MD Gastrointestinal Tract Disorders 5

Question 1

A 50-year-old man with a history of NSAID use presents with sudden onset epigastric pain radiating to the back and a rigid abdomen. Upright chest X-ray shows free air under the diaphragm. What has occurred?

Accepted Answer

Perforated peptic ulcer

Answer

Perforated peptic ulcer causes pneumoperitoneum (free air under the diaphragm) and peritonitis, presenting as a surgical emergency with sudden severe epigastric pain and abdominal rigidity.

Question 2

A 2-year-old boy presents with colicky abdominal pain, vomiting, and currant jelly stools. Ultrasound shows a 'target sign' in the right upper quadrant. What is the diagnosis?

Accepted Answer

Intussusception

Answer

Intussusception is the telescoping of one segment of bowel into another, classically presenting in children aged 6 months to 2 years with the triad of colicky pain, vomiting, and currant jelly stools.

Question 3

A patient presents with severe mid-epigastric pain radiating to the back, nausea, and vomiting after a heavy meal. Serum lipase is 1,200 U/L. Which is the most common cause of this presentation?

Accepted Answer

Gallstones and alcohol use

Answer

Gallstones and alcohol use together account for approximately 80% of acute pancreatitis cases, with gallstones being the single most common cause in the US.

Question 4

A patient with long-standing Crohn's disease develops a fistula between the small bowel and bladder (enterovesical fistula). Which symptom would most specifically suggest this complication?

Accepted Answer

Recurrent urinary tract infections with polymicrobial bacteria

Answer

Enterovesical fistula allows intestinal bacteria to enter the bladder, causing recurrent polymicrobial urinary tract infections and pneumaturia (air in the urine).

Question 5

A 60-year-old man presents with difficulty swallowing, regurgitation of food eaten hours earlier, and a gurgling mass in the neck. Barium swallow shows a posterior pharyngeal outpouching. What is the diagnosis?

Accepted Answer

Zenker's diverticulum

Answer

Zenker's diverticulum is a false diverticulum (pulsion type) at Killian's triangle in the posterior hypopharynx, causing regurgitation of undigested food and a palpable neck mass.

MD - Doctor of Medicine Practice Test

MD - Doctor of Medicine Practice Test

MD Gastrointestinal Tract Disorders 5