Internal Medicine Exam Gastroenterology and Hepatology 2

Question 1

A 45-year-old man with alcoholic cirrhosis develops tense ascites. Paracentesis reveals 4.5 L of fluid removed. Which intervention is most important to prevent post-paracentesis circulatory dysfunction?

Accepted Answer

Administer IV albumin 6-8 g per liter removed

Answer

IV albumin (6-8 g/L of ascites removed) is the standard of care to prevent post-paracentesis circulatory dysfunction after large-volume paracentesis exceeding 5 L.

Question 2

A 60-year-old woman presents with dysphagia to solids and liquids simultaneously from the onset. Barium swallow shows a 'bird-beak' appearance at the lower esophageal sphincter. What is the most likely diagnosis?

Accepted Answer

Achalasia

Answer

Achalasia classically presents with dysphagia to both solids and liquids simultaneously and shows a bird-beak deformity at the lower esophageal sphincter on barium swallow.

Question 3

A 35-year-old woman presents with recurrent episodes of right upper quadrant pain after fatty meals. HIDA scan shows a gallbladder ejection fraction of 20%. What is the most appropriate management?

Accepted Answer

Laparoscopic cholecystectomy

Answer

Biliary dyskinesia with an ejection fraction below 35-40% and typical biliary symptoms is best treated with laparoscopic cholecystectomy.

Question 4

A 50-year-old man with chronic HCV infection has a serum-ascites albumin gradient (SAAG) of 1.8 g/dL. Which condition does this SAAG value indicate?

Accepted Answer

Portal hypertension

Answer

A SAAG ≥1.1 g/dL indicates portal hypertension as the cause of ascites with 97% accuracy; a value of 1.8 g/dL confirms this etiology.

Question 5

A 28-year-old man with Crohn's disease on azathioprine develops fever, right lower quadrant pain, and a palpable mass. CT reveals a 4 cm periappendiceal abscess. What is the best initial management?

Accepted Answer

Percutaneous CT-guided drainage and IV antibiotics

Answer

Abdominal abscesses in Crohn's disease are best managed initially with percutaneous drainage and antibiotics, allowing inflammation to resolve before elective surgery.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Gastroenterology and Hepatology 2