Welcome to your Gp neelima GIT 4-02-17

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A 34-year-old woman with a history of alcoholism and self-neglect, presents with an episode of blood streaked vomiting attributed to minor Mallory-Weiss tear. She is given an intravenous infusion of 5% dextrose. The following day, her serum potassium concentrations fall to1.9 mEq/L on admission. What is the likely mechanism for the fall in potassium concentration?



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?



In the management of patients with moderately severe ulcerative colitis, which drugs or group of drugs is contraindicated?



A 45 year old woman with jaundice presents with nausea and vomiting, anorexia and depression. She is on rifampin, INH and pyridoxine. Physical exam shows hepatomegaly and abdominal tenderness. Labs reveal her SGOT (AST) and SGPT (ALT) are greatly increased, alkaline phosphatase is slightly increased. The most likely diagnosis is



A 50 year old man comes to the emergency room with a history of vomiting for three days. His past history reveals that for approximately 20 years, he has been getting relief from epigastric pain, lasting for 2 to 3 weeks. He remembers getting pain relief by taking milk and antacids. Physical examination showed fullness in the epigastric area with visible peristalsis, absence of tenderness and normal active bowel sounds. The most likely diagnosis in this patient is



All of the following intestinal complications more common to Crohn´s disease than ulcerative colitis, except



A 70 year old woman with a history of coronary artery disease presents for a routine checkup. The physician notices that she has lost 10 kg since her last visit 6 months ago. When questioned, she gives a history of intermittent periumbilical pain that always begins 30 minutes after eating and lasts about 2 hours. According to her the pain is worse after large meals and so she has begun to eat less out of fear of pain. The most likely diagnosis is



The foods that are ok for a patient with Celiac disease to eat are



A patient presents with weight loss, easy bruising and greasy smelly stools. A dermatitis herpetiformis rash is also noted on his arms. A diagnosis of celiac sprue is suspected. The most appropriate method for diagnosis is



A 44-year-old man presents with lower gastrointenstinal bleeding. The patient undergoes colonoscopy and is found to have numerous polyps. Pathology from a polyp biopsy reveals a hamartoma. What is the most likely diagnosis?



What is the most sensitive diagnostic method for confirming acute cholecystitis?



A 55 year old alcoholic man is brought in to the emergency department after being found unconscious by his daughter who called the paramedics. Paramedics report finding the man in a stuporous condition in the bathtub, covered with vomit. On arrival at the emergency department, the man is clammy and his blood pressure is 85/50 mm Hg. The most likely cause of his hypotension is



A 31-year-old male has extreme fatigue. On exam mild right upper quadrant tenderness and scleral icterus is present. Labs show elevated liver enzymes. HbsAg and anti-HBc are positive. Liver biopsy shows ground by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198326&Page=14#16945306">GLASS appearance and there is intense lymphocytic inflammation and destruction of limiting plate. Only periportal fibrosis is seen. Most consistent diagnosis with this profile is:

This patient has signs and symptoms of hepatitis (fatigue, icterus) and studies show HbsAg elevation.
The anti-HBc antigen begins to rise within the pre-icteric phase The histologic appearance of the liver confirms the diagnosis of hepatitis B infection because of?



A 48 year old male presents to the emergency room with sudden onset of severe upper abdominal pain with vomiting. The pain is located in the epigastrium with radiation to the back. History of chronic epigastric pain is not present. The most commonly encountered predisposing factors for this patient´s condition is



A 24 year old man presents to a rheumatologist with complaints of joint pain involving the large joints of the legs. He also complains of a persistent itchy rash that consists of red vesicles on the extensor surface of his forearms. Further questioning indicates that exacerbations in the joint pain are frequently accompanied by diarrhea. The gastrointestinal disease that is most likely to be implicated as the cause of the patient´s joint and dermatologic problems is



Correct statement regarding the development of appendicitis in pregnancy is



A 55-year-old had two episodes of bright red hematemesis a month ago. No alcohol, medication, prolonged abdominal pain, or retching history exists except for long-standing heartburn. Melena was present. What is the etiology of bleeding?



The clinical presentation of Wilson´s disease is due to abnormal accumulation of which one of the following?



A 54 year old alcoholic man develops chronic severe upper abdominal pain and indigestion. Radiograph demonstrates several small opacities in the upper abdomen. This patient will most likely develop which of the following disorder?



Upper endoscopy and biopsy of a 45 year old man with subacute epigastric pain, weight loss, and early satiety shows helicobacter pylori infection and gastric carcinoma. FALSE statement regarding H. pylori and gastric cancer is



A 44 year old man with a long history of chronic alcohol use was diagnosed with end stage liver cirrhosis and portal hypertension. Investigations revealed an elevated creatinine level. Which of the following could NOT have precipitated the decompensation of his liver cirrhosis?



A 37 year old male has a three day history of bloody diarrhea. He was apyrexial and mildly icteric. His Hb is 10.5 g/dL, WBC count is 19 x109/L, platelet count is 70 x109/L, serum urea is 12.5 mmol/L (2.5-7.5), Serum AST is 90 U/L (1-31) and PT is 12s (11.5-15.5). Peripheral film shows fragmented red cells. The most likely cause of his illness is which one of the following?



A male aged 32 years develops profuse diarrhoea with mucus and blood. Biopsies from the flexible sigmoidoscopy show evidence of ulcerative colitis. True statement regarding this condition is which one of the following?



A 56-year-old woman had an accident 1 week ago. Her abdomen was struck by the steering wheel. She localizes severe mid-abdominal pain to the umbilicus with radiation to the back. She is in mild distress secondary to pain with no other findings. No masses, rebound tenderness, or guarding exists. CT is as follows:



A 60-year-old woman has abdominal swelling and vague pain.
Fluid thrill and shifting dullness are positive. Paracentesis is performed.












































Ascitic fluid
Albumin: 2.8 g/dL
White blood cells: 100/mm 50% neutrophils
Serum
White blood cells: 5,700/mm
Hematocrit: 37%
Platelets: 287,000/mm
AST: 2 9 U/1. 9
ALT: 31U/L
Albumin: 3.7 g/d

Which of the following is the most appropriate next step in management?



A 60 year old female comes to the office because of pain in the left lower quadrant of her abdomen for the past 48 hours. The pain is associated with tenesmus, loss of appetite and a sensation of being febrile. History of irritable bowel symptoms is present but she has not taken any medications for it. Vital signs are: temperature 37.3C (99.2F), Pulse 84/min and regular and respirations 12/min. On physical examination the abdomen is tender in the left lower quadrant. No rebound tenderness is present and bowel sounds are normal. Leukocyte count is 10,200 with 71% segmented neutrophils and 3% band forms. The patient is prescribed tetracycline therapy and is asked to take liquid diet. Three days later she returns because of the worsening of the pain, associated with chills. What is the most appropriate next step?



Out of the following, which is not an extra-intestinal manifestation of an inflammatory bowel disease?



A 39 year old alcoholic woman presents with complaints of epigastric pain radiating to her back with nausea and vomiting. Epigastric tenderness is present on physical examination. The most likely diagnosis is



Which of the following is not a risk factor for hepatocellular carcinoma?



A 44 year old obese woman presents to the Emergency Room with a history of right upper quadrant pain lasting two hours. She states that this is her third attacks of similar pain in the past two months. The pain is sudden in onset and is sharp, constant and radiates to her right shoulder. On examination she is afebrile and has mild right upper quadrant tenderness. The most likely diagnosis is



A patient with chronic peptic ulcer disease asks for the best method for curing this disease. Your answer would be which one of the following?



Which of the following is not a feature of necrotizing enterocolitis?



Which symptom does not favor the diagnosis of achalasia?



A 36 year old man returns for follow of an abnormal liver chemistry profile ordered 3 weeks ago during a routine examination. At that time, his physical examination was normal, but he had a serum AST concentration of 72 U/L. His Serum bilirubin and alkaline phosphatase concentrations were normal. History includes an episode of hepatitis A at age 22 years. He has no history of transfusions or intravenous drug use. He drinks two to three beers daily. Today´s follow-up test results show:

Anti-HAV Positive
Anti-HBs Negative
HBsAg Positive
HBeAg Positive

The most appropriate next step in management is



All of the following are intrahepatic causes of portal hypertension EXCEPT



In case of which one of the following should the small bowel obstruction be managed with prompt surgical decompression?



A 16 year old boy has been taken to the emergency department three times for acute abdominal pain, but was released each time without a definitive diagnosis. The frustrated emergency department physicians now consider him to be "crazy" and have labeled him as having "irritable bowel syndrome." On the fourth occasion, as part of the workup a urinalysis is performed, the results of which are shown below:






















Color: yellow-brown
Specific gravity: 1.0025
WBC: 25
RBC: 0

Microscopic: gram-negative rods, mixed flora
The most appropriate diagnosis is



Which of the following is not present in irritable bowel syndrome (IBS)?



A 74 year old man with well-controlled type 2 diabetes mellitus is scheduled for an abdominal CT scan with oral and intravenous iodinated contrast. The medication that should be withheld 48 hours before and after the procedure is



An uncommon infectious cause of acute diarrhea 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



Prolonged vomiting is usually associated with what electrolyte abnormality?



An elderly nursing home resident woman is brought to the emergency room in shock. The nursing home staff is upset about her condition and stresses that the patient was completely well yesterday, and had only complained of "feeling a little ill" several hours before being brought in. Physical examination reveals a tense abdomen with guarding. This patient´s condition is most likely caused by which one of the following?



A 37 year old patient consults a physician because of bloating and increased abdominal size. Exploratory laporatomy is performed, which reveals loculated masses of semi translucent mucinous material produced by a mucinous cystadenoma. The most likely sites for a primary tumor in this patient are?



A 25-year-old woman pregnant lady with a long history of ulcerative colitis takes mesalazine. She also smokes 15 cigarettes daily. She now presents with a deterioration of symptoms with six bloody stools per day. Which of the following statements is correct?



A 47 year old man complains of fatigue and by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198616&Page=9#35411719">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



Which of the following is not caused by exposure to lead?



The appropriate treatment for hemochromatosis is which of the following?



A 37 year old male reports a mild intermittent jaundice without other associated symptoms for the past several years. His liver function test are normal except for a total bilirubin of 1.3 mg/dL (N 0.3-1.0) and an indirect or unconjugated bilirubin of 1.0 mg/dL (N 0.2-0.8). His CBC is normal. His past medical and surgical history is unremarkable. Findings are similar on repeat laboratory testing. Which of the following is the most likely cause of these findings?



Which of the following has NOT been incriminated as a cause of hepatic encephalopathy?



A 48 year old male has confusion and drowsiness. A diagnosis of hepatic encephalopathy is suspected and treatment with lactulose is begun. True statement regarding lactulose is which one of the following?



A 23 year old man presents 1 week after returning from a 6 month visit to Pakistan. He has fever, rigors and headache. On exam he is febrile (38°C) with BP of 115/65 mmHg, and pulse of 100/min. His abdomen is tender in the right upper quadrant. Hb is 11.0 g/dL, WBC count is 15.5 x109/L with neutrophils 13.5 x109/L and platelet count is 350 x109/L. Blood film is negative for malarial parasites. ALP, AST and CRP are elevated. CXR shows small right pleural effusion. Which investigation would be of diagnostic value?



A 43 year old man has intermittent episodes of severe, crushing chest pain that extends to the back and the jaw and last from a few seconds to several minutes. Many times the pain is accompanied by dysphagia and triggered by the ingestion of certain foods. ECG and cardiac enzymes have been negative. Barium swallow shows disorganized peristaltic contractions. Manometry shows that approximately one half of wet swallows produce repetitive simultaneous esophageal sphincter has normal pressures and exhibits normal relaxation. The most likely diagnosis is



A 70-year-old man has colon cancer. Abdominal CT scan shows no metastases. Only there is significant intramural calcification of gallbladder. The calcified walls are thickened and no pericholecystic fluid present. No abdominal pain exists. What in addition to resection of the colon cancer, should be done?



A 66-year-old man has chronic secretory diarrhea and episodes of flushing for the last few months. He also reports 10 to 12 foul-smelling stools in a day. Stool cultures and a stool test are negative. During flushing, he appears dyspneic with wheezing. What now is the most appropriate test to confirm the diagnosis?



An 80-year-old diabetic with unknown analgesic ingestion has melena and dizziness. She is pale, pulse is 90 bpm, blood pressure is 100/65 mmHg and has lower midline scar from an operation for intermittent claudication three months previously.
She is anemic with fecal occult blood strongly +ve and no Upper GI endoscopy findings. What is the most likely cause of her hemorrhage?



A 54 year old white male smoker suffered from gastroesophageal reflux symptoms unrelieved by intensive medical therapy with PPI. A recent biopsy performed during upper endoscopy identified Barrett´s esophagus. Which one of the following is true about this condition?



A 68 year old male suffers sudden mid abdominal pain. He is pale looking and diaphoretic but elicits no intensity of pain during abdominal palpation. The most likely diagnosis is?



A 72 year old man presents with recurrent bilateral upper lobe pneumonia with mild dysphagia. Physical examination is normal. The investigation of choice to arrive at the diagnosis is which of the following?



Total parenteral nutrition is appropriate for patients



A 22 year old college student presents with intermittent chest pain for about 6 months. He states that the pain can occur at any time, but often occurs late in the day. The pain can be sharp, dull, or aching and may last for hours. He is physically active and is carrying a full academic load. The pain is not related to exercise and does not restrict his activities. His father and paternal uncle had myocardial infarctions within the past year. Physical examination is normal, although the patient appears restless and has a heart rate of 100/min. The most likely diagnosis is



A 50 year old alcoholic suddenly starts vomiting blood and eventually loses consciousness. His wife finds him lying on the bathroom floor. He has no prior history of hematemesis and had not been vomiting prior to the appearance of the blood. The most likely cause of this man´s condition is which one of the following?



A patient´s segment of jejunum had a nodular lesion located in the submucosa. Histologic examination revealed that the tumor is composed of uniform round cells arranged in trabeculae, with a "salt and pepper" chromatin pattern. by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198628&Page=11#2936154">ELECTRON microscopic studies reveal secretory granules, and immunohistochemical stains are positive for serotonin. Which of the following parameters correlates best with the metastatic potential of this tumor?



A 53 year old man presents with epigastric pain that improves with meals. Endoscopy reveals a 2 cm ulcerated area located 3 cm distal to the pyloric junction. Basal acid output is within normal limits. The strongest contribution to the development of this disease is most likely to be made by



A 44 year old woman presents with a fever of 102.5°F, nausea, vomiting, and unrelenting right upper quadrant pain. Murphy´s sign is positive and WBC is 20,000. What is the most likely diagnosis?



A 60 year female with numbness in the lower extremities and macrocytosis has a normal serum folate level and a serum B12 level of 200pg/mL (N 150-800). The laboratory finding that would confirm the diagnosis of B12 deficiency is



A patient develops acute liver failure after the ingestion of acetaminophen. What antidote should be administered?



Important role in defense against peptic ulcer formation is NOT played by which of the following?



FALSE associations regarding the Zollinger Ellison syndrome is which one of the following?



A 33 year man has been chewing tobacco since childhood. He does not smoke but occasionally uses alcohol. He presents with thickened white region in his mouth. Biopsy shows hyperkeratotic skin with some mild dysplasia. The most likely location of the lesion on the basis of history and biopsy is



A 60 year old male has left leg pain and weight loss. On exam, unilateral erythema, swelling, and warmth are noted over the left leg. On ultrasound day his left leg is no longer painful but his right leg is swollen. Ultrasound shows a deep venous thrombosis in the right leg, but no clot in the left leg. What underlying condition is the likely cause of his presentation?



A 37 year old woman presents with a recent history of pruritis, fatigue and jaundice. Liver biopsy shows periportal fibrosis with periportal inflammation and prominent enlargement of the portal tracts. The antibodies most likely to be found in the blood include which one of the following?



A 55 year old woman has an 18 month history of chest pain and dysphagia for both solids and liquids. She smokes 20 cigarettes per day and drinks 16 units of alcohol per week. Physical exam was normal. The likely diagnosis is



A 42 year old previously healthy male is admitted with a single haematemesis after taking 300 mg of aspirin 5 hours ago. His pulse is 120/min, BP of 110/75 mmHg (lying) and 90/60 mmHg (standing). Respiratory and abdominal exam is normal. His hemoglobin is 7 g/dL. The likely cause of his haematemesis is



A 53 year old woman has a history of worsening dysphagia over many years. Recently there had been episodes of ill defined central chest discomfort and nocturnal cough. The most likely diagnosis is which one of the following?



A 42 year old asymptomatic female underwent an abdominal ultrasound scan as part of a clinical trial and was found to have gallstones but entirely normal liver function tests. The most appropriate management is



A 57 year old type 2 diabetic female has diarrhoea and vomiting. She has noticed small amounts of blood in her stools. The vomiting started one day after a meal of chicken and chips. Her Type 2 diabetes is treated with diet alone. Stool cultures reveal Campylobacter jejuni. The most appropriate therapy is



In a patient with haematemesis an oesophagogastroduodenoscopy detects a bleed in the greater curvature of the stomach. Artery that is most likely to be the source of the bleeding is which one of the following?



A 67-year-old woman is concerned about her risks for breast, ovarian, and colon cancer. Breast and pelvic examination is unremarkable. A mammogram is normal. Findings from a barium enema are shown. Which of the following is the most common presenting symptom of this condition?



A 35 year old letter carrier has ulcerative esophagitis and has lost 30 lb in 3 months. He is emaciated and appears ill. Pulse is 98 beats/min, temperature 37.8°C, respiratory rate 24/min, and blood pressure 95/60mmHg. His dentition is poor, and there is evidence of oral thrush. Some posterior cervical and axillary nodes are palpable. The heart, lung, and abdominal examinations are normal. As you continue to investigate, you take a more detailed history. The finding that is most likely to be related to the patient´s problem is



A 21 year old student consults you because of diarrhea of 10 weeks duration. His illness started in February, two weeks after a skiing trip in the Rocky Mountains, with nausea, anorexia and abdominal discomfort. by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198643&Page=4#15712328">SHORTLY thereafter, his stools became frequent and watery. Physical examination is unremarkable. Complete blood count, including differential, is normal. Stool examination shows absence of fecal leukocytes. The most likely causative organism involved is



A 62 year old man is seen in the emergency room and is diagnosed as having acute pancreatitis. Which one of the following would suggest more severe illness?



A 36 year old man returns for follow of an abnormal liver chemistry profile ordered 3 weeks ago during a routine examination. At that time, his physical examination was normal, but he had a serum AST concentration of 72 U/L. His Serum bilirubin and alkaline phosphatase concentrations were normal. History includes an episode of hepatitis A at age 22 years. He has no history of transfusions or intravenous drug use. He drinks two to three beers daily. Today´s follow-up test results show:

Anti-HAV Positive
Anti-HBs Negative
HBsAg Positive
HBeAg Positive

The most appropriate next step in management is



A 26-year-old female has spontaneous bacterial peritonitis. Which one of the following infectious agents is LEAST likely to produce spontaneous bacterial peritonitis?



A 45 year old man presents to the ER with several episodes of severe vomiting. Investigations demonstrate a normal hemoglobin concentration, a normal mean corpuscular hemoglobin concentration, and a hypochromic anemia. History reveals that the patient has consumed alcohol heavily for the past 20 years. Physical examination reveals dysphagia and brittle nail beds. The most likely cause of the patient´s anemia is



What should be the first step in resuscitating a patient with a GI bleed?



Which one of the following findings most reliably indicates diagnosis of iron deficiency anemia in adults?



A 66 year old man presents with a chief complaint that solid food gets stuck in the middle of his chest. He lost 11kg weight over the last 3 months. The most likely diagnosis is



A 32 year old man with a 15 year history of ulcerative colitis develops intermittent cholestatic jaundice. Ultrasonographic examination fails to reveal gallstones. Liver biopsy demonstrates a large bile duct obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) would show



Treatment for hyperkalemia that causes a true excretion of potassium is



A male of age 33 years with a ten year history of ulcerative colitis presents with pruritis and jaundice. His bilirubin level, alkaline phosphatase level, and GGTP are all elevated. Endoscopic retrograde cholangiopancreatography (ERCP) reveals intrahepatic bile duct by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198643&Page=17#90253265">BEADING" and narrowing. The most likely diagnosis is



A 37 year old woman experiences a greasy, malodorous diarrhea. She works in a daycare and has recently gone camping in western Pennsylvania. Stool cultures are performed that were heme and leukocyte negative. Diagnostic feature of giardiasis would be which one of the following?



A patient presents with watery diarrhea and severe dehydration. Stool cultures are positive for Shigella. He is started on IV fluids and is placed on anti-motility medication. Oral bactrim is started and his condition improves over the next 24 hours. Potentially fatal complication of this management that could still occur is



Factor that is responsible for lowering total serum calcium without changing ionized calcium levels in patients with chronic liver disease is which one of the following?



IV bicarbonate is used to treat which complication of liver failure?



A 54 year old male on no current treatment for his quiescent ulcerative colitis is found to have an ESR of 95mm/hr. His Hb is 13.2/dL, WBC count is 4.5 x109/L, Platelet count is 160 x109/L, corrected calcium is 2.58mmol/L, IgG is 25g/L (6-13), IgA is 1.8g/L (0.8-3.0) and IgM is 1.6g/L (0.4-2.2). The most appropriate next investigation is which one of the following?



A 77 year old woman with hip osteoarthritis presents with altered bowel habit. Rectal biopsy demonstrates normal epithelium and pigment laden macrophages in the lamina propria. The most likely cause of these findings is



A patient presents with haematemesis. Esophagogastroduodenoscopy detects a bleed in the lesser curvature of the stomach. Which artery is likely to be the cause of the bleeding?



A 57 year old man has a history of abdominal discomfort that is relieved by passing stool. He has had a feeling of urgency and incomplete evacuation. His symptoms worsen with eating. He also noticed that he has passed mucus per rectum. He is overweight with a BMI of 38 kg/m2. He has adjusted his diet in the last six months. The most appropriate diagnosis is



A 25 year old woman had ulcerative colitis (UC) for seven years and was prescribed mesalazine 1.5 g per day. She smoked 20 cigarettes per day and was 10 weeks pregnant. She has worsening of symptoms with six bloody stools per day. Which statement is correct?



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