Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Gastroenterology
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Question 1# Print Question

A 36-year-old man presents with cramping abdominal pain, urgency, bloody diarrhea, and weight loss. Physical examination reveals lowgrade fever, heme positive stools, and tenderness to palpation in the lower abdomen. Colonoscopy with biopsy is performed and the diagnosis of Crohn disease is made.

Which of the following findings is not associated with Crohn disease?

A. Loss of haustral markings (lead-pipe colon)
B. Transmural inflammation
C. Oral ulcers
D. Noncaseating granulomas on biopsy
E. Perirectal fistulas

Question 2# Print Question

A 29-year-old woman presents to the physician because of fatigue, dark urine, nausea, vomiting, and decreased appetite. She reports that the symptoms started 1 month ago and have worsened in the last week. She has an insignificant past medical history but does endorse IV drug use as well as unprotected sexual intercourse with several partners over the last 6 months. She is unable to recall her immunization history. Laboratory results show elevated AST (210 U/L) and ALT (352 U/L) levels. The physician determines she is at high risk for hepatitis B virus.

What laboratory test(s) should be ordered to screen for ACUTE hepatitis B infection? 

A. Anti-HBe
B. HBsAg and anti-HBs
C. HBeAg
D. HBsAg and IgM anti-HBc

Question 3# Print Question

A 39-year-old woman presents with epigastric pain that has radiated to her back for the last 8 hours. She endorses nausea and vomiting. Her past medical history is significant for hyperlipidemia; however, she does not take any medications other than a multivitamin. She denies alcohol or drug use. On examination, the patient is slightly febrile at 38.4°C, with a blood pressure of 114/83 mmHg, a heart rate of 98 beats per minute, and a respiratory rate of 22 breaths per minute. The patient has decreased bowel sounds and guarding in the midepigastrium.

Which of the following results is the most specific finding in this condition?

A. Elevated amylase
B. Elevated ALT
C. Elevated lipase
D. Positive fecal fat test

Question 4# Print Question

A 49-year-old man with an extensive history of intravenous drug abuse over 10 years ago presents with anorexia, nausea, and malaise. He also reports dark urine for the last 2 months. His past medical history is significant for bipolar type 2 disorder. He takes no medications and reports a distant history of alcohol abuse. Physical examination is significant for hepatomegaly but no ascites. The patient demonstrates no signs of depression. Laboratory results reveal the following.

  • Albumin 3.6 g/dL
  • Total bilirubin 1.2 mg/dL
  • Direct bilirubin 0.8 mg/dL
  • Aspartate aminotransferase 420 U/L
  • Alanine aminotransferase 280 U/L
  • Alkaline phosphatase 78 U/L
  • Prothrombin time (PT) 12 s
  • International normalized ratio (INR) 1.3
  • Hemoglobin 12.8 mg/dL
  • Creatinine 1.2 mg/dL
  • Polymerase chain reaction=  Detectable serum hepatitis C virus RNA

A biopsy of the liver is performed that demonstrates bridging fibrosis.

Which of the following is the best next step in management of this patient?

A. Follow-up in 4 months with monitoring of symptoms
B. Vaccinate him against hepatitis B virus (HBV) and Hepatitis A virus (HAV)
C. Upper endoscopy
D. Liver transplantation

Question 5# Print Question

A 27-year-old woman presents with diarrhea and abdominal pain for the last 8 months. She denies bloody stools, weight loss, or fatigue. The patient just recently started what she describes as a “stressful” career in investment banking. She is concerned that she might have Crohn disease as both her maternal uncle and maternal grandmother have the disorder. Further questioning reveals that the diarrhea and abdominal pain occur about once per week (generally Friday mornings before she gives her weekly presentation), and the other days she is “constipated.” The abdominal pain is alleviated after defecation. Physical examination is unremarkable.

What is the next best step in management for this patient?

A. Colonoscopy
B. Oral corticosteroids
C. Loperamide
D. Reassurance and recommendation for a high-fiber diet and exercise

Category: Q&A Medicine--->Gastroenterology
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