NMS Q&A Family Medicine

SECTION VIThe Gastrointestinal Tractin Primary Carechapter 14Medical Problems of theGastrointestinal TractExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 35-year-old woman has returned from a prolongedstay due to business in the Caribbean islands with acomplaint of severe and unrelenting diarrhea. Shehad not been taking antibiotics and had no history ofdiarrhea in the past. She has lost weight and complainsof fatigue. Her blood count shows hemoglobinlevel of 10 g/dL with a mean cell volume measured at101 m 3 (normal 80 to 96). The stools are bulky, particularlyfoul smelling and they float. Which of thefollowing is most likely the best treatment, assumingconfirmation of the diagnosis?(A) Loperamide orally 4 times per day as needed(B) Clear liquids only for 3 days followed by lowresiduediet for 1 week(C) Tetracycline course orally for 3 weeks(D) Vancomycin 500 mg 4 times per day for 10 to14 days(E) Azithromycin 500 mg daily for 3 days2 A 45-year-old female enters an urgent care centerwith a complaint of acute abdominal pain. She relatestwo attacks of less severe abdominal pain within thepast 3 months that radiated around the right flank tothe mid-thoracic dorsal area. On examination, sheexhibits spider angiomata and dilated flank veins.The pain has rapidly built over a period of about36 hours. The pain radiates through to the back oppositethe epigastric area and seems to be relieved byleaning forward. Each of the following is true regardingthis case except for which statement?(A) The most sensitive diagnostic test is the serumamylase.(B) Lipase elevation begins within 4 to 8 hours andremains elevated 8 to 14 days.(C) The vast majority of attacks are mild and notfatal.(D) The severity of disease is directly proportionateto the size of the amylase elevation.(E) This patient must be treated to prevent deliriumtremens while managing the underlyingcondition.89