Welcome to your Gp neelima GIT 6-02-17

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After a careful history and physical and a cost-effective workup, you have diagnosed your patient with IBS. What other condition would you expect to find in this patient?



All of the following are true regarding pancreatic pseudocysts, except:



What is the best method to cure a patient who has a chronic peptic ulcer disease?



A 52 year old male presents to the emergency room with severe epigastric pain, low-grade fever, tachycardia, and mild hypotension. The patient has a history of moderate to heavy social drinking. The resident suspects acute pancreatitis. The single most important laboratory finding to confirm the diagnosis of pancreatitis is



When considering therapy for the obese patients, one should know that the major component of caloric expenditure is



A patient complains of nausea, vomiting, and diarrhea. He notes that his symptoms improve markedly when bread and pasta are removed from his diet. Marked histologic changes would most likely be seen at which of the following sites in this patient´s disease?












A 69 year old man is found to have occult blood in the stool during a periodic health maintenance examination. Colonoscopy reveals a mass in the sigmoid colon. He undergoes surgery for resection of the mass which is shown in the photograph. The most significant risk factor associated with the incidence of this disease is



A 46 year old businessman presents to his physician with complaints of feeling tired and several months of abdominal pain and "dark-colored" urine. On physical examination the patient is slightly jaundiced and his gallbladder is palpable but not tender. The disorder that is most likely associated with the given presentation is



A 35 year old alcoholic male presents with severe abdominal pain, nausea and vomiting. He feels slightly better lying in the fetal position on his left side. On examination, his bowel sounds were diminished and his abdomen was diffusely tender. Cullen´s sign was present. Lab data reveals elevated lipase and amylase levels in the serum. Which of the following is not associated with poor prognosis of this disorder?



A young healthy patient develops upper GI bleeding after severe vomiting. The most likely explanation for this is which of the following?



A 62 year old man with a history of alcohol abuse presents with the new onset of ascites. All of the following statements are true, except



A 50 year old know IV drug abuser presents with endocarditis. After treatment with antibiotics, he develops watery diarrhea associated with crampy abdominal pain. This patient is HIV negative. The most likely cause of his diarrhea is:



A 77 year old nursing home resident presents with symptoms of watery diarrhea, dehydration, and malaise. No fecal leukocytes or fever is present. The infectious agent that is most likely responsible for this presentation is



A 25 year old man presents with symptoms of facial flushing which spreads to the trunk and upper extremities associated with diarrhea and wheezing. Exam showed erythematous facial flushing which eventually turned purplish. Hepatomegaly was also present. The blood pressure was low during this episode. 5-hydroxyindoleacetic acid level in the urine was elevated. The most likely diagnosis is



Which of the following is NOT an indication for hepatitis A vaccine?



All of the following predispose to gastroesophageal reflux disease, EXCEPT



A 66 year old woman presented with lower gastrointestinal bleeding, not associated with abdominal pain, anorexia, or weight loss. Examination showed tachycardia with a blood pressure of 90/70 mm Hg and pallor. Rectal examination revealed bright red blood. Her hematocrit was 22%. The most common cause for this patients bleeding is which one of the following?



A 62 year old male with known alcohol related cirrhosis presented with ascites, abdominal tenderness and peripheral oedema. A diagnostic tap revealed a neutrophil count of 400/mm3 (<250mm3). Which one would provide most immediate benefit?



A 50 year old male has loose stools. He is dehydrated, weak and in shock. He had previously been complaining of large stool volumes for a 1 month period. Stool colour was normal. There was no history of laxative abuse and no significant past medical history. What is the likely diagnosis?



A 51-year-old woman has pruritus and fatigue for at least the last 6 months. She has occasional arthralgias, dry mouth and dry eyes. Hepatomegaly exists.

































































Laboratory studies show:
Sodium 139 mEq/L
Potassium 4.4 mEq/L
Chloride 101 mEq/L
Bicarbonate 24 mEq/L
BUN: 12 mg/dL
Creatinine: 0.7 mg/dL
Glucose: 96 mg/dL
Albumin: 3.1 g/dL
AST (SGOT): 58 U/L
ALT (SGPT): 81 U/L
Alkaline phosphatase: 85 U/L
Bilirubin: 2.0 mg/dL
GGT5 82U/L
Protein, total: 9.8 g/dL

Which of the following is the most appropriate management to delay progression of this patient´s condition?



A 45 year old woman presents with left lower quadrant pain with non-bloody stool. Tenderness is present over the area. She is afebrile and her rectal examination is normal. Diverticulum is seen in a barium enema study. The most appropriate intervention is



A 66 year old obese man complains of strong and sudden mid abdominal pain radiating to his left flank. Physical exam does not show any findings. The most likely diagnosis is



Gastric carcinoma metastases to the left supraclavicular node are associated with



A 62 year old woman is admitted to the hospital for increased abdominal growth. She has noted that her abdomen has rapidly expanded over the past month. She is not aware of any medical problems and has not seen a physician in many years. On physical examination, her heart rate is 90/min, and her blood pressure is 105/65 mm Hg. She looks cachectic and her abdomen is markedly distended, with a positive fluid wave. Ultrasound demonstrates a large amount of ascites. The quantity of 500 mL of fluid is aspirated from the peritoneal cavity, and the fluid has a specific gravity of 1.010, very low protein, and few cells. The history that would be most consistent with this patient´s presentation is



A 74 year old man presents with severe acute abdominal pain. Physical examination revels tenderness with guarding localized to the left lower quadrant. A CBC with differential shows a white count of 18,000/mm^3 with increased neutrophils band forms. Paracentesis demonstrates mixed flora bacteria with many neutrophils in the peritoneal fluid. The most likely source of the infection is



A 19 year old boy is brought with complains of facial dystonias and upper extremity tremors. His father died from cirrhosis of the liver. Examination shows brownish green discoloration around the limbus of his cornea. His liver function tests were elevated. The diagnostic test of choice in this patient would be



Several members of a family develop abdominal pain, nausea, and vomiting, followed in a few hours by different degrees of paralysis, about 24 hours after dinner of home canned beans. The most likely etiology of their illness is which one of the following?



Which treatment of variceal bleeding is contraindicated when managing an acute bleed?



A 53 year old man develops esophageal cancer. Which of the following is NOT a risk factor for the development of esophageal cancer?



True statement regarding hepatitis C is which one of the following?



A 21 year old boy is brought to the emergency room by a friend who states that he has been getting progressively somnolent during the last few hours. He had been quite depressed lately because his girlfriend left him, and he was even heard to be talking about suicide. Patient´s blood gases are normal, but his LFTs are elevated. Treatment with which of the following is started on the basis of presumptive diagnosis?



A Japanese male aged 52 years presents with weight loss, early satiety, jaundice, and anemia. Upper endoscopy reveals a "leather bottle" stomach or linitus plastica. Which of the following is NOT associated with this tumor?



A previously healthy 21 years old woman began having nausea and vomiting 24 hours after ingestion of chicken followed by watery diarrhea that has lasted three days with a fever of 103° F. She was diagnosed with Salmonella gastroenteritis. What is the most by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=198733&Page=21#63876849">IMPORTANT aspect of management?



Which one of the following is the best first test in evaluating the cause of iron deficiency anemia?



Examination of a 40 year old female with systemic sclerosis who presents with malaise is significant for jaundice, and serum chemistry studies show moderately elevated serum alkaline phosphatase, while AST and ALT are only minimally elevated. Which autoantibodies would be most helpful in elucidating the likely etiology of her liver disease?



A 44 year old woman is diagnosed with a duodenal ulcer. The most sensitive test for detecting current infection with Helicobacter pylori is which one of the following?



A 34 year old obese Afrocarribean woman has mild jaundice. She is teetotaler and her BMI is 30kg /m2. Her bilirubin is 25 µmol/L, AST is 140 U/L (1-31), ALT is 155 U/L (5-35), and random blood glucose is 11.2 mmol/L. Hepatitis B and C screening is negative and anti-nuclear antibodies titre is 1: 16. Ultrasound abdomen reveals hyperechogenic hepatic parenchyma. Liver biopsy reveals lesions suggestive of alcoholic liver disease. The likely diagnosis is



A male aged 68 years has alcoholic cirrhosis complicated by mild ascites. Which feature is likely to be present in this patient?



A man is referred for possible treatment of Hepatitis B. He has stigmata of chronic liver disease. There is portal hypertension and ascites. His INR is 2.2 (<1.4) and albumin 25 g/L 37-49). HBsAg and HBeAg are positive. Hepatitis C screen is negative. Which one of the following would be suggested for treatment?









A 48-year-old alcoholic has severe persistent pain located in the epigastric area along anorexia, fever, and chills. She had a recent bout of pancreatitis 5 weeks ago. She is febrile and tachycardic. Examination suggests a tender, ill-defined epigastric mass, with no rebound or guarding. There is leukocytosis and increased lipase and amylase. LFTs are normal. CT abdomen is as follows:

What is the most appropriate next step?



A 51-year-old with chronic liver disease (due to Hepatitis C) is icteric with bitemporal wasting. Liver is 7 cm in the midclavicular line, and splenomegaly is present with near-tense ascites lower extremity edema upto the mid-calf. Albumin = 2.1 g/dL, total bilirubin = 12.1 mg/dL, and a prothrombin time = 19 seconds. Which of the following is the most appropriate therapy for this patient?



A 78 year old homebound female has constipation that is not adequately responding to increased fluid and psylliun (Metamucil) supplementation. What is the safest stimulant laxative to add to her regimen?



A 34 year old male with epigastric pain and positive serology for H. pylori was treated with triple therapy. Several months later, he was asymptomatic but his serology was positive. The best management of this patient is



The finding that would best establish the suspected diagnosis of spontaneous bacterial peritonitis 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?



What is the most common acid base disorder in liver disease?



Examination of a 22 year old student with symptoms of weight loss, abdominal pain, fever, and joint pain shows peripheral lymphadenopathy, steatorrhea, nystagmus, and cranial nerve defecits. Small bowel biopsy reveals a heavy infiltration of macrophages that stain positive for periodic acid-schiff (PAS) reagent. The most likely diagnosis is



Out of the following, which statement is correct?



In persons with severe liver disease which one of the following coagulation defects may be seen?



Which one of the following clinical sign may NOT be caused by malabsorption?



A 33 year old woman has profound nausea, vomiting, sweating, hyperventilation, tachycardia, and vertigo. According to her she had a few glasses of wine with her friends when she suddenly became ill. She has been previously diagnosed with a duodenal ulcer and is currently taking medication for her condition. Which drug is responsible for her latest symptoms?



A 34 year old with a history of recurrent anemia was noted have target cells and Howell Jolly bodies on a blood film examination. His Hb is 7.0 g/dL, MCV is 77 fL, MCH is 26.2pg, serum B12, red cell folate and serum ferritin are low. The disease specific antibody that is most likely to be present is



A group construction workers presented with diarrhoea, flushing, sweating and a hot mouth. They ate lunch in the staff canteen and fell ill minutes after that. They admitted that they ate tuna fish and wine. The likely cause of food poisoning is which one of the following?



A 54 year old male presents with dysphagia, retrosternal discomfort and weight loss. Studies reveal achalasia. What is likely to provide symptomatic relief?



A new diagnostic test for malabsorption has been analysed and the results are as follows.


























  Disease present
test result yes no
+ve 0.9 0.1
-ve 0.2 0.8

Applying this test to a case of chronic diarrhoea from a patient group where the prevalence of malabsorption is known to be 20% (probability = 0.2). The probability of a patient having malabsorption if they have a positive test is



A 71 year old woman has a history of pancreatitis and persistent diarrhea. She also has osteoporosis and a history of deep vein thrombosis. Which drug would become less effective after she starts taking Cholestyramine to relieve intolerable itching?



A 61 year old male has a 5 day history of lower abdominal pain and diarrhea. He has a history of chronic obstructive airways disease and has had numerous acute infective exacerbations over the last three months. On exam he was dehydrated, with a temperature of 38.6°C, a BP of 102/72 mmHg and has a distended, tender abdomen. The most appropriate investigation for this patient is



A 61 year old female with liver cirrhosis has abdominal pain, malaise and nausea. She quit drinking since the diagnosis 8 months ago. On exam she has moderate ascites and generalized abdominal tenderness. Her Hb is 11.2 g/dL, WBC count is 15 x109/L, PT is 21 sec, albumin is 28 g/L, and total bilirubin is 56 µmol/L. Ascitic fluid protein is 26 g/L, ascitic fluid amylase is normal and ascitic fluid WBC count is 500 x109/L. The likely reason for her current problem is



Concerning iron the true statement is which one of the following?



A 65 year old man has been having bloody diarrhea for 2 days. His BP is 90/70 mm Hg and pulse is 110/min. His Hb is 9 mg/dL. A nasogastric tube is inserted and aspiration produces clear, green fluid without blood. Digital rectal examination and anoscopy show that there is blood in the rectal vault but does not identify a source. The most appropriate diagnostic study at this time is



An 82-year-old bedridden woman has severe constipation with no bowel moves in the past 5 days and from today; she has lower abdominal discomfort and distention. She takes hydrochlorothiazide and acetaminophen with codeine for severe arthritic pain in both hips. The rectal vault is filled with hard stool. Which of the following is the most appropriate next step in management?



A 70-year old (c/o of previous uncomplicated MI) has a 1-week history of crampy lower abdominal pain and bloody diarrhea. Symptoms began with mild postprandial abdominal cramping followed by diarrhea, which became bloody after 2 days. She has moderate tenderness to palpation of the left lower quadrant. A rectal examination reveals bloody stool and no masses. Which of the following is the most likely diagnosis?



A 29 year old male presents with abdominal pain radiating to the back, after a weekend of heavy drinking. What is the investigative and prognostic modality of choice for the suspected diagnosis?



A feature of secretory diarrhea is



An immigrant from Santo Domingo has severe myalgias, diarrhea, and fever. He had a marked eosinophilia and his Creatinine phosphokinase level was elevated. There were no changes in his dietary habits. What is the treatment of choice in this patient?



A 62 year old man says that he occasionally brings up what appears to be undigested food long after his meal. According to him he sometimes chokes on food, and that his wife says he has bad breath. What is the most likely diagnosis?



A 30 year old woman presents with fatigue. Blood analysis demonstrates macro ovalocytes and hypersegmented neurophils, with serum vitamin B12 levels being 89 mg/ml. LEAST likely to be a cause of her condition is



A 22 year old man while working in Africa complains that his urine is amber, his stool is gray, and he has a yellow tinge to his skin and eyes. He has fatigue and anorexia. His liver function tests were elevated. The recommended treatment in this patient is



Colonoscopy with biopsy of a 61 year old woman with a 30 lb weight loss, bright red blood per rectum, decreased appetite, and weakness shows adenocarcinoma of the colon. Metastatic lesions to the liver are present and she was diagnosed with Dukes stage D metastatic colon carcinoma. Which is NOT a treatment used for metastatic colon cancer?



A 27 year old woman developed crampy abdominal pain, watery diarrhea and fever two weeks after a 14 day course of IV antibiotics for a community-acquired pneumonia. The most likely diagnosis is



A male aged 43 years presents with weight loss and watery diarrhoea. Labs reveal hypokalaemia with a pancreatic mass. A diagnosis of VIPoma would be supported by which one of the following?



A 50-year-old alcoholic has abdominal discomfort. Abdomen is distended and tender with decreased bowel sounds and is positive for shifting dullness. Grade 2+ lower extremity edema is present bilaterally.


































Total protein: 5.7g/dL
Albumin: 2.7g/dL
Alkaline phosphatase: 210u/L
AST: 170u/L
ALT: 85U/L
Amylase: 45u/L
Lipase: 39U/L

CT shows:

Define cause!



A 47 year old man with a family history of Haemochromatosis presented advice. Labs reveal serum ferritin of 453 g/L (15-300), serum iron of 29mol/L (12-30), serum iron binding capacity of 46mol/L (45-75) and iron saturation of 63 per cent (20-50). The appropriate next step in management is



A 44 year old has abdominal pain and watery diarrhoea. She is taking ibuprofen and has been previously investigated for infertility. She was given PPI for 6 weeks with no relief. Calcium level is 2.86 mmol/L, phosphate is 0.8 mmol/L (0.8-1.4), CRP is 10 mg/L (<10). Endoscopy reveals multiple small duodenal ulcers. Test for H. pylori is negative. The likely diagnosis is



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