Welcome to your Gp neelima GIT 3-02-17

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A 61-year-old lady presented with heartburn. She is known to have osteoporosis and has been talking alendronate for a number of years. Which of the following is the most likely cause of her symptoms?



A 67-year-old man with known aortic valvular disease is admitted with deteriorating dyspnea. He has Hemoglobin=9 g/dL and MCV=70 fL.














Upper gastrointestinal tract endoscopy: Normal
Duodenal biopsy: Normal

What investigation is useful?



A 44 year old man presents with fatigue and joint pain. On physical exam he is found to have dark skin and a palpable liver. His urine shows glucosuria. To reach the diagnosis which of the following would help?



A 47 year old man complains of fatigue and by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198182&Page=5#6830646">SHORTNESS of breath. Peripheral blood smear shows macrocytosis. Labs are as follows:
Hematocrit: 32% (Normal 42%-52%)
Hemoglobin: 103 g/L (Normal 140-174 g/L)
Serum vitamin B12 level: 66pmol/L (Normal 150-750 pmol/L)
Serum folate level: 16nmol/L (Normal 4-22 nmol/L)
The most unlikely cause is



Ranson´s criteria is a set of values that predicts the mortality rate of alcoholic pancreatitis. Which one of the following does NOT correspond to an increased risk of mortality?



A 55-year-old alcoholic male with hepatitis C undergoes orthotropic liver transplant. On 5th post-op day he begins to experience tremor, tachycardia, hypertension, malaise, nausea and visual hallucinations. On exam his wound is dry and clear without abdominal tenderness. His symptoms and appropriate treatment are best explained by which pair?



A 44 year old man presents with lower gastrointestinal bleeding. The patient undergoes colonoscopy that shows numerous polyps. The patient is missing several fingernails and is noted to have alopecia. The most appropriate diagnosis is



The gastrointestinal symptoms NOT associated with malabsorption is



A 55 year old patient is found to have a hepatic abscess. Physician suspects that the abscess is amebic in origin. The management indicated in this case is



A 54 year old woman presents complaining of fatigue. Her hematocrit is 32%, despite the fact that she went through menopause 5 year ago. The physician suspects gastrointestinal bleeding and refers her to a gastroenterologist. A thorough evaluation does not disclose any evidence of malignancy and the gastroenterologist suspects the bleeding may be due to developmental abnormality. The developmental abnormality that might account for unexplained small intestinal bleeding is which one of the following?



A patient has persistent substernal pain despite antacid use. Endoscopy demonstrates irregular erythematous patches several centimeters above the gastroesophageal junction. Biopsy of one of these lesions demonstrates epithelial changes. The cell type that was most likely observed in the involved areas is



Autopsy of a person shows the typical finely granular surface of a kidney with diffuse arteriolosclerosis. The histopathologic changes consist of hyalinization of the media of arterioles and multifocal loss and sclerosis of cortical glomeruli. Condition that would be most likely associated with these findings is



Corticosteroid treatment is appropriate in which of the following clinical scenario?



What is the most common small bowel malignancy?



A 42 year old woman has a several year history of progressive abdominal colic and constipation. Colonic biopsy stained with H&E shows pink acellular material deposition in the submucosa and around blood vessels. The acellular material exhibits green birefringence when stained with Congo red. The birefringence is thought to be most closely related to which protein properties?



In a normal person a tube with transducer at its end is swallowed and passed an unknown distance down the esophagus and records pressure of 25 mm Hg between swallows. Within 2 seconds the pressure falls to 5 mm Hg after small amount of water intake, where it remains until returning to its resting pressure 6 seconds later. In esophageal disease patient it records a pressure of 39 mm Hg at same location. After swallowing, the pressure fails to decrease. In which site is the transducer likely located?



A 52 year old man presents with diarrhea, flushing, and wheezing. Examination is significant for a grade II/VI diastolic murmur located at the right sternal border at the 4th intercostal space. Which substance is likely to be elevated in his urine?



A 34 year old woman with alcoholic cirrhosis is admitted with deteriorating encephalopathy and abdominal discomfort. An ascitic tap reveals a polymorphonuclear cell count of 350 cells per mm3. The appropriate therapy is



A 66 year old man is being investigated for weight loss and dyspepsia. Endoscopy reveals an ulcerated lesion in the stomach and biopsy shows the presence of a low grade mucosa associated lymphoma with H. pylori. CT of chest and abdomen were normal as were bone marrow aspirate and trephine. The best treatment option for this patient is which one of the following?



A female aged 80 years presents with confusion associated with a chest infection. She received standard treatment, and 4 days later she developed green, then bloody diarrhoea. Which organism is most likely to be responsible?



A 60 year old male has a 2 cm adenoma removed from his sigmoid colon. Biopsy confirms an adenocarcinoma in situ with moderately differentiated dysplastic cells. Pathology confirms total excision with clear resection margins. The most appropriate follow up management for this patient is



A 41 year old male with abdominal pain is found to have a raised bilirubin of 60micromol/L. The provocation test with IV nicotinic acid is positive. The best course of action is which one of the following?



A 53 year old man with a diagnosis as a child of coeliac disease had been asymptomatic despite poor dietary compliance. He presents with a 1 month history of intermittent, colicky, central adnominal pain and 3 kilogram weight loss and positive faecal occult bloods. The most appropriate investigation is



A woman aged 60 years has abdominal discomfort, bloating and altered frequency in stools for 6 months. Her symptoms worsen after meal where she also feels nausea. Exam is normal. She is suspected of having irritable bowel syndrome. Which investigation should be undertaken to exclude other diagnoses?



A 72-year-old male presents with haematemesis and melaena. Blood pressure is 82/44 mmHg, with a heart rate of 117bpm. He has a history of idiopathic cirrhosis, and there is mild encephalopathy. You fluid resuscitate him with colloid, blood, FFP and dextrose. Which of the following is the next best step in management?



Which one of the following requires urgent referral for upper endoscopy?



A 50 year old man presents to the emergency room vomiting up bright red blood. He has a history of hemochromatosis. He had his most recent phlebotomy yesterday. His blood pressure is 110/85mmHg, pulse 115 beats per minute, 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 drowsy and confused but has no focal neurologic signs. The most likely cause of this patient´s bleeding is which of the following?



Which of the following is not a risk factor for colon cancer?



All of the following are true of technetium 99m-labeled sulfur colloid liver scans EXCEPT



A 26-year-old female presents with altered mental status and spider angiomas on exam. She was found to have cirrhosis of the liver of unknown etiology. She was not an alcoholic and she did not take drugs. What is the most likely diagnosis?



Which of the following is NOT related with pigmented gallstone formation?



Carcinoembryonic antigen (CEA) is NOT elevated in which one of the following diseases?



A 65 year old married male is admitted to the hospital complaining of abdominal mass. The patient consents to surge, and the mass is removed along with 1/3 of the patient´s colon. The report from the pathologist confirms that the mass was cancerous and, further, that the tumor had extended thought the colon wall and metastasis is likely. Under the circumstances the physician estimates life expectancy at less than one year. The patient has not yet been informed of either´s the extent of the cancer´s spread or his projected life expectancy. As the physician enters the patient´s room to inform the patient of the negative prognosis the patient is sitting with his wife and teenage daughter. What would be the statement that the physician should say after the introduction?



A 66 year old man complains of mild weight loss, constipation, fatigue, and shortness of breath. He also has cough and a mild fever. Blood studies indicate iron deficiency anemia. A stool guaiac test is positive. Chest X-ray reveals a moderate sized pleural effusion is noted and subsequently tapped. Analysis of the fluid reveals increased lactate dehydrogenase levels and carcinoembryonic antigen. The most likely diagnosis is



An elderly individual is diagnosed with a protein-losing gastroenteropathy. The endoscopy demonstrates markedly enlarged rugal folds. No ulcerations are seen. Assuming that the charges are due to a benign process, the most finding on biopsy of the mucosa would be



A 44 year old jaundiced alcoholic man presents to the emergency room complaining of bright red blood in his last stool. He denies pain on defecation or change in his bowel habits. The most likely finding on sigmoidoscopic examination would be



The clinical sign that is described by a periumbilical hematoma is



A 43 year old Japanese woman presents with mid-epigastric tenderness, which is relieved with ingestion of milk. No associated symptoms of weight loss, jaundice, or change in appetite are present. She is a smoker but does not take any nonsteroidal drugs or aspirin. Urea breath test was positive. The best treatment for this patient is



High dietary ingestion of which one of the following is related to development of gastric carcinoma?



A 52 year old alcoholic man is found to have elevated liver enzymes. A liver biopsy show the features revealed in the photomicrograph. If the patient stops from further drinking, this condition will most likely evolve into which of the following?



Out of the following, which is associated with biliary colic?



Which of the following does NOT result in constipation?



A 43 year old man with a history of chronic alcohol intake presents with diarrhea, weight loss, and malnutrition. He has bulky, greasy, excessively malodorous stools that float. Qualitative stool fat showed numerous fat globules per high powered field. The serum carotene level was decreased. The most likely diagnosis is



Correcting hypovolemia is necessary in management of which complication of hepatic failure?



True statement regarding alcoholic liver disease is which one of the following?



A patient with hepatitis is undergoing evaluation for progressive renal failure. Liver biopsy shows inflammation of vessel walls with nodular areas of fibrinoid necrosis. Investigations are negative for p-ANCA and c-ANCA. Hepatitis type that is associated with his current condition is which one of the following?



A 23 year old febrile student presents with fatigue and difficulty swallowing. Examination shows exudative tonsillitis and cervical lymphocytosis, with about 30% of the lymphocytes exhibiting atypical features, as well as mild thrombocytopenia. Serum sample causes the agglutination of sheep red blood cells. What additional finding is most likely to be present?



A 31 year old Caucasian male has a six month history of weight loss, abdominal pain, and diarrhoea. On examination you note finger clubbing. The LEAST likely diagnosis is which one of the following?



A woman had lunch at a Chinese restaurant. She presented with diarrhea and vomiting in the evening. There was no fever. The likely cause of food poisoning in her case is which one of the following?



A 53 year old male presents with general deterioration. He drinks 25 units of alcohol each week and smokes 5 cigarettes daily. Exam reveals jaundice, spider nevi on chest. His temperature is 37.2°C and has hepato-splenomegaly. His bilirubin, ALP and AST are increased. HBsAg is positive, HBeAg is negative and Hepatitis B virus DNA is undetectable. The likely diagnosis is



A male aged 30 years presents with acute, profuse, watery diarrhoea with some blood after returning from Tanzania. He had been taking oral rehydration salts. The most appropriate treatment is which one of the following?



A 71 year old man has pruritus and 2 kg weight loss of 2 weeks duration. He is jaundiced and has not drunk any alcohol for at least eight years. A month ago he completed a course of co-amoxiclav for sinusitis and is also taking ibuprofen for osteoarthritis. His bilirubin, AST and ALP are elevated. Abdominal ultrasound reveals gallstones but no biliary duct dilatation. The most likely cause of his jaundice is



A male aged 29 years presents with symptoms of severe gastro oesophageal reflux. Most useful in assessing the role of surgery is which one of the following?



In chronic hepatitis B virus (HBV) infection, presence of hepatitis B e antigen (HBeAg) signifies which of the following?



The most common cause of a Fistula-in-ano is



Which of the following is most likely to be associated with a recurrent painful swelling of a Submandibular salivary gland?



A female presents with a pain in the right upper quadrant of her anus. The mass coming out is painful and red. The most appropriate initial management is



In managing a patient with an acute GI bleed, the most sensitive indicator of decreased blood volume is



A 24 year old student comes to the emergency room complaining of right upper quadrant abdominal pain for several hours. He admits to drinking excessive amounts of alcohol 3 days ago. Over the course of the last few days he recalls that he ingested the contents of an entire bottle of acetaminophen. He is afebrile, with normal vital signs and slight tenderness in the right upper quadrant. The most likely set of liver function enzymes in this patient would be



Which of the following is NOT a mechanism for the development of megaloblastic anemia?



Which of the following is NOT indicated in the treatment of liver failure?



A 71 year old man who is under treatment for hypertension has several abnormal liver function tests. He is a nondrinker and is not taking any medications likely to cause hepatotoxicity. During more extensive history taking, he tells you that he does use some over the counter medications. The most likely responsible for the abnormal laboratory findings is



All of the following are consistent with primary (spontaneous) bacterial peritonitis, except



A 66-year-old man has sudden onset of severe periumblical abdominal pain, diarrhea and vomiting. On exam his abdomen is diffusely tender, pulse rapid irregularly irregular, pale forearm and no palpable brachial pulse. Urine and stool are positive for blood chemical testing. His Hb is 16.4g/dL and WBC 25000/mm3. What imaging procedure would specifically diagnose his abdominal pain?



A 46 year old man presents with symptoms of severe epigastric pain, diarrhea, and weight loss. H2 blockers provide no relief. His serum gastrin level is elevated to over 800 ng/L. Upper endoscopy was performed that showed a lesion located in the postbulbar duodenum. The most likely diagnosis is



A 32 year old alcoholic male is noted to have anemia. What is the most probable type of anemia and its associated treatment?



The recommended medical treatment for chronic hepatitis B is which one of the following?



A 40 year old businessman who has long standing cirrhosis from chronic alcohol use presents with symptoms of abdominal bloating. On examination he was found to have a fever, ascites, testicular atrophy, and a small, nodular liver. The most common cause of infection in this patient is



Which one of the following is NOT a feature of ascending cholangitis?



A patient´s ABG is obtained and shows a pH of 7.51 and a pCO2 of 48 mm Hg. On a serum blood sample, Na+ = 136 meq/L, K+ = 3.2 meq/L, Cl- = 100 meq/L, and HCO3- = 37 meq/L. The most likely diagnosis is



An autopsy is performed on a male who suddenly began vomiting voluminous quantities of blood and bled to death. His stomach´s photograph is shown below. The major pathogenic attribute of the most likely infectious agent in this condition is also shared by which organism?



A 36 year old has diarrhea, abdominal pain, and flushing. Investigation reveals elevated urinary 5-HIAA level. An agent to alleviate the diarrhea and flushing is prescribed. Which is the most appropriate treatment for this patient?



A clinical study is investigating serum haptoglobin levels and serum bilirubin in the diagnosis of hemolysis and jaundice. Lab analysis is shown below. Which one is consistent with acute intravascular hemolysis?



Exam of a 57 year old obese woman shows hepatomegaly. 6 years ago she was diagnosed with diabetes mellitus and takes metformin and gliclazide. She drinks 15 units of alcohol weekly and stopped smoking 10 years ago. No stigmata of liver disease are evident. Total bilirubin is 11 µmol/L, ALP is 145 U/L, AST is 100U/L, ALT is 150U/L, Albumin is 40 g/L, and Ferritin is 434 µg/L. Ultrasound reveals an echo bright appearance of the liver and gallstones in the gallbladder. The likely cause of her liver disease is



A 51 year old ex-footballer has a long history of alcohol misuse. He now presents with epigastric pain. Out of the following, which one suggests a diagnosis of peptic ulceration rather than chronic pancreatitis?



A 43 year old female presents with tiredness. Her Hb is 7.8 g/dL, MCV is 72 fL, WBC count is 7.6 x 109/L, platelet count is 350 x 109/L, serum ferritin is 8µg/L. She was started on oral iron therapy and a month later her Hb was 8.0 g/dL. The likely cause of the failure of her haemoglobin to respond to this treatment is



A 25 year old female has ingested an unknown quantity of paracetamol tablets 4 hours ago. She presents with nausea, vomiting, anorexia and right subchondral pain. Which feature suggests that she should be transferred to liver unit?



A 54 year old woman has lethargy, diarrhea together with joint pain and intermittent fever. These symptoms have developed over the 6 months during which time she has lost 6 kg in weight. Supraclavicular lymphadenopathy is noted. The most likely diagnosis is which one of the following?



A 33 year old woman with Crohn´s Disease has a history of a right hemicolectomy for ileo-colonic disease. Since the operation she has had frequent diarrhoea but no blood in the stools. Her ESR is 10mm (0-20mm/1st hour), platelet count is 240 x109/L, and serum CRP is 7 mg/L (<10). The best treatment is



A 40 year old man has a history of left-sided crohn´s colitis. He was treated with steroids and mesalazine but has had several relapses in the past year. The last relapse was complicated by gastric bleeding. His Hb is 10.8 g/L, MCV is 76 fL, MCH is 24pg and serum CRP is 30 mg/L. Abdominal X-ray is normal. The appropriate management is



A 73 year old man is discharged from hospital after a stroke. During his stay he was started on several new medications. He presents with diarrhoea. Medication that is the most likely cause is which one of the following?



A 55 year old man has abdominal pain. He suffers from chronic pancreatitis and often seeks pain control after drinking alcohol. For the last couple of months he has had chronic, dull pain, which is not as severe and located more over his left upper quadrant. Previously, the pain was mainly umbilical. His temperature is 99oF, BP is 126/84, pulse is 98/min, and respiratory rate is 16/min. The spleen tip is palpable. His hematocrit is 32%, WBC count is 7000/mm3, MCV is 70 µm3 and platelet count is 490,000/mm3. LFTs are unchanged from his baseline. Upper endoscopy shows profound gastric varices. The most likely diagnosis is



A 36 year old woman presents with severe, stabbing abdominal pain radiating from the epigastrium to the back and chest. She is nauseated and her abdomen feels bloated and painful, the pain is worse lying down. She has tachycardia, a low-grade fever, an absence of bowel sounds, and an exquisitely tender abdomen. She drank excessive amounts of alcohol last night. She has no past medical or family history for cardiac disease. A plain radiograph of the abdomen shows no air under the diaphragm. Which of the following process is most likely on-going in this patient?



A 36 year woman presents complaining of epigastric pain that is exacerbated by eating. An EGD reveals the presence of a duodenal ulcer. A test for Helicobacter pylori is positive. The most appropriate treatment is which of the following?



A 65 year old hypertensive female has chronic constipation. She presents with metabolic acidosis and hypokalemia. The most likely cause of her present condition is



A 25 year old female rushes to an emergency department because she is afraid she is dying. She is experiencing chest pain, a sensation of choking, nausea, and tingling sensations up and down her arms. When the screening nurse examines the patient, her face is flushed and sweating. Her pulse is 140 per min and respirations are 25/min. When the emergency department physician examines her 15 minutes later, her symptoms are dissipating; her pulse is 100 min, and respirations are 20 min. The ECG is normal, expect for some residual tachycardia. Which associated medical condition is most commonly diagnosed in such patients?



A 50 year old female complains of generalized itching. Examination reveals that she has mild jaundice, and laboratory evaluation reveals elevated conjugated bilirubin and increased alkaline phosphatase. A liver biopsy shows granulomatous inflammation centered on small bile ducts within the portal spaces. The appropriate diagnosis would be supported by which of the following findings?



A 66 year old man develops periumbilical pain which then localizes to the right lower quadrant. On physical examination, his temperature is 38.0 C (100.5°F) rectally and his abdomen is tender. The most appropriate diagnosis is



A 66 year old man has had severe alternating constipation and diarrhea for the past 2 months. Hemoccult test on a stool sample is positive for occult blood. Colonoscopy shows a large, annular, encircling mass 25 cm above the anal verge, in the descending colon. This tumor would first metastasize to which of the following nodes?



A 55 year old teacher presents with headaches and fatigue. He is a nonsmoker, however he admits to many years of alcohol abuse. A small, nodular liver is revealed on physical exam. A routine CBC demonstrates a hematocrit of 63%. Vital signs are within normal limits, and oxygen saturation is 98%. The peripheral smear shows normo-cellular erythrocytes, with increased reticulocytes and nucleated red cells. Erythropoietin and bilirubin levels are elevated; carboxyhemoglobin levels are decreased. The most likely diagnosis is



A 57 year old woman presents with diffuse pruritis, mild jaundice, and an elevated alkaline phosphate level. Physical examination reveals an enlarged liver. The test of choice to diagnose primary biliary cirrhosis is



A 78 year old man presents with pain in the upper portion of his neck on swallowing. He occasionally regurgitates undigested old food and also has bad breath. The most likely etiology of his problem is



A 48 year old female presents with sudden strong pain in her right upper quadrant. She has a fever of 38.5 degrees and she is vomiting. No jaundice is present. The most likely diagnosis is which of the following?



All of the following are factors in the development of gastritis, EXCEPT



Which of the following is NOT a risk factor for the development of hepatocellular carcinoma (HCC)?



The best way to screen routinely for colon cancer is which one of the following?



A 90 year old nursing home resident complained of abdominal pain and vomiting after eating, and a poor appetite. Gastric emptying studies showed that this patient had delayed gastric emptying and thus early satiety. Which of the following is FALSE regarding gastroparesis in the elderly?



A 44 year old worker presents with severe, chronic epigastric pain associated with diarrhea. Pain did not improve with H2 receptor blockers, such as cimetidine. An upper GI series revealed a large gastric mucosal fold. The serum gastrin level was greater than 1,000 mg/L before and after a meal. The most likely diagnosis is



Vitamin K is used to treat which complication of hepatic failure?



A 42 year old woman with polcythemia Vera develops progressive severe ascites and tender hepatomegaly over a period of several months. LFTs are near normal. The likely diagnosis would be established by



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