An 11-year-old boy is brought to the emergency department by his parents because of episodic abdominal pain and stools with blood and mucus. During each episode, the patient pulls both knees to his chest. Physical examination reveals a finding shown in the image. Endoscopy reveals multiple hamartomatous polyps in the small intestine.
Which of the following is the most likely diagnosis? (no answer choices)
Peutz-Jeghers syndrome
The other choices are incorrect:
A 34-year-old man presents to his primary care physician for his yearly physical examination. He recently began experiencing a burning sensation below his sternum and a sour taste in his mouth. Treatment is initiated with as-needed famotidine for symptom relief.
Which of the following best describes the mechanism of action of the drug prescribed for this patient?
A. Bind to and inhibit the H+/K+-ATPase of parietal cells
B. Binds to M3-receptors
C. Binds to and activates prostaglandin receptors
D. Binds to and inhibits histamine receptors
E. Somatostatin analog that binds to receptors
D. Binds to and inhibits histamine receptors
The other choices are incorrect:
A 40-year-old male presents to the office because of burning retrosternal chest pain after meals. The pain improves with antacids. He denies nausea, vomiting, palpitations, and syncope. The physical examination shows an obese male with normal vital signs and a normal physical examination. The ECG is normal. Upper endoscopy reveals proximal dislocation of the gastroesophageal junction 3 cm above the diaphragmatic indentation of the esophagus and erosive changes in the lower esophagus.
This patient is at most increased risk of developing which of the following conditions?
A. Achalasia
B. Esophageal adenocarcinoma
C. Gastric adenocarcinoma
D. Metaplastic atrophic gastritis
E. Mucosa-associated lymphoid tissue lymphoma
F. Squamous cell carcinoma of the esophagus
B. Esophageal adenocarcinoma
The other choices are incorrect because they are not consequences of GERD:
A research study used healthy volunteers to determine baseline concentrations of electrolytes in gastrointestinal secretions. Subjects consumed a bolus of food, and investigators measured flow rate, electrolyte concentrations, and pH at multiple sites along the gastrointestinal tract. The data obtained from one collection site were used to construct the figure shown.
Which of the following organs is most likely responsible for the changes recorded on the graph?
A. Duodenum
B. Gallbladder
C. Pancreas
D. Salivary Glands
E. Stomach
C. Pancreas
The other choices are incorrect:
What is my favorite animal?
Dogs (duh)
A 24-hour-old boy is brought to the pediatrician because of poor appetite and constipation since birth. On physical examination, the abdomen is distended but nontender, and bowel sounds are normoactive. Barium enema shows a narrow rectosigmoid colon with dilation of the proximal segment.
What condition is associated with this patient's disease? (no answer choices)
Down syndrome
The other choices are incorrect:
A 29-year-old woman presents with difficulty swallowing solids and liquids for the past 9 months. A barium swallow study shows dilation and tapering of the esophagus and concentric distal stenosis.
The best drug for treating this patient’s condition has which of the following mechanisms of action?
A. Blocking the action of histamine at H2 receptors on parietal cells
B. Blocking the synthesis of pyrimidines (eg, thymidine)
C. Decreasing calcium availability in smooth muscle cells
D. Decreasing proton secretion into the stomach lumen
E. Enhancing the phosphorylation of myosin light chains
C. Decreasing calcium availability in smooth muscle cells
The other choices are incorrect.
Some of the choices are drugs used to treat gastroesophageal reflux disease:
The other choices are implicated in other disorders:
A 27-year-old woman with a history of diarrhea and gastrointestinal bleeding undergoes a colonoscopy. Results reveal hundreds of adenomatous polyps located diffusely throughout her colon. Her family history is significant for colon cancer in her father and paternal grandmother.
Which of the following patterns of genetic mutation is characteristic of the most likely diagnosis in this patient?
A. Autosomal dominant
B. Autosomal recessive
C. Germline mutation
D. Somatic mutation
E. X-linked recessive
A. Autosomal dominant
The other choices are incorrect:
A 25-year-old female comes to her primary care physician after learning about an extensive history of colon cancer in her family. Her mother and maternal uncle were diagnosed with colon cancer before the age of 50. The woman’s sister had endometrial cancer and a tumor of the small intestine. The physical examination is normal. A colonoscopy shows flat polyps in her cecum. One year later, a repeat colonoscopy shows malignant transformation of some polyps. Molecular testing shows a mutation in a DNA mismatch repair gene.
Which of the following is the most likely diagnosis?
A. Familial adenomatous polyposis
B. Gardner syndrome
C. Hereditary nonpolyposis colorectal cancer
D. Peutz-Jeghers syndrome
E. Turcot sydrome
C. Hereditary nonpolyposis colorectal cancer (lynch syndrome)
The other choices are incorrect. The following choices are not associated with a DNA mismatch repair gene mutation:
What is my favorite color?
Black/gray
A 1-year-old boy is brought to the office because of irritability for the past 3 days. He has episodes of inconsolable crying with vomiting and has passed only one stool in the past 2 days, which contained blood and mucus. He has no past medical history and has achieved all age-appropriate milestones. Temperature is 38.9°C (102.1°F), pulse is 150/min, and respirations are 44/min. On physical examination, the abdomen is distended, and the patient cries with palpation. An x-ray of the abdomen reveals dilated loops of small bowel.
Which of the following is this patient’s most likely diagnosis?
A. Appendicitis
B. Duodenal atresia
C. Hirschsprung Disease
D. Intussusception
E. Pyloric Stenosis
D. Intussusception
The other choices are incorrect:
A 57-year-old man comes to the physician because of a 2-week history of decreased libido. He was recently started on a medication for gastroesophageal reflux disease. He reports that he has been taking higher than the prescribed doses of this medication for persistent symptoms of heartburn.
The drug most likely prescribed for this patient’s reflux also puts him at increased risk for which of the following additional adverse effects?
A. Constipation
B. Gynecomastia
C. Interstitial Nephritis
D. Involuntary Movements of the Lips and Tongue
E. QT Prolongation
B. Gynecomastia
The other options are incorrect:
A 56-year-old man presents to his physician with vague abdominal discomfort and fatigue. He has a history of hepatitis C. Physical examination reveals a tender liver, palpable to 6 cm below the costal margin, and scleral icterus. CT scan of the abdomen is shown. Laboratory studies show:
Aspartate aminotransferase: 200 U/L
Alanine aminotransferase: 450 U/L
Total serum bilirubin: 2.8 mg/dL
Direct bilirubin: 2.2 mg/dL
Serum alkaline phosphatase: 405 U/L
The tumor marker most likely to be increased in this patient is also likely to be elevated in which of the following malignancies?
A. Breast cancer
B. Choriocarcinoma
C. Colorectal adenocarcinoma
D. Neuroblastoma
E. Prostate carcinoma
F. Yolk sac carcinoma
F. Yolk sac carcinoma
Alfa-fetoprotein levels can also be elevated in patients with germ cell tumors, such as yolk sac tumors. Yolk sac tumors (also known as endodermal sinus tumors) arise from the germ cells that eventually become the adult gonads. Yolk sac tumors are the most common malignant testicular tumors in children.
The other choices are incorrect:
A 50-year-old woman comes to the clinic because of burning epigastric pain for the past 2 months. The pain is relieved with meals. She denies nausea and vomiting. A gastric acid secretion test reveals a stomach pH of 1.1 (normal: 1.5 to 3.5).
Secretion of which of the following substances can counteract the hyperacidity noted in this patient?
A. Acetylcholine
B. Gastrin
C. Intrinsic Factor
D. Nitric oxide
E. Secretin
F. Pepsin
E. Secretin
The other choices are incorrect:
How old am I?
25 (I think)
An otherwise healthy 20-year-old man comes to the emergency department because of severe lower abdominal pain. The pain began in the periumbilical region and has migrated to the right lower quadrant over the past 12 hours. He reports nausea; one episode of nonbilious, nonbloody vomiting; loss of appetite; and a mild fever. Temperature is 38.3°C (100.9°F), pulse is 90/min, and blood pressure is 135/85 mm Hg. On examination, the patient is in acute distress. His abdomen is not distended but is severely tender in the right lower quadrant with rebound tenderness and involuntary guarding.
Which of the following is the most common underlying pathophysiology behind this patient’s disease?
A. Cystic Duct Obstruction
B. Helicobacter pylori infection
C. Obstruction of the luminal gastrointestinal tract
D. Postoperative adhesions
E. Stress Ulcer
C. Obstruction of the luminal gastrointestinal tract
The other choices are incorrect:
A 69-year-old male with a history of colorectal carcinoma reports severe episodes of nausea and vomiting shortly after receiving chemotherapy. The vital signs are stable. Physical examination shows a cachectic man with temporal wasting. Cardiopulmonary examination is unremarkable. He is prescribed a medication for vomiting that may prolong the QT interval on ECG.
Which of the following mechanisms corresponds to the most likely prescribed medication?
A. Acetylcholine receptor antagonist
B. Dopamine receptor antagonists
C. Histamine receptor antagonists
D. Norepinephrine reuptake inhibitor
E. Serotonin receptor antagonist
E. Serotonin receptor antagonist
The other choices are incorrect.
The following choice is not used to treat nausea or vomiting:
The following choices are used to treat nausea but would not be first-line treatment for this patient:
A 40-year-old male comes to the office because of daily diarrhea over the past 5 months. During this time, his stools have smelled worse than they used to and appear oily. He has lost 9 kg (20 lb) over the past 5 months despite having a good appetite. He is in recovery from alcohol use disorder and has had multiple bouts of acute pancreatitis in the past.
Which of the following initial tests would help direct investigation toward the most likely cause of this patient’s weight loss?
A. Anti-tissue transglutaminase IgA assay
B. Colonoscopy
C. Serum Lipase
D. Stool ova and parasite tests
E. Sudan III staining
E. Sudan III staining
The other choices are incorrect.
The following choices may be helpful for pancreatic disease but not malabsorption:
The other choices could diagnose gastrointestinal issues with different clinical scenarios:
A 44-year-old man presents to the emergency department immediately after an episode of hematemesis. Medical history includes cirrhosis secondary to hepatitis C. Physical examination shows scleral icterus and spider angiomas. His abdomen is distended with shifting dullness to percussion. Rectal examination reveals maroon stool.
Which of the following vessels from the portal circulation contributed most directly to this patient’s bleeding?
A. Hemiazygos vein
B. Inferior Vena Cava
C. Left Gastric Vein
D. Right Gastric Vein
C. Left Gastric Vein
The other choices are incorrect:
What is the name of the county I am from?
Beford county (yee yee)
A 34-year-old man comes to the physician because of itchiness and fatigue for 3 months. Medical history is significant for chronic bloody diarrhea, which the patient has been experiencing intermittently for the past 3 years. He also has a history of knee joint pain for the past 1 year. Physical examination reveals scleral icterus, excoriations, and hepatomegaly. Cholangiography shows obliteration of the intrahepatic and extrahepatic bile ducts. Laboratory studies show an ALT value of 130 U/L, AST of 120 U/L, and alkaline phosphatase of 400 U/L.
Which of the following is a risk factor for this patient’s most likely diagnosis?
A. Hepatitis C Infection
B. Primary Biliary Cholangitis
C. Systemic Lupus Erythematosus
D. Ulcerative Colitis
E. Wilson Disease
D. Ulcerative Colitis
A 67-year-old woman comes to the clinic because of fatigue and weight loss. She is ultimately diagnosed with colon cancer with liver metastasis. Treatment options are discussed, including infusion of a monoclonal antibody. The monoclonal antibody is directed against a cellular factor that is also involved in wet age-related macular degeneration.
Which of the following peptides is most likely targeted by the monoclonal antibody under consideration?
A. Epidermal growth factor
B. Interleukin-1
C. Interleukin-6
D. Tumor necrosis factor-α
E. Vascular endothelial growth factor
E. Vascular endothelial growth factor
The other choices are incorrect:
A 50-year-old male comes to the physician for his annual visit. The patient is asymptomatic and has an unremarkable medical history. The patient has no known family history of colorectal cancer. Routine colonoscopy reveals a pedunculated polyp. The histologic appearance of the polyp is shown.
Which of the following is the most likely diagnosis?
A. Hamartomatous polyp
B. Hyperplastic polyp
C. Sessile serrated polyp
D. Tubular adenoma
E. Villous adenoma
D. Tubular adenoma
The other choices are incorrect:
A 22-year-old woman comes to the clinic because of increasing shortness of breath, weakness, and fatigue. She has a history of heavy menstrual bleeding. Physical examination reveals hair loss, koilonychia, and pale mucous membranes. Laboratory studies show a hemoglobin concentration of 6 g/dL, a mean corpuscular hemoglobin concentration of 24 Hb/cell, a mean corpuscular volume of 65 fL, and an RBC distribution width of 17%.
What part of the gastrointestinal tract is responsible for absorbing the nutrient in which this patient is most likely deficient?
A. Duodenum
B. Gastric body
C. Gastric fundus
D. Ileum
E. Jejunum
A. Duodenum
The other choices are incorrect:
Psyche! It's a question:
A 27-year-old male presents to his primary care physician for evaluation of abdominal pain and intermittent, nonbloody diarrhea. The patient has had similar episodes over the past 4 years. He has also been experiencing fatigue and had a 4.5-kg (10-lb) weight loss over the past few months. His temperature is 38.2°C (100.8°F), pulse is 82/min, respirations are 18/min, and blood pressure is 126/84 mm Hg. On physical examination, the patient appears ill and has aphthous ulcers in the mouth. Abdominal examination reveals moderate right-lower-quadrant tenderness to palpation. Rectal examination reveals no abnormalities. A colonoscopy is ordered.
Which of the following findings would most likely be associated with this patient’s presentation?
A. Mucosal and submucosal inflammation
B. Mucosal polyps
C. Normal mucosa
D. Saccular outpouchings
E. Transmural inflammation
E. Transmural inflammation
Crohn disease is characterized by transmural inflammation of the bowel wall and cobblestone mucosa, with skip lesions occurring anywhere along the digestive tract. Creeping fat, bowel wall thickening, and noncaseating granulomas (T-helper type 1 cell mediated) are also seen in this disease.The other choices are incorrect:
Some of the other findings could present with chronic diarrhea:
The other findings have varied clinical presentations: