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Category: Q&A Medicine--->Gastroenterology
Page: 9

Question 41#Print Question

A 26-year-old man presents with new-onset confusion, tremor, and “clumsiness” for the last 3 to 4 weeks. He decided to come in after he could not remember the name of his long-term girlfriend. He has no significant past medical history and denies alcohol or illicit drug use. Physical examination shows stable vital signs and hepatomegaly. Laboratory studies reveal the following:

  • Total bilirubin   2.0 mg/dL
  • Direct bilirubin   1.2 mg/dL
  • Aspartate aminotransferase   281 U/L
  • Alanine aminotransferase   269 U/L
  • Alkaline phosphatase   110 U/L

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

a. Liver biopsy
b. α-1 antitrypsin levels
c. Lumbar puncture for cerebrospinal fluid (CSF) analysis
d. Serum ceruloplasmin levels


Question 42#Print Question

A 24-year-old woman presents with a history of diarrhea. She reports returning 2 months ago from a church-affiliated hiking trip. Since returning, she has developed diarrhea, abdominal pain, and increased flatulence. Of note, she just finished taking one of her friend’s ciprofloxacin for 7 days without any improvement.

Which of the following antibiotics should be prescribed to this patient?

a. Ampicillin
b. Metronidazole
c. Cefazolin
d. Extend the course of ciprofloxacin


Question 43#Print Question

A 51-year-old woman with a history of diabetes mellitus type 2 presents for her annual physical examination. The patient denies alcohol or drug use. Physical examination reveals an obese woman with hepatomegaly. Laboratory studies reveal the following:

  • Total bilirubin   1.1 mg/dL
  • Direct bilirubin   0.2 mg/dL
  • Aspartate aminotransferase   72 U/L
  • Alanine aminotransferase   61 U/L
  • Alkaline phosphatase   110 U/L
  • Smooth muscle antibody   Negative

A liver biopsy is performed and demonstrates macrovesicular steatosis and necrotic hepatocytes, in addition to centrilobular zone fatty accumulation.

Which of the following is the most likely diagnosis in this patient?

a. Nonalcoholic steatohepatitis
b. Autoimmune hepatitis
c. Alcoholic hepatitis
d. Cholelithiasis


Question 44#Print Question

A 21-year-old man presents with flatulence, abdominal pain, and diarrhea for the last 2 years. He has noticed that these symptoms occur after drinking milk or eating yogurt. The diarrhea is nonbloody, watery, and explosive. The patient denies fever, chills, or weight loss. Physical examination is unremarkable.

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

a. Acid steatocrit testing
b. Hydrogen breath test
c. Blood cultures
d. Intestinal biopsy


Question 45#Print Question

A 59-year-old man with a history of hypertension presents with a 2-month history of weight loss (9.1 kg (20 lb)), malaise, and “yellow skin.” The patient denies any abdominal pain. He drinks alcohol socially (three beers per week on average) and has never used illicit drugs. He has a temperature of 36.8°C, blood pressure of 124/90 mmHg, heart rate of 96 beats per minute, and a respiratory rate of 18 breaths per minute. Physical examination reveals jaundice, but no hepatomegaly or abdominal tenderness. Laboratory results reveal a severely elevated alkaline phosphatase (910 U/L) and negative anti-mitochondrial antibodies.

Which of the following is the most likely diagnosis in this patient?

a. Primary biliary cirrhosis
b. Biliary obstruction secondary to malignancy
c. Biliary obstruction secondary to gallstone
d. Chronic viral hepatitis infection




Category: Q&A Medicine--->Gastroenterology
Page: 9 of 10