Internal-Medicine

96 4: Gastroenterology
43. (B) In neonates, the transmission of hepatitis B
results in a 90% probability of developing
chronic infection. The ongoing infection (often
resulting in hepatoma) is a major cause of morbidity
and mortality in many parts of the
world. (Kasper, p. 1829)
44. (A, B) Immunoglobulin injection can provide
prophylaxis against hepatitis A, and it is felt
that hepatitis B immune globulin is protective
for hepatitis B. (Kasper, p. 1829)
45. (D) Hepatitis D is a defective ribonucleic acid
(RNA) virus that requires the helper function of
hepatitis B virus (or other hepadnavirus) for
its replication and expression. (Kasper, p. 1826)
46. (C) Hyperglycemia is very common in pancreatitis
and is usually multifactorial in origin.
Factors involved include decreased insulin
release, increased glucagon release, and elevated
adrenal glucocorticoids and catecholamines.
(Kasper, p. 1897)
47. (B) The sclera are high in elastin content, which
has an affinity for bilirubin. Therefore, jaundice
is usually detected here first. Fluorescent
lighting makes recognition more difficult. In
some individuals, dark skin color makes jaundice
more difficult to detect. (Kasper, p. 238)
48. (A) Hemolysis results in predominantly unconjugated
bilirubin. Unconjugated hyperbilirubinemia
is caused by overproduction, decreased
uptake, or decreased conjugation. (Kasper, p. 240)
49. (E) Ménétrier’s disease, an uncommon disease
involving the stomach, is characterized by large
gastric folds. Intravenous administration of
radioactive-labeled albumin may show up to
a 40% loss in the GI tract in protein-losing
enteropathy, but is not available for routine
clinical use. Treatment of protein-losing enteropathy
is usually directed at the underlying condition.
(Kasper, p. 1762)
50. (D) Joint involvement in inflammatory bowel
disease may involve sacroiliitis or specific large
joint peripheral arthritis. The latter type of
arthritis parallels the course of the bowel disease.
The sacroiliitis (spondylitic) variety follows
an independent course. (Kasper, p. 1786)
51. (D) This likely represents diarrhea secondary
to Clostridium difficile infection. It is mediated
by toxins, not by direct bacterial invasion.
Cephalosporins, because they are so widely
used, are the most common cause of the disease.
On a per case basis, however, clindamycin
is the most likely antibiotic to cause the disease.
(Kasper, p. 760)
52. (E) The patient with primary biliary cirrhosis
(PBC) is typically a middle-aged woman with
itching. Patients are often asymptomatic and
diagnosed only on routine blood work. The
cause of PBC is unknown, but a disordered
immune response may be involved. A positive
antimitochondrial antibody test is found in over
90% of symptomatic patients. (Kasper, p. 1861)
53. (B) Postgastrectomy steatorrhea does not
result from mucosal abnormality. The mucosa
is also normal in pancreatic steatorrhea.
Postgastrectomy maldigestion and malabsorption
is caused by rapid gastric emptying, reduced
dispersion of food in the stomach, reduced luminal
levels of bile, rapid transit of food, and
impaired pancreatic secretory response. (Kasper,
p. 1770)
54. (A) The string sign represents long areas of circumferential
inflammation and fibrosis. It is
seen in the stenotic and nonstenotic phase of
Crohn’s disease. In addition to the string sign,
abnormal puddling of barium and fistulous
tracts are other helpful x-ray signs of ileitis.
Other radiologic findings in Crohn’s disease
include skip lesions, rectal sparing, small ulcerations,
and fistulas. (Kasper, p. 1781)
55. (A) Although carcinoid tumor can cause diarrhea,
it is very uncommon. This young woman
is overweight, suggesting an eating disorder,
which is associated with laxative abuse. Abuse
of stimulant laxatives such as senna can cause a
secretory diarrhea. Magnesium-based laxatives
will cause an osmotic diarrhea. (Kasper, p. 228)