Internal-Medicine

CHAPTER 4
Gastroenterology
Questions
DIRECTIONS (Questions 1 through 10): Each set
of matching questions in this section consists of a
list of lettered options followed by several numbered
items. For each numbered item, select the
appropriate lettered option(s). Each lettered option
may be selected once, more than once, or not at all.
EACH ITEM WILL STATE THE NUMBER OF
OPTIONS TO SELECT. CHOOSE EXACTLY THIS
NUMBER.
Questions 1 through 6
(A)
(B)
(C)
(D)
(E)
(F)
polypoid adenoma
leiomyoma
lipoma
adenocarcinoma
primary gastrointestinal (GI) lymphoma
carcinoid tumor
For each patient with a small bowel tumor, select
the most likely diagnosis.
1. A 56-year-old woman presents with weight loss
and watery diarrhea. She also notices periumbilical
pain and bloating after eating. A small
bowel x-ray reveals an area of narrowing and
the lesion is surgically resected. The pathology
report shows this to be the most common
endocrine tumor of the GI tract. (SELECT ONE)
2. A 72-year-old man is investigated for iron deficiency
anemia. There is no clinical history of
upper or lower GI bleeding, but his stools are
fecal occult blood positive. His colonoscopy is
negative for any obvious sources of bleeding,
but upper endoscopy reveals ulceration in the
distal duodenum that is biopsied. The pathology
report shows this to be the most common primary
malignancy of the small bowel. (SELECT
ONE)
3. A 23-year-old man of Middle Eastern decent is
investigated for symptoms of chronic diarrhea,
vomiting, and abdominal cramps. He has lost
20 lb and appears unwell. A small bowel x-ray
shows diffuse nonspecific mucosal abnormality.
Upper endoscopy is performed to visualize
the small bowel and obtain biopsies. The
pathology report identifies the mucosal abnormality
as “immunoproliferative small intestinal
disease” (IPSID). This form of small bowel
tumor can be treated with antibiotics in its early
stages. (SELECT ONE)
4. A 21-year-old woman develops acute periumbilical
pain that localizes to the right lower
quadrant. She appears unwell, and on examination,
there is tenderness and guarding in the
right lower quadrant. A pregnancy test is negative
and a pelvic examination rules out pelvic
inflammatory disease. A clinical diagnosis of
acute appendicitis is made and she has an
uncomplicated laparoscopic appendectomy.
The pathology report notes acute inflammation
and a tumor for which the appendix is a
very common site of involvement. (SELECT
ONE)
79
Copyright © 2007 by The McGraw-Hill Companies, Inc. Click here for terms of use.