Gastrointestinal and Nutrition Flashcards

A 48-year-old male with a long history of heavy alcohol consumption presents with jaundice, ascites, and fever. His laboratory results show an AST of 300 U/L, an ALT of 120 U/L, and an elevated GGT. Which of the following features is most characteristic of alcoholic liver disease?

Answer: AST:ALT ratio > 2:1

An AST to ALT ratio greater than 2:1 is a classic laboratory finding highly suggestive of alcoholic liver disease. [6, 8, 11] In most other forms of liver injury, the ALT is typically higher than or equal to the AST. The absolute levels of aminotransferases in alcoholic hepatitis are usually only moderately elevated (<500 U/L). [2, 14, 26]

A 68-year-old female with a history of autoimmune gastritis presents with progressive fatigue, paresthesias in her lower extremities, and glossitis. A complete blood count reveals a macrocytic anemia. Which of the following is the most likely underlying deficiency?

Answer: Cobalamin (Vitamin B12)

The patient's presentation of macrocytic anemia combined with neurological symptoms (paresthesias) is a classic manifestation of cobalamin (Vitamin B12) deficiency. [32, 34, 36] Her history of autoimmune gastritis is a major risk factor for pernicious anemia, which is the leading cause of B12 deficiency due to a lack of intrinsic factor needed for absorption. [3, 5, 7]

According to the most recent United States Preventive Services Task Force (USPSTF) recommendations, at what age should average-risk adults begin screening for colorectal cancer?

Answer: 45

In May 2021, the United States Preventive Services Task Force (USPSTF) updated its guidelines, lowering the recommended age for average-risk adults to begin screening for colorectal cancer from 50 to 45. [9, 12, 16] This change was based on data showing an increasing incidence of colorectal cancer in younger adults. [12]

A 4-week-old male infant presents with a 1-week history of non-bilious, projectile vomiting immediately after feeding. The mother reports he seems hungry all the time. On physical examination, an olive-sized mass is palpated in the epigastric region. What is the most appropriate next step to confirm the diagnosis?

Answer: Abdominal ultrasound

The history and physical exam findings are classic for hypertrophic pyloric stenosis. Abdominal ultrasound is the preferred, most sensitive, and specific imaging modality to confirm the diagnosis. [13, 23, 24] It is non-invasive, avoids radiation exposure, and allows for direct measurement of the pyloric muscle thickness and channel length. [25, 28]

A 25-year-old male is diagnosed with moderate-to-severe ileocolonic Crohn's disease. Which of the following biologic agents is often considered a first-line therapy for inducing and maintaining remission in this patient?

Answer: Infliximab (an anti-TNF agent)

For moderate-to-severe Crohn's disease, biologic therapies such as anti-TNF agents (e.g., infliximab, adalimumab) are recommended as a first-line treatment to both induce and maintain clinical remission. [15, 29, 45] Corticosteroids like prednisone are used for short-term induction but not maintenance, while mesalamine has limited efficacy in moderate-to-severe disease. [4, 10]

A 55-year-old male complains of a chronic, gnawing epigastric pain that improves with meals but worsens 2-3 hours later. He has no alarm symptoms. Which of the following is considered the most accurate diagnostic test for an active *Helicobacter pylori* infection in this patient?

Answer: Upper endoscopy with biopsy

While the urea breath test and stool antigen assay are excellent non-invasive tests, upper endoscopy with biopsy is considered the most accurate or 'gold standard' for the diagnosis of an active H. pylori infection. [30, 39] It allows for direct histological examination, rapid urease testing, and culture. In a patient over 50 with new-onset dyspepsia, endoscopy is also indicated to rule out other pathology like malignancy.