealed on serum analysis. The most likely diagnosis is



A 35 year old woman complains of severe abdominal pain. Examination showed enlarged parotid glands, callused knuckles, and dental erosions. Her amylase level was over 300 and she was anemic. The most likely diagnosis is



Protein restriction and gut cleansing are used in management of which complication of hepatic failure?



A 64 year old man has 2 months of worsening watery diarrhea, dehydration, and weight loss. Diarrhea is unrelated to food and that he often also experiences cramping abdominal pain and flushing of the neck and face. The onset is usually sudden and is preceded by stress or alcohol intake. Exam shows a blood pressure of 85/68 mm Hg and a pulse of 102.min. Hepatomegaly is seen. Ultrasound shows lesions in the liver consistent with metastases. Which test would likely confirm the diagnosis?



A 43 year old woman with ulcerative colitis is found to have anti-smooth muscle antibodies. The next most appropriate test for this patient is which one of the following?



A female aged 64 years presents with symptoms suggestive of irritable bowel syndrome. Which finding would represent a ´red flag´ indicator and prompt further investigation?



A 70 year old woman has right upper quadrant abdominal pain. She complained of chills, nausea, and some vomiting. She has pain to deep palpation in the right upper quadrant, along with muscle guarding and rebound. Her temperature is 40oC. Labs show WBC count of 22,000/mm3 with multiple immature forms, a bilirubin of 5 mg/dL and ALP of 840 U/L. Sonogram shows multiple stones in the gallbladder, normal wall thickness without pericholecystic fluid, dilated intrahepatic ducts, and common duct with a diameter of 2.1 cm. Sonographer cannot identify stones in the common duct in addition to intravenous fluids and antibiotics. What is the appropriate next step?



A 67 year old man has epigastric and substernal chest pain. Similar episodes are present in the past. On each ED visit his cardiac evaluations are negative and he is discharged. He has been treated for gastroesophageal reflux disease (GERD) over the past 10 years with ranitidine and antacids, which only intermittently relieve his symptoms. The next best step at this time is



A 24-year-old woman after successful bone marrow transplantation now has lower chest pain and blood-tinged vomitus after a bout of gastroenteritis that affected her entire family. She did develop a significant mucositis before and during her bone marrow transplantation. Labs show:


















White blood cells: 7300/ mm3
Hct: 39%
Platelets: 256,000/mm3

An upper gastrointestinal double contrast barium examination is performed and shows no abnormalities of the esophagus or stomach. Which of the following is the most likely etiology for her symptoms?



Following are the causes of major lower gastrointestinal hemorrhage except



A 69 year old woman comes for flexible sigmoidoscopy as part of a yearly screening. A 3 cm polyp is found in the sigmoid colon and is removed. She returned 6 hours later complaining of left lower quadrant pain, fever, nausea and vomiting. Vital signs are: temperature 38.1°C (100.6°F), pulse 110/min respirations 26/min and blood pressure 120/60 mm Hg. Abdominal examination discloses bowel sounds, tenderness and guarding in the left lower quadrant. Rectal examination shows no stool and only tenderness superiorly. What is the most appropriate next step?



A 25 year old woman presents with a 6 month history of abdominal pain. A physical examination, including pelvic and rectal examinations, is normal. Which component of history would indicate a need for further evaluation?



A 44 year old woman presents with pruritus and progressive jaundice, with increased liver function test and total bilirubin. The next appropriate investigation to be performed is



A 25 year old man presents for evaluation of a 4 month history of postprandial diarrhea, weight loss 9 pounds, and lower abdominal pain. He denies recent travel on antibiotic use. His temperature is 38.0 C (100.4), and he has several oral aphthous ulcers. On abdominal examination, there is tenderness and mild voluntary guarding in the right lower quadrant. A rectal examination reveals brown stool that is strongly guaiac positive. The most likely causing this patient´s symptoms is



A 46 year old unemployed house painter presents to the emergency department with a gradual onset of lethargy and weakness. A physical examination is remarkable for 4+pitting edema of the lower extremities and a prominent abdomen?

Laboratory Findings
Serum sodium...............122 mEq/L (N 135-145)
Serum osmolality...........260 mOsm/kg H2O (N 230-296)
Urine sodium...............5 mEq/L
Urine osmolality...........250 mOsm/kg H2O
What is the most likely diagnosis in this case?



A 44 year old man presents with dark skin and a palpable liver. His father died of cirrhosis. The most likely diagnosis is



A 65 year old female complains of right upper quadrant pain. She is febrile. Physical exam shows slight abdominal tenderness. The appropriate investigation to confirm the diagnosis is



A 50 year old man with a prolonged history of intermitted alcohol abuse is brought to the emergency department with reports of upper gastrointestinal bleeding. The patient thinks he got food poisoning and has been vomiting all day. He was startled when he started vomiting large amounts of blood. Although he has tried to curtail his drinking, he has been successful. The patient is normotensive, tachycardic, and drowsy on examination. Blood tests including a complete blood count, liver function tests, and pancreatic enzymes are all within normal limits. Fecal occult blood test is negative. No palmar erythema or caput medusa is seen. An upright x-ray film of the chest is unremarkable. The most likely cause of this man´s bleeding is



A 42 year old man with diarrhea, weight loss, and epigastric discomfort undergoes endoscopic examination. Examination reveals diffusely thickened rugal folds, suggestive of the linitis plastic type adenocarcinoma. Biopsy reveals no cancer but dramatic hyperplasia of superficial mucous cell with scan gastric glands. This man may be losing excessive amounts of which of the following from his digestive tract due to this condition?



A 36 year old man with prolonged history of alcohol abuse presents to his physician asking for help to stop drinking. According to him he has not felt well over the last couple of months and has lost around 30 lb. He also smokes one pack of cigarettes/day and admits to the occasional use of heroin for which he has spent time in jail. Bilateral lower extremity edema is present on physical examination. Blood studies reveal a normocytic anemia, high red blood cell distribution width, and low serum albumin. Further evaluation reveals increased levels of carcinoembryonic antigen. The most likely diagnosis is



A 59 year old alcoholic man develops a palpable abdominal mass. Ultrasound reveals a 9 cm cystic lesion adjacent to the pancreas. What by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198123&Page=13#98871726">IMPORTANT complication that might occur if this cyst ruptured?



A 51 year old woman has been diagnosed with primary biliary cirrhosis. She has portal hypertension and ascitis. Her physician placed her on a waiting list for liver transplantation. Which of the following is NOT an absolute contraindication for liver transplantation?



All of the following are true regarding melena, EXCEPT



A man presents to a physician because of troubling heartburn and difficulty swallowing. Esophageal motility studies demonstrate a near complete absence of smooth muscle peristalsis and lower esophageal sphincter tone. No mass lesions are noted and the esophagus is not dilated. The finding that would also be present is



A 32 year old woman presents with complaints of weakness and headaches. She has been irritable and depressed lately. Examination shows that the patient is jaundiced and her liver is small and firm. Neurologic examination is remarkable for choreoathetotic movements and a fine tremor that when her upper limbs are extended, resembles a bird flapping its wings. Test that would most likely lead to the correct diagnosis is



A 33 year old female presents with complaints of burning substernal chest pain of several months duration. The pain is exacerbated by large meals, cigarettes, and caffeine. Her symptoms are worse when she lies on her back, especially when sleeping at night. Antacids often improve her symptoms. This woman is at risk for developing which of the following conditions?



A patient develops persistent Macrocytic anemia. The patient is experiencing symmetric paresthesias of the hands and feet. Which of the following organ´s cancer is most strongly associated with this patient´s condition?



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