GI Summer Review -Answers- Bosch (2013)

8/11/2019 GI Summer Review -Answers- Bosch (2013)

1/16


2/16

2013

Gl

Summer

Review;

Barbara

D

Bosch.

M D page 2

A

34 year-old

man comes

to

the emergency

department

complaining

of the

sudden onset of

vomiting

an d epigastric

abdominal

pain

radiating

to

the

back.

On

physical

examination,

the patient is

afebrile

and has abdominal

tenderness;

decreased bowel sounds are

noted,

as is

diffuse bruising that

he

describes as

having appeared suddenly. He

also reports continuous

epistaxis.

Laboratory tests

show

a slightly

elevated

WBC

count,

thrombocytopenia,

increased

amylase an d

lipase activity,

increased

prothrombin time

(PT)

an d

partial

thromboplastin

time (PTT), and the presence

of fibrin split products.

An

abdominal

ultrasound

performed

at

the

bedside

shows a

dilated common bile

duc t. Wh ich

of the

following

is the

most likely etiology of

this

patient's

abnormal

coagulation

profile?

A. abdominal aortic

aneurysm

meag+ \

,

20?

acute pancreatitis

Vv

*

y*

*

C.

appendicitis

FK?*>

.

V

?

\

'

,*

D. gastric

ulcer

\

2

'*>

.*,

W

E.

gram-negative sepsis

boA

Jf?

In the

H&E-stained

photomicrograph, the

arrow points

to which o f the

following specific

structures?

central

(hepatic)

vein

hepatic artery

5?

portal

vein

D.

sinusoid

E.

space of Disse

On

the

da y

of the

BaL*aaBrcafcQn-in

pathology,

a 26 year-old medical student notices that he r

sclerae have a

sfightyellowish

color.

She ha s never

ha d

a major illness. On physical exam,

there

are

no

significant

findings other than the

mild scleral icterus.

Laboratory studies

revea l a total bilirubin

of

4.9 mg/dL

(normal

0.1-1.0

mg/dL)

with a

direct

bilirubin of 0.8

mg/dL (normal

0.0-0.3

mg/dL). The

scleral icterus resolves within

2

days. Which

of

the following conditions

is

most

likely

to produce

these

findings?

IV

/

A.

acute

hepatitis

A

virus

infection

y

\

B.

Dubin-Johnson

syndrome

hST

& n

tQ)

Gilbert

syndrome

T*

D.

ingestion of acetaminophen

-

o>

A

60

year-old

woman presents to

the

physician

with

painlesy?eddish-brown

blood

in

heTstooT)

Initial

laboratory

tests show

the

following

results:

hematocrit:

33%

(normal

36-46%)

hemoglobin:

11

g/d

L

(normal

12-16

g/dL)

mean corpuscular volume: 73

pm 3

(normal

80-100

pm3)

white blood

cell count:

8,000/mm3

(normal

4,500-1

1

,000/mm3)

platelet

count:

200,

000/mm3

(normal

150,

000-400,

000/mm3)

Which of

the following

is

the

most

important next

step

in

the

management

of

this

patient?

A.

abdominal plain

films

colonoscopy

C.

CT scan of

the abdomen

D.

esophagoduodenoscopy

E.

pelvic

ultrasound

A patient

presents to

the

emergency

room

withTpper

Gl

bleeding

Administration

of

an agonist/

analog

of

which of the

following agents

would inhibit

gastric,

ar.id

spr.rpfinn?

*

/K.

acetylcholine

gastrin

-6T

histamine

pepsin

somatostatin

i


3/16

2013

Gl

Summer

Review;

Barbara

D.

Bosch, M.D.

page

3

A2year-olchild

presents

with_a

history

ofeonataT

)7nchT

UJ1CV

_

_

_

_ _

as

well

as

aQhronic

cougand

SluincgFironirdiafrhea

frjthliqhlcolored

Joul-smelling

stools.

A

deTiciency

of

which

of

the

following

vitamins could

develop?

A. ascorbic

acid

B. folate

C.

niacin

retinolCvi*

Ay

E.

riboflavin

F.

thiamine

d\

~

C-Vk-oAWLXj*

You recommend a

colonoscopy to

a

50

year-old

patient.

He agrees, bu t

wants

you

to

describe

the

procedure

an d

potential

risks and

complications.

You

explain

that the goal of

the

procedure

is to

look

at

the

entire length

of the

large

intestine with

a

flexible

fiberoptic colonoscope

and

to biopsy

any

observable lesions.

You tell him that

there

is

a small risk of perforating the

bowel,

especially

when

the

colon takes a sudden turn or

twists

on itself

at

regions

where

it

is

intraperitoneal

rather

than attached

to the

posterior

abdominal

wall

(retroperitoneal). With your

knowledge

of

anatomy,

which

of

the

following regions

of the large

intestine pose

the

greatest

risk for

perforation

to

the

gastroenterologist?

A . a sc en din g

colon,

transverse colon and descending colon

B.

descending

colon,

sigmoid

colon an d

rectum

yC>

hepatic

flexure,

splenic

flexure

and

sigmoid

colon

D.

hepatic

flexure,

transverse colon and

splenic

flexure

E. splenic

flexure,

descending

colon

an d sigmoid

colon

A

hepatitis panel

is

ordered

for a

27

year-old

woman as

part

of a routine workup for

abdominal

pain.

Results

of serologic testing

are negative

for HBeAg

an d

HBsAg,

bu t

positive

for

HBsAb and

IgG

HBcAb.

Which

of the following is the

appropriate

conclusion?

The

patient

has been

exposed

to

hepatitis

B

and has

completely

recovered.

B.

The

patient

has

been

exposed

to

hepatitis

B

an d is

in

the acute disease

phase.

C.

The

patient

has been

exposed

to

hepatitis

B

an d

is in

the window

phase.

D.

The

patient

ha s

been

exposed

to

hepatitis B

bu t was not

infected.

E.

Th e

patient

has been

exposed

to

hepatitis

B

and is now chronically

infected.

F.

The

patient

ha s been successfully vaccinated for

hepatitis

B.

An

overweight, 46 year-old

man has complained

of heartburn

for the

past

is

pr

ears.

A photomicrograph from

a

biopsy

of

his lower esophagus

vided. Which of

the

following

is

the most likely diagnosis?

f

Barrett

esophagus

Candida esophagitis

C.

herpes

esophagitis

D.

Plummer-Vinson syndrome

E.

viral

esophagitis

A

67 year-old woman

has

experienced

severe

nausea,

vomiting,

early

satiety,

and

a

9-kg weight

loss over the

past

4

months.

On

physical

examination,

she ha s mild muscle wasting.

Upper gastrointestinal

endoscopy shows

that

the

entire gastric

mucosa is eroded

and erythematous.

Upper

gastrointestinal

imaging

studies reveal that the

stomach is

small

and shrunken.

Which

of

the following

is most

likely

to

tie

founon

histologic

examination of a gastric biopsy

specimen?

jlffi

chronic

atrophic

gastritis

B.

granulomatous

inflammation

t

Q

C.

intestinal-type

adenocarcinoma

.

parietal

cell hyperplasia

T

V\r~*

0

signet-ring cell

adenocarcinoma,


4/16

2013

Gl

Summer

Review;

Barbara

D.

Bosch,

M.D.

page

4

Which

one o f

the

following is

most likely to be

present

within

the

smooth

endoplasmic reticulum

of

hepatocytes?

v

--

.

albumin

cholesterol

_

C. fibrinogen

D.

glycogen

* ~'a

E.

hydrogen peroxide

-

lpcowitPWck

t-Jr v\

hemolytic

anemia

I

~

pancreatic

carcinoma

lv

I


5/16

2013

Gl

Summer Review; Barbara

D.

Bosch,

M.D.

page 5

In

the

accompanying photomicrograph

of an H&E-stained

tissue

section,

the

structures

indicated

by

arrows are which

of

the

following?

A.

clusters

of hepatocytes

B.

intralobular ducts

C

islets

of Langerhans

D.

parasympathetic

ganglia

E.

serous acini

A

19 year-old woman is

bothered

by


6/16

2013 Gl Summer

Review;

Barbara D.

Bosch,

M.D. page

6

A

45

year-old

woman

presents

with intermittent

episodes

of

epigastric

pain

an d

is found to have

gallstones

on ultrasound. However,

she

is no t

jaundiced. During

exploratory surgery, one stone

is

found to be

obstructing

a

duct.

In

view of her

symptoms,

where is the most

probable

location of the

obstruction?

A. ampulla

of

\Zater~~p >

0

C.

common

heoatic duct

.

common

hepatic

duct

D.

cystic duct

-t>duct

of

Santorini

--

x-rn

Over the

past 3

months, a

41 year-old man ha s

noticed that h is

skin

has

become progressively

more

ye llo w. O n physical exam,

he

is afebrile

but has scleral icterus and

generalized

jaundice.

Laboratory

studies show

a

total

serum

bilirubin

of 8.9 mg/dL

(normal

0.1-1.0

mg/dL)

with

a

direct bilirubin of 6.8

mg/dL

(normal

0.0-0.3

mg/dL).

Serum

ALT

and AST levels

are

normal.

A l iver biopsy

shows

histologic features

of sclerosing cholangitis.

Which

of

the following

diseases

is

most

likely

to coexist

with the liver

disease?

A. celiac

sprue

B.

chronic pancreatitis

C.

Crohn

disease

D.

diverticulosis

ulcerative colitis

A

22

year-old

woman

ha s

ha d several

episodes of aspiration

of food

associated with

difficulty

swallowing

during the

past

year. A barium swallow shows markeoreiobhaaeal

dilation

abovS

the

leybl

of

thedower

esophageal

sphincteft

A

biopsy specimen

from the lower esophagus shows an

sence

of

the

mventprir.

gangTlgfTATHat

js

the

most

likely diagnosis?

achalasia

B.

Barrett

esophagus

C.

Boerhaave

syndrome

D.

Plummer-Vinson

syndrome

E.

Schatzki

ring

A

55

year-old

man presents

with general ized back

pain. X-ray

examination

o f the

spine reveals two wedged thoracic vertebrae,

T7

and T8.

He

is found to

be anemic

with a

normal

peripheral

blood smear. However,

examination of

his bone marrow

shows

an

increased

number of

the

type

of

cells indicated

by

arrows

in

this

photomicrograph of

the

small intestine.

These cells

synthesize

which

of the

following?

collagen

B.

heparin

and histamine

C. his taminase

(> IgA

E.

myeloperoxidase

A 3 week-old bo y

presents

to

his pediatrician because

his

mother has noticed

that

he

looks yellow .

On

questioning, she elaborates that

the

jaundice

began several days

after

birth and has been

associated with

dark

urine and

acholic stools. Laboratory studies

show

a

direct

bilirubin

leve l o f 5 .0

mg/dL

(normal

0.0-0.3 mg/dL) and

a

total bilirubin

level of 5.5 mg/dL

(normal

0.1-1.0

mg/dL).

Which

of

the

following

is the most likely diagnosis?

\oMt\ihK\

jQ/


7/16

2013

Gl Summer

Review; Barbara D.

Bosch,

M.D.

page

7

A 25

year-old

man with

acquired

immunodeficiency disease (AIDS)

has

malabsorption,

chronic

abdominal

pain,

low-grade

fever,

and

nonbloody diarrhea.

In

fecal

smears,

large

numbers

of oocysts

containing

four

sporozoites

are

observed.

Which

of the following

organisms

is

the

most

likely

etiologic

agent?

Cryptosporidium

parrum

/ B.

Entamoeba histolytica

j

C. Giardia lamblia

\J

D.

Taenia

solium

E.

Toxoplasma

gondii

A

30

year-old

woman sees he r physician

because she

has had

diarrhea

an d

fatigue,

as

well

as a 3-kg

weight

loss over

the

past

6 months.

On

physical

examination,

sh e

is afebrile

and has

mild muscle

wasting,

but

her

motor

strength

is normal. Laboratory studies show no occult

blood,

ova

or

parasites

in the

stool.

A biopsy

specimen

from

the upper jejunum

is

obtained. The

patient

is

placed

on a

special

diet with

no wheat

or

rye

grain

products.

This

dietary

change produces

dramatic

improvement.

Which of

the following

microscopic

features was most likely seen on

the

biopsy

specimen?

A.

crypt

abscesses

/

B. foamy macrophages within the lamina

propria

I

/

C. lymphatic

obstruction

\y

D.

non-necrotizing

granulomas

villous

blunting

an d flattening

A

26

year-old

man

has

recently aten

raw

oystersjon

three

occasions1

The

patient

ha s

always

been

healthy,

but now

has the

sudden onset of

fatigue,

loss of

appetite,

nausea,

vomiting,

abdominal

pain,

and fever. Which o f the following viral

pathogens

is

most likely

responsible

for

this

clinical

Presen,aj9~s

/ff

hepatitis B

virus

rotavirus

A

63

year-old man

who

had worsening congestive

heart

failure with

cardiac

dysrhythmias in

the last

year of

his

life

died

of

pneumonia.

At

autopsy,

his

pancreas

is small an d hard.

Microscopic

examination shows

extensive

atrophy

of the

acini with abundant

collagenous interstitial

fibrosis,

but

the

islets

of Langerhans

appear

normal.

Inspissated

proteinaceous

secretions

are

present

in

branches

of the

pancreatic

duct.

The

heart

weighs

500

g

(normal

300-350 g),

and

al l four chambers

are dila ted. What

condition is

most

likely to

account for

these

findings?

blunt trauma to the abdomen

B.

cholelithiasis

t

chronic alcoholism

diabetes melli tus

E. hypercholesterolemia

A 42

year-old

woman

has to

undergo(emergency

choiecystecto

fo

du e

to

intense

surgery is indie

wing

arrows?

$

\

.

3

/L

T 4

5

'he

structure to

be

removed during

Accompanying radiograph

by

which of the


8/16

2013

Gl

Summer

Review;

Barbara D

Bosch,

M .D. page

8

A

full-term

neonate

presents to the

pediatrician

with failure

to

pass

meconium.

Digital examination

of

the rectum

results

in

a gush

of retained fecal material.

Which of

the

following is the most

likely

diagnosis

in

this infant?

carcinoma of the colon

Chagas

disease

Hirschprung

disease

imperforate

anus

necrotizing

enterocolitis

of

Plasma

The figure to the

right sh ows a

gastric

parietal

cell with

selected

membrane transporters and

channels.

What

do

X,

Y and Z

represent?

Y Z

IT K+

K* IT

CI'

hco3-

Na+

IT

IT K+

Prlliptrjt

lll

HCO-s

atr

Lume

C. H

D. K+

E. Na+

The

symptoms

of

thiamine

deficiency

were

first

described

over 4000

years ago. In adults,

these

symptoms

commonly

include

polyneuropathy

of the

distal extremities,

resulting

in

paresthesias and

motor dysfunction.

In

addition

to neuropathy,

how

else can

isolated

thiamine

deficiency

present

in

adults?

A.

chronic infections

.

.

diarrhea,

dermatitis

an d dementia

C.

Tjerirritability,

seizures and

jaundice

peripheral

edema an d congestive

heart

failure

E.

renal

failure

An obese

43

year-old white woman

presents to

the

emergency

department

with

right upper

quadrant

pain,

fever and jaundice.

Abdominal

examination

reveals

right

upper

quadrant

tenderness

without

peritoneal signs.

Endoscopic

retrograde

cholangiopancreatography shows several stones

in the

common

bile duct. Laboratory testing reveals a

WBC

count of

14,200/mm3

(normal

4,500-

11

,000/mm3),

with

74% segmented

neutrophils,

and a serum amylase level

of 78 U/L

(normal

25-125

U/L).

Which

of

the

following is the most likely

diagnosis for

this patient?

A.

acute

appendicitis

acute

pancreatitis

acute

viral

hepatitis

bacterial

cholangitis

cholesterolosis

.

Recanalization

of

the bile duct

after

the 13th week

of

development

allows

for

bile

produced

in

the liver

to

reach the

duodenum.

However*juM

C.

midgut

D. yfJIeuroperitoneal

membrane

/septum

transversum

5>

I


9/16

2013 Gl Summer

Review;

Barbara D.

Bosch, M.D.

page 9

A 36

year-old

woman is

in

the sixth month

of

he r

pregnancy,

but she

is

unsure

of

her

dates

because

she

was taking

oral

contraceptives

at

the

time sh e became

pregnant.

She

experiences

the

sudden

onset of severe

abdominal

pain.

On

physical

exam,

she is afebrile

an d

normotensive.

There is right

upper

quadrant

tenderness on

palpation.

An ult rasound scan of

the abdomen shows

a

well-

circumscribed,

7-cm

subcapsular

hepatic

mass. Paracentesis

yields

bloody fluid. At

surgery,

the

mass

in

the

liver,

which has

ruptured

through

the

capsule,

is

removed. The

remaining

liver

appears

unremarkable.

Which

of

the following is

the

most

likely diagnosis?

cholangiocarcinoma*

3

fibrolamellar

hepatocellular

carcinoma

epatic

adenoma

osa

hepatocellular

carcinoma

metastatic

carcinoma

testae.,

\

VvesfcH

I

C\r

A

32

year-old

man

presents

with diarrhea

and

symptoms

of

peptic

ulcer disease. Endoscopy reveals

two

ulcers,

one

in

the first

portion

of the duodenum and one in

the

mid-duodenum.

However,

they

do

not

respond

to the usual

peptic

ulcer

treatment programs.

The

most likely

explanation

for

the findings

in

this

patient

is which of

the following?

-autoantibodies

to

intrinsic

factor

ectopic

hypersecretion

of gastrin

gastric mucosal

atroohv

_

c.il

Menetrier disease

pressure

ulceration from

y.

vascular

abnormality

A pathologist views the tissues

in

the

accompanying photomicrographs

in

a

biopsy

specimen.

She determines that

the tissues are

normal. The

presence

of

both of these

tissues indicates

that

the

sample

was

taken from

the

region

of the

junction between

which of the

following?

Ar mouth

and

esophagus

/

esophagus

and

stomach

itomach

and duodenum

Ileum

an d colon

rectum an d anus

A

Syarlold

manjresents

to the

clinic with

ffieral

icterusipatosplenomegaly$|scites>and

a

history

of

episodes

of

feundice

over'the oast

th'fgg vear&7

He

was involved

in

an

auto

accident

when

A

LTrVteT

he

was

21,

fo r which he

req

u

i

re


10/16


11/16

2013

Gl

Summer

Review;

Barbara

D.

Bosch, M.D. page 11

A 56

year-old man

who is a health care

worker

presents

to his

physician

with

vague

abdominal

discomfort.

A

physical

examination reveals a tender

liver,

palpable

to

6

cm

below

the

costal

margin,

and

scleral icterus. His laboratory

studies are significant

for

an

aspartate

aminotransferase (AST)

level

of

20 0 U/L

(normal

8-20

U/L),

an

alanine

aminotransferase

(ALT)

level

of

450 U/L

(normal

8-20

U/L),

an d an alkaline

phosphatase

level of 24 5

U/L

(normal

20-70

U/L).

A

CT scan

of the abdomen

shows a dominant solid

nodule

in

the liver. The tumor

marker

mjst

likely to be

elevated

in

this patient

is

also

agobd

indicator

of

which

of the

following malignancies?

Sh.

choriocarcinoma

.

//

colorectal carcinoma

clSK

SCuroZstoma

QtU,

prostatic

carcinoma

-V-n

n

.

Vo,k

sac

tUmor

yf

A

28 year-old

recently

divorced man with

no significant

past

medical history

presents

with progressive

lower

abdominal

pain

and cramping over

the

past

4

days,

which are

relieved

by

defecation.

He

has

uVir

suffered

from

substantigkgTooand

mucoid

diarrhea\jiring

th'g

time.

His

temperature

is

Lab

studies

reveal

arylevited

WBC

courSt

and'tgiTerythrocyte

sedimentation

Sigmoidoscopy

reveaWextensrveTectaTand sigmoid hyperemia

aTid

edema,

numerous

superficial

ulcerations,

an d

small focal mucosal

hemorrhages, many

of which have

suppurative

centers. These

B.

Crohn disease

C.

cytomegalovirus

enterocolitis

hP&

9*0

A

pseudomembranous

colitis

-erative

colitis

A

30

year-old

man seeks

help

because

heJ]tesLiLrfeels(full

afterating55lcsmal>


12/16

2013 Gl Summer Review;

Barbara

D.

Bosch.

M.D.

page

12

A 39 year-old woman

presents

with

dyspnea,

fatigue,

pallor,

and

tachy

cardia.

Laboratory results reveal

a

hematocrit of

32 %

(normal

36-44%),

a red cell mean

corpuscular

volume of

102

fL (normal

78-98

fL),

and a

vitamin

B12

level of

95

pg/mL (normal

200-900

pg/mL) due to impaired

absorption.

Autoantibodies are

detected

to a cell

type

which

produces

intrinsic

factor.

Referring

to the

accompanying

diagram,

in

which

region

woulft

those

cells be

found?

V

A 44 year-old

woman

has noticed

increasingly

severe

fatigue

an d generalized

pruritus

for

the past

8

months. Serum levels

of

alkaline

phosphatase

and cholesterol are elevated;

antimitochondrial

antibody titer

is

elevated, bu t

ANAs are

no t present.

The

serum

total

bilirubin

concentration

is

slightly

elevated.

A

l iver biopsy

is

performed

revealing granulomatous

destruction of

small

intrahepatic

bile

ducts.

Which

of

the

following

conditions

is most

likely?

_

A.

autoimmune

hepatitis

B.

choledocholithiasis

'n.rve'W.r.oA

ft*

C.

hepatitis B

primary biliary

cirrhosis

E. primary sclerosing

cholangitis

F.

Wilson

disease

w

VA

A

66

year-old

man

presents with

a 3-month

history of intermittent

dysphagia

that ha s

now

become

constant

an d

is

accompanied

by

pain and

weight

loss.

X-rays

of

the

esophagus

with barium

swallow

show

structural and

filling defects,

and reduced

peristalsis.

A

biopsy is

taken, f rom which

a

representative

photomicrograph

is

provided.

The

best

diagnosis

is which of the

following?

fd'

adenocarcinomaCTT0*9

-

BrBarrett

esophagus

~

Candida

esophagitis

fibrous

stricture


13/16

2013

Gl

Summer

Review;

Barbara

D.

Bosch,

M.D. page

13

inaseVsefes

-

**#*&*

>,&

1>.

.

J

.

v Iv

r- '

r

-

C-Jysozyme

mucus

an d

HCOV

pepsinogen

A

52

year-old

woman is

referred to

a

gastroenterologist

for

persistent

abdominal

is

performed.

of normal

tissue

structures

A.

B.

enterokina;

An 1

8

year-old

woman

presents

with

a

one-week history

of

fever

an d

malaise>She

has

mild

jaundice

and a

(ffightly

Hemoglobin

is

13.8 g/dL

(normaM3M(fg/dL);

WBC count is

13,000/mm

(normal

4,500-1

1,000/mm3).

SeruiTLJubinJs

mg/dL

(normal

0.1-1.0

mg/dl_)

an d is 95% unconjugated

bilirubinLiver

enzyme

tests

arenona

Which

of

the following

is

the most likely cause

of this

patient's

signs

an d

symptoms?

jC

alcohol

abuse

c\

decreased

glucuronyl

transferase

hemolysis


14/16

2013 Gl Summer

Review;

Barbara

D

Bosch,

M.D page 14

Jaundice caused

by common

bile

duct obstruction is usually

characterized

by

which o f the

following

laboratory

findings?

Urine Urine

Bilirubin Urobilinogen

A.

t

B. T

-gP

T

D.

Normal

E.

Normal

F.

Normal

T

Normal

1

t

Normal

i

A

13

month-old child is brought to

the emergency department

after

his

parents

found blood

in his

stool.

They

state

that

he did

no t

appear

distressed

at the time,

although

he

now displays

some

tenderness

to

abdominal

pressure.

Other

than

this

tenderness,

there

are

no significant findings

on

physical

examination. After performing

radionuclide imaging using

mTc

pertechnetate,

the

doctor

makes a d iagnos is and

recommends

surgery

to correct the problem. What

is

the probable source of

this child's

condition?

A.

blockage of the intestine

du e

to folding

of the

distal ileum into the

proximal

colon

B. breakdown of

the gastric

mucosal

barrier with

erosion

of

the

underlying

mucosa

damage

to the

intestinal

epithelium

due to ingestion of

coins

ectopic

gastric

epithelium

in a

persistent omphalomesenteric

duct

E.

incomplete bowel

rotation

resulting

in obstruction of

the

superior

mesenteric artery

A 2

year-old girl

with

a

lifelong

history of malabsorptive

an d

foul-

smell ing diarrhea,

weakness an d

general

failure

to thrive

has

just

undergone

a sma ll

intestine biopsy

(see

accompanying

photomicro

graph).

Her

parents

believe

her problems began

at 6 months of

age,

when

she

started

eating

solid

foods, but have significantly

worsened

over

the

past few

months.

The only recent

change in her

diet

is

that she

eats a

bowl o f cereal

every

morning

with

her parents

before

they

go

to work.

Sh e

tried a dairy-free

diet

a

month

ago,

bu t

it did not improve

her

symptoms.

Which

of

the

following

js

the

likely

diagnosis?

/yA.

abetalipoproteinemia

/

>.

celiac

disease

cystic fibrosis

pQ-

lactase

deficiency

viral

enteritis

F/Vhipple

disease

1

'mmm

'

'MS

s :v


15/16

2013

Gl Summer

Review;

Barbara D. Bosch,

M.D.

page

15

A

healthy volunteer received a

continuous

infusion

of physiological

gastrin

concentrations before an d after treatment

with

peptide X.

The

production

of

gastric

acid an d

pancreatic

bicarbonate

secretion

was

monitored before an d after administration of

peptide

X

(at

arrow).

Peptide X

is

most likely to

have been which

of

the

following

hormones?

angiotensin

II

cholecystokinin

motilin

secretin

somatostatin

Last':

=sf;i

Js i

FfcMhc

HCDj

B.

C.

E.

aarc*Mlc

HZO

unrc

H

I r~

i

l

Qutotfl :


16/16

2013 Gl Summer

Review;

Barbara

D.

Bosch,

M.D.

page

16

A 23

year-old

man

has been

complaining

of

intermittent

diarrhea,

fever and

abdominal pain for

several

months. A radiograph

of

the

small

bowel

reveals

several

separatg_areas

of

luminal

narrowing.

A

photomicrograph

of this

patienVCiieal

bfopsy

is shown.

What

is

the

most

likely

diagnosis?

-r

abetalipoproteinemia

tvlvAvH

carcinoid

tumor

A.

B.

E.

F.

celiac disease

Crohn

disease

ulcerative

colitis

Whipple

disease

,r>;

/'

l

r

.

Date post:	02-Jun-2018
Category:	Documents
Upload:	jessica-moore
View:	218 times
Download:	0 times

GI Summer Review -Answers- Bosch (2013)

Documents