Internal Medicine Exam Gastroenterology and Hepatology 3

Question 1

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?

Accepted Answer

Pancreatic head adenocarcinoma

Answer

Courvoisier's sign (palpable non-tender gallbladder with painless jaundice) in an older patient strongly suggests malignant biliary obstruction, most commonly pancreatic head carcinoma.

Question 2

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?

Accepted Answer

Primary sclerosing cholangitis

Answer

Primary sclerosing cholangitis (PSC) presents with characteristic 'beaded' intra- and extrahepatic biliary strictures on MRCP and is strongly associated with IBD, particularly ulcerative colitis.

Question 3

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?

Accepted Answer

IV corticosteroids

Answer

Severe UC (Truelove-Witts criteria: >6 bloody stools/day plus systemic features) requires hospitalization and IV corticosteroids as first-line treatment.

Question 4

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?

Accepted Answer

Endoscopic surveillance with biopsies per Barrett's protocol

Answer

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.

Question 5

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?

Accepted Answer

Furosemide causing hypokalemia and alkalosis

Answer

Excessive diuresis with furosemide causes hypokalemia and metabolic alkalosis, which increases ammonia production in the kidney and reduces ammonia excretion, precipitating hepatic encephalopathy.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Gastroenterology and Hepatology 3