Internal Medicine Exam Gastroenterology and Hepatology 5

Question 1

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?

Accepted Answer

Nonalcoholic steatohepatitis (NASH)

Answer

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.

Question 2

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?

Accepted Answer

Vasoactive intestinal peptide (VIP)

Answer

VIPoma (Verner-Morrison syndrome or WDHA syndrome) presents with watery diarrhea, hypokalemia, and achlorhydria due to excess VIP secretion from a pancreatic neuroendocrine tumor.

Question 3

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?

Accepted Answer

Azathioprine can be continued during pregnancy as the risk of relapse outweighs fetal risk

Answer

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.

Question 4

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?

Accepted Answer

Right colon (cecum and ascending colon)

Answer

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.

Question 5

A 48-year-old man is diagnosed with Wilson's disease presenting as acute liver failure. Which finding on labs would be most characteristic?

Accepted Answer

Low serum alkaline phosphatase with Coombs-negative hemolytic anemia

Answer

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.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Gastroenterology and Hepatology 5