Gastroenterology Comprehensive Quiz

A 45-year-old woman diagnosed with chronic idiopathic constipation fails to respond to increased dietary fiber and prune juice. It is decided to add another agent. Which of the following acts on the intestinal chloride channels to relieve constipation?

Which one of the following features on clinical examination would suggest a kidney rather than a spleen as the cause of a palpable left upper quadrant mass?

A 45-year old woman presents with 6 months of epigastric pain that is worse between meals and darkening of her stool. She also reports symptoms of heartburn. The pain is typically relieved by over the counter antacids. On physical exam she has diffuse tenderness in the epigastric region. Her stools are positive for heme. Esophagogastroduodenoscopy demonstrates a 2cm duodenal ulcer that is positive for H. pylori. Which of the following is the recommended intial therapy given these findings?

The urea breath test is useful in the diagnosis of which one of the following conditions?

A 72-year-old male has been experiencing epigastric abdominal discomfort that worsens after eating, progressive weight loss, and greasy stools over the past 3 months. Physical exam is unremarkable. Labs reveal normocytic anemia with hemoglobin of 10.5 g/dL, normal kidney function, and normal liver tests. Amylase and lipase are normal. CT scan of the abdomen reveals mass-like lesions in the head of the pancreas with indistinct boundaries and no vascular invasion, a diffusely abnormal (“sausage-shaped”) pancreas with delayed enhancement, and a beaded irregular pancreatic duct. The common bile duct looks normal. No hepatic masses are noted. Serum IgG4 is elevated and serum CA19-9 levels are normal. EUS ( Endoscopic ultrasound )of the pancreatic mass is negative for malignancy.

Which is not a Vitamin K dependent clotting factor produced by the liver?

Malabsorption due to mucosal intestinal defects is seen in:

The major enzyme responsible for protein digestion in the small bowel is:

The three major anatomical constrictions within the adult esophagus include all of the following except:

A 29-year-old male presented with complaints of prolonged diarrhoea with abdominal pain, weight loss and generalised fatiguability. On physical examination he was found to have a low-grade fever, diffuse abdominal tenderness, and a palpable mass in the right lower quadrant. Perineal examination revealed presence of skin tags around the anus. Oral examination revealed presence of aphthous ulcers. Biopsy findings included transmural inflammation and presence of non-caseating granulomas. ASCA (anti-saccaromyces cerevisiae antibodies) was positive. What is the most likely diagnosis?

The following are features typical of ulcerative colitis except:

A 55-year old male has been experiencing heartburn, regurgitation, dysphasia and hoarseness of voice. Esophagogastroduodenoscopy showed esophagitis. Which of the following is not a risk factor associated with the disease?

A 52-year-old female with a history of hepatitis C-related cirrhosis decompensated by ascites presents with progressive weight gain, leg swelling, and exertional dyspnea over the past 2 months. She is compliant with salt restriction and is on furosemide 80 mg daily and spirinolactone 200 mg daily. Physical exam reveals an elevated jugular venous pulse, holosystolic murmur along the left sternal border (which increases with inspiration), tense ascites, and leg edema. What might be a reason for the change in clinical symptoms?

All of the following are indications for urgent endoscopy for upper gastrointestinal bleed EXCEPT:

A 36-year-old woman with AIDS and a CD4 of 34/uL presents with odynopahia, progressive dysphagia, and daily fevers with an unintentional weight loss of 10 kg. She has been treated with clotrimazole lozenges without relief. On exam she has a BMI of 16 and a weight of 46 kg. Her temperature is 38.2 C. There is no thrush on oral examination. She undergoes an esophagogastroduodenoscopy (EGD) which reveals serpiginous ulcers in the distal esophagus without vesicles. There are no yellow plaques. Biopsies of the lesions show intranuclear and intracytoplasmic inclusions in large endothelial cells and fibroblasts. What is the best treatment for this patient’s esophagitis?

In achalasia, the most effective long term therapy is:

A 60-year-old female patient presented to the clinic with insidious onset of rectal bleeding and frequent stools with mucoid discharge. Physical exam revealed mild abdominal tenderness in the lower left quadrant. On serological testing pANCA (perinuclear antineutrophil cytoplasmic antibodies) was found to be positive. Histologically, the inflammation was found to be limited to the mucosa and submucosa, with continuous inflammation extending proximally from the rectum seen on colonoscopy. What is the most likely diagnosis?

Laxatives are used in management of constipation. Which of the following laxatives is incorrectly matched with its class?

A 56-year-old physician attends your office the day after an upper endoscopy was performed for dyspeptic symptoms. He has already read the report, which mentions diffusely thickened gastric folds. He is very worried and asks about the potential differential diagnosis. Which of the following is not a differential diagnosis for thickened gastric folds?

The advantage of endoscopy over barium radiography in the evaluation of dysphagia include all of the following EXCEPT:

Which of the following is the most common cause of lower GI bleed under age of 50?

A 15-year-old who had been suffering from epigastric pain was referred to the gastroenterologist. Carbon 13 urea breath test was found to be positive. Biopsy specimens from esophagogastroduodenoscopy, stained with Giemsa demonstrated microorganisms adhering to the gastric epithelium, a decreased mucus film and a large inflammatory infiltrate. What are the characteristics of the likely causative organism?

Which of the following tests is most useful in the assessment of pancreatic exocrine function?

Which of the following statments regarding the treatment of gastroesophageal reflux disease (GERD) is TRUE?

The enzyme amylase is principally responsible for the breakdown of which one of the following?