Internal-Medicine

Questions: 54–65 89
60. A 33-year-old woman is recently diagnosed
with primary biliary cirrhosis (PBC). She is
inquiring about available treatments for this
condition, including if there is a cure for the
disease. Which of the following treatments is
most likely to “cure” her PBC?
(A)
(B)
(C)
(D)
(E)
ursodiol
methotrexate
azathioprine
liver transplantation
glucocorticoids
61. A 47-year-old woman complains of food sticking
every time she eats anything solid. She has
lost 10 lb since the symptoms started, and
points to her midthorax as the site where she
feels the food is sticking. If this is due to
mechanical obstruction, this historical information
suggests which of the following locations?
(A) at the location the patient points to
(B) at or above the location the patient
points to
(C) below the location the patient points to
(D) at or below the location the patient
points to
(E) the historical information is unhelpful in
suggesting a location
62. A 52-year-old man has episodes of severe
chest pain associated with dysphagia. He has
been seen twice in the emergency room, and
both times the symptoms responded to sublingual
nitroglycerin. He then had a full cardiac
evaluation including electrocardiogram
(ECG), cardiac biomarkers, and an exercise
stress test, which were all normal. Which of
the following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
herpetic infection
a motor disorder
midesophageal cancer
peptic stricture
external esophageal compression
63. A 16-year old girl has recently been referred to
your family practice. She is a recent immigrant
from Southeast Asia, and has been taking isoniazid
(INH) and rifampin for uncomplicated
tuberculosis. Routine blood tests are unremarkable,
except for an elevated direct bilirubin.
Other liver enzymes and function tests are completely
normal. Which of the following is the
most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
hemolytic anemia
INH toxicity
Crigler-Najjar syndrome type I
rifampin toxicity
Rotor’s syndrome
64. A 45-year-old woman presents with a 1-week
history of jaundice, anorexia, and right upper
quadrant discomfort. On examination she is
icteric, with a tender right upper quadrant
and liver span of 14 cm. There is no shifting
dullness or pedal edema and the heart and
lungs are normal. On further inquiry, she
reports consuming one bottle of wine a day for
the past 6 months. Which of the following laboratory
tests is most likely to be characteristic
of a patient with jaundice secondary to alcoholic
hepatitis?
(A)
(B)
(C)
(D)
(E)
ratio of AST:ALT is 3:1 and the AST is
500 U/L
ratio of AST:ALT is 2:1 and the AST is
250 U/L
ratio of AST:ALT is 1:1 and the AST is
500 U/L
ratio of AST:ALT is 1:1 and the AST is
250 U/L
ratio of AST:ALT is 1:3 and the AST is
750
65. Which of the following medications causes
predictable, dose-dependent hepatocellular
injury?
(A)
(B)
(C)
(D)
(E)
morphine
INH
gold
acetaminophen
acetylsalicyclic acid (ASA)