Gastro-Intestinal REVIEW QUESTIONS


Question 1

Correct Answer:
1. An infant who was healthy at birth is brought to your office for her first office visit at the age of 6 weeks. You notice that the infant is jaundiced and that there is bilirubin staining of the wet diaper. Which one of the following diagnoses is most consistent with these findings?

a. Physiologic jaundice of the newborn
b. Hemolysis secondary to Rh incompatibility
c. Crigler-Najjar syndrome
d. Gilbert's syndrome
e. Biliary atresia




Use the following Table for questions 2 through 5


          Patterns of Serologic Results in Tests
                   for Hepatitis 
  _____________________________________________________

             Anti-HBc    Anti-HBc
      HBsAg    (IgM)      (IgG)    Anti-HBs   Anti-HDV
  _____________________________________________________

(A)     +        +          -         -          -
(B)     +        +          -         -          +
(C)     -        -          +         +          -
(D)     -        -          -         +          -
(E)     +        -          +         -          +
  ______________________________________________________


  Abbreviations: HBsAg=hepatitis B surface antigen; anti-
  HBc=aritibody to hepatitis B core antigen; IgM = immuno-   
  globulin M; IgG=immunoglobulin G; anti-HBs = antibody to
  to HBsAg; and anti-HDV=antibody to hepattitis D virus.

Questions 2 - 5
For each patient described, select the most likely pattern of serologic results in tests for hepatitis (see preceding Table).


Correct Answer:
2. A 30-year-old surgeon who was vaccinated 1 year ago against hepatitis B
a b c d e


Correct Answer:
3. A 45-year-old laboratory technician who had acute hepatitis 15 years ago but is currently asymptomatic and has normal liver enzyme levels
a b c d e


Correct Answer:
4. 4. A 25-year-old drug abuser who has a history of chronic hepatitis B and now develops fulminant hepatitis
a b c d e


Correct Answer:
5. 5. A 40-year-old, homosexual man with acute hepatitis B
a b c d e


Questions 6 - 10
The following diseases are associated with diarrhea. For each disease, select the most likely type or mechanism of diarrhea.


Correct Answer:
6. Chronic pancreatitis with pancreatic insufficiency

a. Secretory diarrhea
b. Inflammatory diarrhea
c. Rapid transit diarrhea
d. Osmotic diarrhea
e. Fat maldigestion or malabsorption with steatorrhea



Correct Answer:
7. Infection with Vibrio cholerae
a. Secretory diarrhea
b. Inflammatory diarrhea
c. Rapid transit diarrhea
d. Osmotic diarrhea
e. Fat maldigestion or malabsorption with steatorrhea



Correct Answer:
8. Ulcerative colitis
a. Secretory diarrhea
b. Inflammatory diarrhea
c. Rapid transit diarrhea
d. Osmotic diarrhea
e. Fat maldigestion or malabsorption with steatorrhea



Correct Answer:
9. Lactase deficiency
a. Secretory diarrhea
b. Inflammatory diarrhea
c. Rapid transit diarrhea
d. Osmotic diarrhea
e. Fat maldigestion or malabsorption with steatorrhea



Correct Answer:
10. Infection with Trophervma whippeiii
a. Secretory diarrhea
b. Inflammatory diarrhea
c. Rapid transit diarrhea
d. Osmotic diarrhea
e. Fat maldigestion or malabsorption with steatorrhea


Questions 11 - 13
For each description listed below, select the most appropriate disease.


Correct Answer:
11. The disease is rare in the USA. Water-borne epidemics in underdeveloped countries are associated with a high mortality rate in pregnant women.

a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E



Correct Answer:
12. The disease is caused by a DNA virus that can become integrated into the genome of the hepatocyte. An effective vaccine is available to prevent this type of hepatitis.
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E



Correct Answer:
13. Most infections with this hepatitis virus that are acquired during adulthood result in chronic disease.
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D
e. Hepatitis E



Question 14

A 22-year-old man used illicit intravenous drugs briefly 1 year ago. He is asymptomatic and has no history of viral hepatitis. Serum alanine anminotransferase and bilirubin concentrations are normal.
Serologic studies show:

Hepatitis B surface antigen (HBsAg)Positive
Hepatitis B core antibody (HBcAb)Positive
Hepatitis B e antigen (HBeAg)Negative
Antibody to surface antigen (Anti-HBs)Negative
Antibody to e antigen (Anti-HBe)Positive

Correct Answer:
14. Which of the following statements best describes the current condition?
a. He is in the incubation period, is highly infectious, is likely to develop acute hepatitis B.
b. He is in the incubation period, is minimally infetious, and is likely to develop acute hepatitis B.
c. He is in the incubation period, is minimally infetious, and is likely to develop acute hepatitis B.
d. He is a chronic carrier of hepatitis B and is highly infectious.
e. He was infected previously with hepatitis B. has recovered and is immune to hepatitis B.



Question 15

A 35-year-old woman requests a routine health assessment. She has no specific medical complaints or past medical hstory. Her father developed colon cancer at age 54 but is still living. His brother died of colon cancer at aae 41. Their father (the patient's grandfather) died in his sixties of colon cancer. His sister died of gastric cancer. The patent's sister was recently diagnosed with endometrial cancer at age 43.

The patient has a good appetite and has no nausea, vomiting, or weight loss. She has had no change in her bowel habits or hematochezia, and her menstrual periods are normal. Physical examination is normal. Digital rectal examination is negative for fecal occult blood. A screening complete blood count and biochemical profile are normal.


Correct Answer:
15. Which of the following actions is most appropriate?

a. Perform annual occult blood tests of three stool specimens. Initiate screening with flexible sigmoidoscopy at age 50.
b. Perform colonoscopy at least every 2 years.
c. Barium enema now; if normal no further evaluation.
d. Perform colonoscopy now; if no polyps are seen, no further investigation is necessary.
e. Perform fecal occult blood testing and flexible sigmoidoscopy now. If no polyps are seen now, the patient should be followed routinely with fecal occult blood testing and flexible sigmoidoscopy beginning at age 50.


Questions 16 - 19
For each type of liver disease shown below, select the most likely causative drug.


Correct Answer:
16. Acute hepatitis

a. Isoniazid
b. Nitrofurantoin
c. Trimethoprim-sulfamethoxazole
d. Acetaminophen and chronic alcohol consumption



Correct Answer:
17. Fulminant hepatic failure
a. Isoniazid
b. Nitrofurantoin
c. Trimethoprim-sulfamethoxazole
d. Acetaminophen and chronic alcohol consumption



Correct Answer:
18. Cholestasis
a. Isoniazid
b. Nitrofurantoin
c. Trimethoprim-sulfamethoxazole
d. Acetaminophen and chronic alcohol consumption



Correct Answer:
19. Chronic hepatitis
a. Isoniazid
b. Nitrofurantoin
c. Trimethoprim-sulfamethoxazole
d. Acetaminophen and chronic alcohol consumption


Questions 20 - 23
For each clinical situation of a colon polyp removed at total colonoscopy, select the appropriate follow-up recommendations.


Correct Answer:
20. Single pedunculated adenoma in a 40-year-old

a. Total colectomy and ileoanal anastomosis
b. No routine follow-up necessary
c. Yearly rectal examination and test for occult blood, with flexible sigmoidoscopy every 3 to 5 years
d. Bi-yearly colonoscopic screening for dysplasia
e. Total colonoscopy in 3 years



Correct Answer:
21. Rectal hyperplastic polyp in a 60-year-old
a. Total colectomy and ileoanal anastomosis
b. No routine follow-up necessary
c. Yearly rectal examination and test for occult blood, with flexible sigmoidoscopy every 3 to 5 years
d. Bi-yearly colonoscopic screening for dysplasia
e. Total colonoscopy in 3 years



Correct Answer:
22. Inflammatory pseudopolp in a 30-year-old with a 10-year history of colitis
a. Total colectomy and ileoanal anastomosis
b. No routine follow-up necessary
c. Yearly rectal examination and test for occult blood, with flexible sigmoidoscopy every 3 to 5 years
d. Bi-yearly colonoscopic screening for dysplasia
e. Total colonoscopy in 3 years



Correct Answer:
23. Hundreds of flat adenomas in a 20-year-old
a. Total colectomy and ileoanal anastomosis
b. No routine follow-up necessary
c. Yearly rectal examination and test for occult blood, with flexible sigmoidoscopy every 3 to 5 years
d. Bi-yearly colonoscopic screening for dysplasia
e. Total colonoscopy in 3 years


Questions 24 - 27
For each patient described below, select the associated nutritional or metabolic abnormality.


Correct Answer:
24. A patient with Crohn's disease

a. Microcytic anemia
b. Growrth retardation
c. Hyperoxaluria
d. BInsulin resistance
e. Hypercalcemia



Correct Answer:
25. A patient with gastric resection
a. Microcytic anemia
b. Growrth retardation
c. Hyperoxaluria
d. BInsulin resistance
e. Hypercalcemia



Correct Answer:
26. A patient with advanced cirrhosis
a. Microcytic anemia
b. Growrth retardation
c. Hyperoxaluria
d. BInsulin resistance
e. Hypercalcemia



Correct Answer:
27. A patient with ileal resection
a. Microcytic anemia
b. Growrth retardation
c. Hyperoxaluria
d. BInsulin resistance
e. Hypercalcemia


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