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 woman with type 2 diabetes has persistently elevated liver enzymes. Liver biopsy shows hepatocyte ballooning, lobular inflammation, and pericellular fibrosis without significant alcohol use. What is the most likely diagnosis?
Answer: Nonalcoholic steatohepatitis (NASH)
NASH is defined by steatohepatitis (ballooning + lobular inflammation + steatosis) in a patient without significant alcohol use and is strongly associated with metabolic syndrome and type 2 diabetes.
A 38-year-old man presents with watery diarrhea (10 stools/day), hypokalemia, and achlorhydria. CT shows a 3 cm pancreatic tail tumor. Which peptide is most likely secreted by this tumor?
Answer: Vasoactive intestinal peptide (VIP)
VIPoma (Verner-Morrison syndrome or WDHA syndrome) presents with watery diarrhea, hypokalemia, and achlorhydria due to excess VIP secretion from a pancreatic neuroendocrine tumor.
A 30-year-old woman with autoimmune hepatitis is in remission on azathioprine monotherapy. She wishes to become pregnant. What is the most appropriate counseling regarding her medications?
Answer: Azathioprine can be continued during pregnancy as the risk of relapse outweighs fetal risk
Azathioprine is considered relatively safe in pregnancy and should be continued to prevent AIH relapse, which poses greater risk to mother and fetus than the medication itself; mycophenolate is teratogenic.
A 72-year-old man with known diverticulosis presents with acute bright red blood per rectum that stops spontaneously. Colonoscopy shows diverticulosis throughout the colon without active bleeding. What is the most common site of diverticular bleeding?
Answer: Right colon (cecum and ascending colon)
Despite diverticula being most prevalent in the sigmoid colon, diverticular bleeding occurs most commonly from right-sided (cecal/ascending) diverticula due to their wider necks and exposed vasa recta.
A 48-year-old man is diagnosed with Wilson's disease presenting as acute liver failure. Which finding on labs would be most characteristic?
Answer: Low serum alkaline phosphatase with Coombs-negative hemolytic anemia
Wilson's disease presenting as acute liver failure characteristically shows paradoxically low alkaline phosphatase (released copper inhibits bone isoform) combined with Coombs-negative hemolytic anemia.
A patient develops C. difficile infection after a course of clindamycin. He is treated with oral vancomycin for 10 days but has his third recurrence within 8 weeks. What is the most effective treatment for recurrent C. difficile infection?
Answer: Fecal microbiota transplantation (FMT)
FMT achieves cure rates of >85-90% for recurrent C. difficile infection and is now recommended by guidelines after multiple recurrences, superior to antibiotic regimens.
A 44-year-old woman presents with episodic diarrhea, flushing, and a new heart murmur. 24-hour urine shows markedly elevated 5-HIAA. CT reveals a 1.5 cm ileal mass and multiple hepatic lesions. What is the first-line therapy for symptom control?
Answer: Octreotide LAR (long-acting somatostatin analog)
Somatostatin analogs (octreotide LAR or lanreotide) are first-line for controlling carcinoid syndrome symptoms and have also demonstrated anti-proliferative effects in well-differentiated neuroendocrine tumors.