Gastroenterology and Hepatology Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Gastroenterology and Hepatology flashcards as text
A 55-year-old man presents with painless jaundice, 15 lb weight loss, and a palpable, non-tender gallbladder. What is the most likely diagnosis?
Answer: Pancreatic head adenocarcinoma
Courvoisier's sign (palpable non-tender gallbladder with painless jaundice) in an older patient strongly suggests malignant biliary obstruction, most commonly pancreatic head carcinoma.
A 40-year-old woman with IBD presents with elevated alkaline phosphatase and fatigue. MRCP shows multifocal strictures and dilations of both intra- and extrahepatic bile ducts. What is the most likely diagnosis?
Answer: Primary sclerosing cholangitis
Primary sclerosing cholangitis (PSC) presents with characteristic 'beaded' intra- and extrahepatic biliary strictures on MRCP and is strongly associated with IBD, particularly ulcerative colitis.
A 25-year-old man with ulcerative colitis has a colonoscopy showing continuous inflammation from the rectum to the splenic flexure. He has 6 bloody stools per day and a heart rate of 102 bpm. What is the most appropriate next step?
Answer: IV corticosteroids
Severe UC (Truelove-Witts criteria: >6 bloody stools/day plus systemic features) requires hospitalization and IV corticosteroids as first-line treatment.
A 62-year-old man undergoes upper endoscopy for evaluation of dysphagia. Biopsy of the distal esophagus shows columnar epithelium with goblet cells. What is the most critical next step in management?
Answer: Endoscopic surveillance with biopsies per Barrett's protocol
Barrett's esophagus with intestinal metaplasia requires endoscopic surveillance per established protocols (every 3-5 years for non-dysplastic Barrett's) to detect dysplasia early.
A 48-year-old woman with known cirrhosis presents with confusion and asterixis after starting a new medication. Which drug is most likely responsible for precipitating hepatic encephalopathy?
Answer: Furosemide causing hypokalemia and alkalosis
Excessive diuresis with furosemide causes hypokalemia and metabolic alkalosis, which increases ammonia production in the kidney and reduces ammonia excretion, precipitating hepatic encephalopathy.
A 33-year-old man presents with recurrent oral ulcers, genital ulcers, and uveitis. He also reports bloody diarrhea. Which GI condition is most strongly associated with this systemic disorder?
Answer: Behçet's disease with GI involvement
The triad of oral ulcers, genital ulcers, and uveitis defines Behçet's disease, which can cause GI ulceration (most often in the ileocecal region) with bloody diarrhea.
A patient with celiac disease continues to have diarrhea and weight loss despite strict gluten-free diet for 12 months. Repeat biopsy shows persistent villous atrophy. What is the most concerning complication to consider?
Answer: Enteropathy-associated T-cell lymphoma (EATL)
Refractory celiac disease unresponsive to strict gluten-free diet, particularly type II, carries a high risk of progression to enteropathy-associated T-cell lymphoma (EATL).