Start Exam: Gastrointestinal Pathophysiology Exam by Dr.

Question: A 66 year old woman has profuse watery diarrhea which has lasted more than 6 weeks. The diarrhea does not improve when oral intake is limited. She has had a 5 pound weight loss. She drinks two glasses of wine nightly. All stool cultures are negative. Fecal leukocytes are negative. A Sudan stain performed on a stool specimen is negative. The D-Xylose test shows 10 grams of xylose in the urine. Stool electrolytes are checked: stool sodium concentration is 85mmol/l and stool potassium concentration is 50mmol/l. Which of the following is the most likely diagnosis?

Choices:

Irritable bowel syndrome

Chronic pancreatitis

Carcinoid syndrome

Small intestinal bacterial overgrowth syndrome

Abuse of lactulose

Question: A 65 year old man comes to the emergency room with the acute onset of peri-umbilical abdominal pain, nausea, and vomiting. He drinks alcohol regularly. He takes no medications. On exam, he has a low grade temperature but other vital signs are stable. He has tenderness in the mid-abdomen without rebound or guarding. His lab tests are: ALT 58 U/l AST 95 U/l Total bilirubin 1.1 mg/dl Alkaline phosphatase 89 U/l Amylase 1105 U/l Lipase 1404 U/l Which of the following is the most likely pathophysiologic mechanism to explain the condition which is causing this patients pain?

Choices:

Prolonged hypotension causing ischemia

Cytotoxic damage to peri-portal hepatocytes

Reduced stimulation of intracellular calcium signaling pathways

Inappropriate activation of pancreatic enzymes

Reduced pancreatic enzyme synthesis and secretion

Question: An 80 year old man has a history of constipation and intermittent left lower quadrant abdominal pain. A colonoscopy shows extensive diverticulosis in the sigmoid colon. He is at risk for which of the following conditions?

Choices:

Carcinoma of the colon

Angiodysplasia

Gastrointestinal hemorrhage

Ulcerative colitis

Malabsorption

Question: A 62 year old man has abdominal pain, hematemesis, and melena. He is not taking NSAIDs (nonsteroidal anti-inflammatory drugs) or aspirin. An upper endoscopy reveals a large posterior wall duodenal ulcer. A biopsy is obtained from the gastric antrum and a rapid urease test is positive. Which of the following findings is most likely?

Choices:

Type A autoimmune gastritis

CagA positive H pylori

Low gastrin levels after a meal

Normal gastric acid production

Absence of gastric metaplasia in the duodenum

Question: A 21 year old man has weight loss and episodic bloody diarrhea. The bloody diarrhea has become more frequent recently. A colonoscopy shows erythema and diffuse small ulcers from the rectum to the mid-transverse colon. Biopsies show architectural distortion and cryptitis. The most likely diagnosis is which of the following?

Choices:

Ischemic colitis

AIDS-associated gastroenteritis

Clostridium difficile colitis

Crohn’s disease

Collagenous colitis (lymphocytic colitis)

Amebiasis

Ulcerative colitis

Cytomegalovirus colitis

Ulcerative jejunoileitis

Question: A barium study on a 55 year old man is shown below: Which of the following would you most likely expect this patient to have?

Choices:

Dysphagia to solids and liquids

Dysphagia to liquids

A hiatal hernia

A duodenal ulcer

Esophageal cancer

Question: A 32 year old woman undergoes a gastric bypass operation for morbid obesity. The surgery goes well and she loses 70 kg in two months. She has two children; the youngest was delivered by caesarean section 2 years ago. She comes into the emergency room complaining of intermittent episodes of right upper quadrant abdominal pain. The physical exam is remarkable for right upper quadrant tenderness. Liver function studies are normal. A right upper quadrant ultrasound shows numerous mobile structures with acoustic shadowing in the gallbladder. The bile duct is not dilated. The most likely risk factor for this patient’s condition is which of the following?

Choices:

Recent pregnancy

Rapid weight loss

Age

High serum cholesterol

High cholesterol diet

Question: A 42 year old man abuses intravenous drugs. He complains of 2 weeks of anorexia and nausea. He noted that his urine turned dark and his stool turned light. Blood work is consistent with acute viral hepatitis. Serologic studies are done: Hepatitis A IgG: positive Hepatitis A IgM: negative Hepatitis C Antibody: negative Hepatitis B surface antigen: positive Hepatitis B surface antibody: negative Hepatitis B core IgM antibody: positive Which of the following best explains the mechanism of hepatic injury in this patient?

Choices:

Direct viral cytotoxic effect

Immune mediated hepatocyte damage

Direct inhibition of hepatocyte DNA replication

Direct inhibition of hepatocyte mRNA translation

Antibody destruction of virus

Question: A 65 year old woman has abnormal liver function tests. She has been experiencing nausea and abdominal pain over the last 7 days. She does not take anti-coagulants. A right upper quadrant ultrasound is normal. Her laboratory tests are as follows: White blood cell count: 12,500 Glucose: 80 mg/dl Amylase: 100 U/l LDH: 305 U/l Lipase: 25 U/l Iron: 250mcg/dl Total iron binding capacity (transferring): 350 mcg/l Ferritin: 100 ng/ml Total bilirubin 7.5 mg/dl (Direct bilirubin 7.1 mg/dl) Alkaline phosphatase 90 U/l ALT 145 U/l AST 295 U/l PT 25 (INR 3.1) Albumin 3.6 g/dl Which of the following is the most likely explanation for these findings?

Choices:

Chronic hepatitis B

Alcoholic hepatitis

Hepatitis A

Primary biliary cirrhosis

Primary sclerosing cholangitis

Question: A 65 year old woman has primary biliary cirrhosis and is awaiting liver transplantation. She has ascites and spider angiomata on physical examination and large esophageal varices on upper endoscopy. Which of the following would most likely be decreased?

Choices:

Resistance to blood flow through the liver

Rate of blood flow through the splanchnic circulation

Level of vasodilators in the blood

Hepatic vein pressure gradient

Peripheral vascular resistance

Question: A 44 year old man complains of persistent heartburn which occurs daily. He denies any dysphagia or odynophagia. Which of the following pathophysiologic mechanisms most likely explains his symptoms?

Choices:

Transient lower esophageal sphincter contractions

Elevated lower esophageal sphincter pressures

Slow gastric motility

Transient lower esophageal sphincter relaxations

Reduced gastric acid production