Internal-Medicine
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82 4: Gastroenterology<br />
23. A 64-year-old woman develops sudden-onset<br />
20. A 29-year-old man with acquired immune deficiency<br />
(E) more than 1000 white cells/mm 3 (E) dietary modification<br />
syndrome (AIDS) comes to the emergency<br />
department because of progressively increasing<br />
abdominal discomfort. Examination shows voluntary<br />
guarding in the upper abdomen. His biochemistry<br />
is normal except for an elevated<br />
amylase at 370 U/L (25–125 U/L). Which of the<br />
following infections can trigger this disorder in<br />
AIDS patients?<br />
abdominal discomfort after eating a large meal.<br />
The pain is constant, localizes to the epigastric<br />
area with radiation to her right scapula. She also<br />
has nausea and vomiting. It eventual subsides<br />
1 hour later. An ultrasound of the abdomen<br />
reveals a dilated common bile duct secondary<br />
to stones. Which of the following statements<br />
regarding common bile duct stones is most<br />
(A) toxoplasmosis<br />
likely true?<br />
(B) Mycobacterium avium complex<br />
(A) all originate in the gallbladder<br />
(C) Mycobacterium tuberculosis<br />
(B) always produce jaundice<br />
(D) Pneumocystis carinii<br />
(C) produce constant level of jaundice<br />
(E) herpes virus<br />
(D) can be painless<br />
(E) indicate anomalies of the bile duct<br />
21. A 55-year-old man from China is known to have<br />
chronic liver disease, secondary to hepatitis B<br />
infection. He has recently felt unwell, and his<br />
hemoglobin level has increased from 130 g/L, 1<br />
year ago, to 195 g/L. Which of the following is<br />
the most appropriate initial diagnostic test?<br />
24. A 53-year-old man presents with diarrhea. He<br />
also complains of facial flushing lasting minutes<br />
at a time. Physical examination reveals facial<br />
telangiectasias and a heart murmur not present<br />
2 years before. This murmur is accentuated by<br />
deep breathing. Which of the following is the<br />
(A) alkaline phosphatase<br />
most appropriate initial diagnostic test?<br />
(B) alpha-fetoprotein (AFP)<br />
(C) aspartate transaminase (AST)<br />
(A) urinary vanillylmandelic acid (VMA)<br />
(D) alanine transaminase (ALT)<br />
(B) serum noradrenaline levels<br />
(E) unconjugated bilirubin<br />
(C) barium enema<br />
(D) serum serotonin levels<br />
22. A 63-year-old man with a long history of alcohol<br />
abuse presents with ascites. He is experiencing<br />
(E) urinary 5-hydroxyindolacetic acid<br />
(5-HIAA)<br />
mild abdominal discomfort and nausea.<br />
Examination reveals tense ascites and generalized<br />
tenderness but no rigidity. A diagnostic<br />
paracentesis of the fluid is performed. Which of<br />
the following ascitic fluid results is most likely<br />
to suggest an uncomplicated ascites due to<br />
portal hypertension from cirrhosis?<br />
25. A 29-year-old woman complains of dysphagia<br />
with both solids and liquids, worse when she<br />
is eating quickly or is anxious. Manometry<br />
reveals normal basal esophageal sphincter<br />
pressure, with no relaxation of the sphincter<br />
on swallowing. Which of the following is the<br />
(A) hemorrhage<br />
most appropriate next step in management?<br />
(B) protein >25 g/L<br />
(A) beta-blocker therapy<br />
(C) bilirubin level twice that of serum<br />
(B) partial esophagectomy<br />
(D) serum to ascites albumin gradient<br />
(C) anticholinergic drugs<br />
>1.1 g/dL<br />
(D) calcium channel blockers
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