Start Exam: Gastrointestinal Pathophysiology Exam by Dr.

Question: A 44 year old man is awaiting liver transplantation for chronic hepatitis C induced cirrhosis. He has ascites, esophageal varices, and intermittent problems with hepatic encephalopathy. His recent blood tests are as follows: ALT 76 U/l AST 35 U/l Alkaline phosphatase 105 U/l Total bilirubin 4.5 mg/dl Direct bilirubin 3.8 mg/dl Prothrombin time 20 seconds (INR 1.8) Platelet count 55,000 Albumin 3.2 Which of the following sets of blood tests provides the best assessment of this patients liver synthetic function?

Choices:

Platelet count and total bilirubin

Prothrombin time and albumin

Prothrombin time and alkaline phosphatase

Prothrombin time and total bilirubin

Albumin and AST

Albumin and ALT

Question: Three days into the hospitalization for an acute illness a CT scan is performed on a 32 year old woman. She initially presented to the emergency room with severe periumbilical pain, nausea, and vomiting. She denied any alcohol use and was on no medications. She had previously been feeling well. She was treated with intravenous fluids and kept nothing by mouth. An initial ultrasound exam of the abdomen revealed gallstones within the gallbladder and a mildly dilated common bile duct. Because her symptoms persisted and she developed a fever the CT scan was obtained. Which of following statements best describes the pathophysiology of this condition?

Choices:

Obstruction of the cystic duct due to gallstones

Activation of pancreatic enzymes within the pancreas

Obstruction of the pancreatic duct due to proteinaceous plugs

Reduction in pancreatic enzyme synthesis and secretion

Reduction in stimulation of intracellular calcium signaling pathways

Question: A barium swallow x-ray on a 55 year old woman 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 52 year old man has had heartburn for over 20 years. He reports no dysphagia or odynophagia. An upper endoscopy shows no significant hiatal hernia. Which of the following esophageal motility test findings would you most likely expect to see in this patient?

Choices:

Frequent transient lower esophageal sphincter relaxations

Elevated resting lower esophageal sphincter pressure

Reduced resting lower esophageal sphincter pressure

Infrequent transient lower esophageal sphincter relaxations

High amplitude peristalatic contractions in the esophageal body

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 75 year old man is admitted to the intensive care unit with upper gastrointestinal bleeding. An upper endoscopy is performed urgently after the patient is resuscitated with intravenous fluids and packed red blood cells. There is a large ulcer in the duodenal bulb with a visible vessel. Endoscopic therapy is applied and the bleeding stops. He is put on intravenous pantoprazole. A rapid urease test on a mucosal biopsy from the gastric antrum is positive. Which of the following findings would one most likely find in this patient?

Choices:

Reduced gastric acid production

Parietal cell antibodies

Normal gastric acid production

Normal gastric antral mucosa

Markedly elevated gastrin level after a meal

Question: A 68 year old woman complains of bright red blood per rectum with extreme pain with defecation. She reports no prior trauma. She had two caesarean sections at the time of the births of her children over 40 years ago. She has intermittent problems with constipation. She has no other medical history. Which of the following findings would you most likely see on physical examination?

Choices:

External skin tags

Scarring from perianal fistulae

Anal fissure

Internal hemorrhoids

Pilonidal cyst

Question: You are evaluating a 29 year old physician for constipation. Her physical examination including ano-rectal exam is normal. Thyroid testing and serum calcium levels are normal. A colonoscopy is normal. You make a diagnosis of constipation-predominant irritable bowel syndrome. The patient has minimal response to bulk forming agents and osmotic laxatives. You recommend beginning tegaserod. The patient asks how this drug works. Which of the following is the best description of the mechanism of action of tegaserod?

Choices:

It stimulates 5-HT3 receptors

It stimulates nitric oxide containing neurons

It inhibits acetylcholine containing neurons

It inhibits water absorption in the colon

It stimulates 5-HT4 receptors

Question: A 25 year old man has had intermittent diarrhea for the past year. Over the past 3 months his diarrhea has increased in frequency and he is waking at night to move his bowels. Lately he has noted blood in the stool with some mucus. He has quite a bit of urgency to move his bowels and notes that the volume of stool output is quite small. He denies significant abdominal pain except for some mild left lower quadrant discomfort associated with a bowel movement. His physical examination is normal. He has no fever. His serum ASCA (anti-saccharomyces cereversiae antibody) level is undetectable and pANCA (peri-nuclear antineutrophil cytoplasmic antibody) level is elevated. Which of the following is the most likely colonoscopic finding?

Choices:

Normal rectum

Deep ulcers in the colon

Normal vascular markings

Diffuse and circumferential pinpoint ulcers in the colon

Pinpoint ulcers in ileum

Question: A 65 year old man, on TPN (total parenteral nutrition) for several months due to an obstructing esophageal cancer, complains of intermittent episodes of severe right upper quadrant abdominal pain radiating to the right shoulder. These episodes are associated with nausea and vomiting. A right upper quadrant ultrasound shows a few small gallstones and sludge in the gallbladder. His serum cholesterol level is 290 mg/dl (normal < 200mg/dl). The most likely predisposing factor for this patient’s sludge and gallstones is which of the following?

Choices:

TPN

Gender

Dehydration

Serum cholesterol level

Esophageal cancer

Question: A 66 year old woman has new symptoms of profuse watery non-bloody diarrhea. The diarrhea does not improve when oral intake is limited. She has had a 5 pound weight loss. All stool cultures are negative. Fecal leukocytes are negative. A Sudan stain performed on a stool specimen is negative. 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

Ulcerative colitis

Abuse of lactulose