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Category: Q&A Medicine--->Gastroenterology
Page: 2

Question 6#Print Question

A 36-year-old man presents to the physician with fatigue and “brown” urine. He has an unremarkable past medical history and endorses IV drug use in his early 20s. Family history is significant for breast cancer on his mother’s side and rheumatoid arthritis on his father’s side. He is afebrile, has a blood pressure of 132/72 mmHg, and a heart rate of 84 beats per minute. Physical examination reveals icteric sclera and skin and pain in the right upper quadrant to deep palpation. Laboratory results reveal the following.

  • Total protein   6.0 g/dL
  • Albumin  3.6 g/dL
  • Total bilirubin   9.8 mg/dL
  • Direct bilirubin  7.9 mg/dL
  • Aspartate aminotransferase   19 U/L
  • Alanine aminotransferase   20 U/L
  • Alkaline phosphatase   760 U/L
  • Amylase   42 U/L
  • Prothrombin time (PT)   12 s
  • Partial thromboplastin time (PTT)   32 s

Which of the following is the best next step in the diagnostic workup?

a. Viral hepatitis panel
b. Endoscopic retrograde cholangiopancreatogram (ERCP)
c. Abdominal ultrasonography
d. Liver biopsy


Question 7#Print Question

A 28-year-old man presents with fatigue and cognitive deterioration. He reports that in the last 2 months he has forgotten several of his friends’ names. His girlfriend states that he has been “impulsive” and has made several poor decisions such as urinating in public and cursing (which he has never done before). Physical examination reveals nonspecific abdominal pain to deep palpation in the right upper quadrant in addition to the finding seen in the photo below.

Which of the following laboratory findings do you expect with this condition?

a. Elevated ferritin
b. Decreased serum ceruloplasmin
c. Decreased urinary copper
d. Elevated serum copper


Question 8#Print Question

A 47-year-old woman presents to the physician with fatigue, pruritus, and jaundice. Physical examination demonstrates xanthelasma, hepatosplenomegaly, and jaundice. Laboratory findings reveal elevated alkaline phosphatase and total bilirubin in addition to the presence of anti-mitochondrial antibody (AMA) and antinuclear antibody (ANA). Liver biopsy demonstrates inflammation of the bile ducts with intraepithelial lymphocytes.

What is the most likely diagnosis? 

a. Autoimmune hepatitis
b. Primary sclerosing cholangitis
c. Primary biliary cirrhosis
d. α1-antitrypsin deficiency


Question 9#Print Question

A 33-year-old man presents with diarrhea for the last 6 weeks. He reports that his stools float and have an oily appearance. They have also been particularly foul smelling. He also endorses a nonspecific and diffuse abdominal pain as well as a 2.3-kg (5-lb) weight loss during this time period. Physical examination is unremarkable and laboratory results reveal a mild iron deficiency anemia. Antibody assays are positive for antiendomysial antibody.

Which of the following is the recommended treatment for this condition?

a. Treatment with corticosteroids
b. Treatment with metronidazole
c. Gluten-free diet
d. Treatment with loperamide


Question 10#Print Question

A 44-year-old man with a recent diagnosis of diabetes mellitus type 2 presents with joint pain, fatigue, and jaundice. He reports that his wife has noted that he looks “tanner” than usual. Physical examination demonstrates clubbing of the fingers, splenomegaly, and gynecomastia. Laboratory results reveal mildly increased AST and ALT, as well as an increased transferrin saturation (72%) and an increased ferritin level (410 ng/mL).

Which of the following is the recommended treatment for this condition?

a. N-acetylcysteine
b. Penicillamine
c. Ursodeoxycholic acid and fat-soluble vitamins
d. Periodic phlebotomies




Category: Q&A Medicine--->Gastroenterology
Page: 2 of 10