GI LIVER PANCREAS

Which of the following would LEAST LIKELY account for an ulcer in the distal esophagus?

Which of the following conditions is characterized by findings of giant rugal hypertrophy, thickened gastric mucosa, excessive mucus production, hypoproteinemia and hypochlorydia?

Most common type of cancer arising from the distal 1/3 of esophagus?

A 35-year-old man with a history of alcohol use disorder is brought to the ER with hematemesis. Prior to this, he has had three episodes of vomiting. His BP is 110/80 mmHg and pulse is 98/min. He has no jaundice. Lungs are clear to auscultation. Abdomen is soft, non tender, and non-distended. There is no hepatomegaly. Endoscopy shows longitudinal mucosal tears at the gastroesophageal junction. This patient's condition is most likely related to which of the following?

A 55-year-old man presents with upper gastrointestinal bleeding and is found to have multiple ulcers in the duodenum. Workup finds his serum gastrin levels to be markedly elevated, and an abdominal CT scan finds a large mass in the tail of the pancreas. A biopsy from this pancreatic mass finds an islet-cell adenoma that secretes gastrin. Which of the following is the best diagnosis?

Which one of the following conditions is NOT part of the spectrum of pathology associated with Crohn disease?

40 year old male patient presented with repeated episodes of bloody stools. Workup and evaluation revealed multiple superficial broad based ulcers, with diffuse inflammation limited to the colon, biopsy revealed inflammation limited only to the submucosal area, which of the following is the most likely condition?

A 54-year-old man comes to the office for evaluation of chronic diarrhea and weight loss. He has had bulky, foul-smelling stools for the past 8 months, which usually occur shortly after eating. There have been no noctumal bowel movements, and he denies fecal incontinence. The patient also experiences dull, epigastric abdominal pain that is exacerbated by eating and unrelieved by antacids. He drinks 6 or 7 beers a day but denies tobacco or illicit drug use. Vital signs are within normal limits. The abdomen is tender to palpation in the epigastrium without distension, rebound, or guarding. Sudan staining of a fecal specimen is positive, and fecal occult blood testing is negative. Blood testing reveals normal hemoglobin. Which of the following pathophysiologic changes are most likely present in this patient?

A 62-year-old man has had anorexia, vomiting, and vague abdominal pain accompanied by weight loss of 6 kg over the past 2 months. Physical examination reveals supraclavicular non-tender lymphadenopathy. He becomes progressively cachectic. An abdominal CT scan shows the stomach is shrunken with the gastric wall thickened to 1 cm and with extensive overlying mucosal erosions. Multiple masses from 1 to 4 cm in size are scattered within the liver. Which of the following conditions most likely preceded development of his illness?

A 62-year-old man has had anorexia, vomiting, and vague abdominal pain accompanied by weight loss of 6 kg over the past 2 months. Physical examination reveals supraclavicular non-tender lymphadenopathy. He becomes progressively cachectic. An abdominal CT scan shows the stomach is shrunken with the gastric wall thickened to 1 cm and with extensive overlying mucosal erosions. Multiple masses from 1 to 4 cm in size are scattered within the liver. Which of the following conditions most likely preceded development of his illness?

A 32-year-old woman has a 10 year history of intermittent, bloody diarrhea. She has no other major medical problems. On physical examination there are no lesions palpable on digital rectal examination, but a stool sample is positive for occult blood. Colonoscopy reveals a friable, erythematous mucosa with focal ulceration that extends from the rectum to the mid-transverse colon. Biopsies are taken and all reveal mucosal acute and chronic inflammation with crypt distortion, occasional crypt abscesses, and superficial mucosal ulceration. This patient is at greatest risk for development of which of the following conditions?

Which of the following conditions is characterized by findings of giant rugal hypertrophy, thickened gastric mucosa, excessive mucus production, hypoproteinemia and hypochlorydia?

The mother of a newborn girl complains to the pediatrician that the infant is coughing, drooling excessively, and vomiting immediately after every feeding. The woman’s pregnancy was complicated by gestational polyhydramnios. The physician attempts to place a nasogastric tube in the infant, but x-ray of the chest reveals that it cannot pass to the stomach, which is distended with air. What is the most likely diagnosis?

A 60-year-old man presents with hematemesis, melena, guaiac-positive stools, and signs of circulatory collapse. He has a 20-year history of burning midepigastric pain and tenderness relieved by food, milk, or antacids. Also, he has been taking high doses of NSAIDs to relieve the pain of long-standing arthritis. Esophagogastroduodenoscopy reveals a peptic ulcer in the upper duodenum. Which of the following is an important association of duodenal peptic ulcer disease?

A 24-year-old woman gives birth to term infant after an uncomplicated pregnancy. Three days after birth, the infant vomits all oral feedings. On physical examination, the infant is afebrile, but the abdomen is distended and tender, and bowel sounds are reduced. An abdominal ultrasound scan shows marked colonic dilation above a narrow segment in the distal sigmoid region. A biopsy specimen from the narrowed region shows an absence of ganglion cells in the muscle wall and submucosa. Which of the following is most likely to produce these findings?

A 40-year-old Caucasian male complains of food "sticking" in his throat. He also experiences nocturnal regurgitation and cough. On barium swallow, the esophagus is dilated, with a n narrowing of the distal esophagus that has been likened to a "bird's beak". Which of the following is the most likely cause of this patient's complaints?

Which polyp has the highest risk of progression to carcinoma?

A 59-year-old man presents to the clinic for complaints of bad breath and recurrent coughing spells. He complains difficulty swallowing at times and is noted to have a moderately sized neck mass during physical examination. What of following is the most likely diagnosis?

A 19-year-old woman presents to the emergency department with severe retrosternal chest pain. Her symptoms began immediately after vomiting. Medical history is significant for bulimia nervosa. Physical examination is notable for crepitus upon chest wall palpation. What of following is the most likely diagnosis?

A 31-year-old man presents to the physician with a 1-year history of chronic recurrent right lower quadrant abdominal pain and diarrhea. The patient also has had low-grade fevers and a 6.7-kg (15-lb) weight loss during this period. Colonoscopy reveals multiple lesions of the terminal ileum and colon. Biopsies of these lesions reveal full-thickness inflammation and ulceration of the involved mucosa. Which of the following is the most likely diagnosis?

A 31-year-old male with cirrhosis, dementia, and Parkinson-like symptoms is diagnosed with a hereditary metabolic disease resulting from the accumulation of a certain metal in various tissues. Impairment of which of the following elimination pathways is most likely responsible?

A 41-year-old man presents to the clinic complaning of substernal chest pain and regurgitation of undigested food. He also reports having difficulty swallowing both solid and liquids. A barium esophgram demonstrates a dilated proximal esophagus with a narrow tapering. Which of the following condition is the most likely to be present in this man? "Please see the picture"

Which of the following disease is associated with transmural inflammation?

A 50-year-old woman with a history of acid reflux presents to her primary care physician for intermittent non-exertional chest pain. The pain is not associated with exercise or shortness of breath. She also reports that for the past few months, she has experienced the sensation of food stuck in her throat. She had been worried about her heart, and so she recently had an extensive work-up for coronary artery disease with her cardiologist, all of which were negative. Suspicious for an esophageal etiology for her chest pain, her physician orders an upper gastrointestinal barium swallow study, which shows a corkscrew-like esophagus. She is started on a calcium channel blocker. Which of the following is the most likely diagnosis?

A 45-year-old man has had vague abdominal pain and nausea for the past 3 years. This pain is unrelieved by antacid medications. He has no difficulty swallowing and no heartburn following meals. On physical examination there are no abnormal findings. Upper GI endoscopy reveals antral mucosal erythema, but no ulcerations or masses. Biopsies are taken, and microscopically there is a chronic non-specific gastritis. Which of the following conditions is most likely to be present in this man?

On reviewing a liver biopsy specimen, the following features are identified: steatosis, Mallory bodies, and acute inflammation. Which of the following is the MOST LIKELY diagnosis?

A 53-year old male, who is a chronic IV drug user and alcoholic, presented with scleral icterus, abdominal tenderness on RUQ and positive fluid wave. Biopsy of the liver was done showing bridging fibrosis and hepatocytes which appear to have finely granular cytoplasm. The most likely diagnosis for this patient is:

A 13-year-old boy presents to the pediatrician with extrapyramidal signs, including a resting and kinetic tremor. An ophthalmologic examination demonstrates the presence of Kayser-Fleischer rings, and his laboratory studies demonstrate elevated liver enzymes. It is likely that the patient’s condition is associated with the accumulation of

A 36-year-old woman at 34 weeks gestation presents to the emergency room for abdominal pain and headaches. She reports noticing these symptoms last night but attributed it to eating some take-out last night. On physical exam, she has tenderness to palpation in the epigastrium. Her blood pressure is 166/115 mmHg. She begins having tonic-clonic seizures. She is immediately prepped for delivery via cesarean section and started on anti-seizure medications. The most likely diagnosis is:

A 42-year-old woman with a history of polycystic ovarian syndrome and diabetes presents to her primary care physician's office for abdominal pain. She reports that she has experienced this for the past few months. On physical exam, her skin is noted to be hyperpigmented. She also has hepatomegaly. Given these findings, her physician sends her for laboratory testing, which shows elevated transaminases, iron, and ferritin. She is scheduled for regular phlebotomy. Which of the following is the most likely diagnosis?

A 5-year-old boy is brought to the office by his mother, who notes that her son's eyes and feet have looked puffy over the last several weeks. She is unaware of exactly when this began but says the patient had a mild upper respiratory tract infection several weeks ago. The boy had no pain but mentions that his shoes seems to fit tightly and bother him, especially when he runs outside during recess at school. The mother also remarks that the boy's urine has been excessively foamy recently. On further questioning, the mother states that she has seasonal allergies and ask whether her child also has allergies. Physical examination is remarkable for periorbital edema and lower extremity edema. Urinalysis shows 4+ proteinuria but is otherwise unremarkable. Which of the following secondary changes is most likely in this patient?

An 18-year old male noted recurrent painless hematuria after having bloody diarrhea and fever 2 weeks before. No other sign or symptom was noted. The most likely diagnosis is:

A previously healthy 24-year-old man experiences acute onset hemoptysis and renal failure. An assay for which of the following would most likely be positive in this case?

A patient with hemoptysis and renal failure has a renal biopsy which reveals crescentic proliferative glomerulonephritis. Immunofluorescence reveals linear deposits of IgG and C3. The diagnosis is:

A 23-year-old woman is being evaluated for recurrent episodes of urinary tract infection. She has had 5 episodes of cystitis and an episode of pyelonephritis over the past year. The symptoms tend to occur a few days following sexual intercourse. The patient has no other medical problems and takes no medications. Her temperature is 36.7 C (98 F), blood pressure is 110/70 mm Hg, respirations are 16/min, and pulse is 65/min. Abdominal and genitourinary examinations are normal. Which of the following is the most likely predisposing factor for pyelonephritis in this patient?

A 70-year-old man is brought to the hospital by his son for evaluation of worsening fatigue. The patient has not seen a physician in the past 15 years. He takes naproxen occasionally for knee arthritis. Physical examination of the prostate shows no abnormalities. Laboratory results are as follows: Complete blood count Hemoglobin 10.5 g/dL Leukocytes 7100/mm3 Platelets 150000/mm3. Serum chemistry Sodium 135 mEq/L Potassium 5.1 mEq/L Blood urea nitrogen 45 mg/dL Creatinine 3.0 mg/dL. Urine sediment is unremarkable. Ultrasound examination shows bilateral small kidneys and no hydronephrosis. Kidney biopsy shows intimal thickening and luminal narrowing of the renal arterioles with evidence of glomerular sclerosis. Which of the following is most likely responsible for this patient's kidney disease?

A 45-year-old woman with a long-term history of poorly controlled diabetes mellitus is found to have proteinuria. A renal biopsy reveals hyaline arteriosclerosis of the afferent and efferent arterioles along with Kimmelstiel-Wilson lesions in a few of the glomeruli. Which of the following is the most likely diagnosis for these glomerular abnormalities?

A 45-year-old man presents with abdominal pain and hypertension. On physical examination, he is found to have an abdominal mass. Further workup confirms the diagnosis of adult polycystic kidney disease. Which of the following vascular complications is associated with this condition?

A 20-year-old woman with the nephrotic syndrome and slowly progressive impairment of renal function marked by azotemia undergoes a renal biopsy. The patient’s response to corticosteroid medication has been unimpressive. The appearance of the biopsy is similar to that shown in the figure. The most likely diagnosis is

A 3-year-old girl presents with generalized edema shortly after recovery from an upper respiratory infection. Laboratory studies reveal marked albuminuria, as well as hypoalbuminemia and hyperlipidemia. Prior similar episodes responded to adrenal steroid medication. The most likely diagnosis is

A 30-year-old female patient presents with a new onset of peripheral edema. Physical examination finds hypertension and bilateral pedal edema. Urinalysis finds massive proteinuria, and evaluation of her serum finds elevated levels of cholesterol. A silver stain of a renal biopsy specimen reveals a characteristic "spike and dome" pattern, and electron microscopy finds a uniform deposition of small electron-dense deposits in a subepithelial location. Which of the following immunofluorescence patterns is most characteristic of this patient's renal disease?

A four-year-old child develops steroid-sensitive nephrotic syndrome. Renal biopsy studies demonstrate normal appearing glomeruli by light microscopy and fusion of foot processes by electron microscopy. Which of the following proteins would be present in the urine in the highest concentration?

A 16-year-old previously healthy girl visits her doctor with recent-onset flank pain. She is given ibuprofen and sent home. A day later, she develops a fever accompanied by nausea, emesis, and worsening flank pain. Upon questioning, she recalls episodes of urgency as well as decreased urine output. Physical examination is notable for a temperature of 38.9°C (102.0°F) and costovertebral angle tenderness. Laboratory findings are as follows: WBC count: 13,900/mm3. What the most likely diagnosis?

Which of the following the most likely cause of the clinical combination of increased blood pressure, edema, hematuria, and red blood cell casts in the urine?

A 56-year-old man with a history of chronic myeloid leukaemia for which he has started receiving chemotherapy presents with left flank pain and oliguria. He has tenderness over his left renal angle. A working diagnosis of kidney stones is made. Both abdominal x-ray and CT scan are unremarkable and no stone is visible. His stone is most likely composed of which of the following?

A 43-year-old woman comes to the office with a 1-month history of dull abdominal pain that occurs mainly after eating. The pain is localized to the right upper quadrant and is especially severe after fatty meals. Physical examination is unremarkable. Ultrasound of the abdomen reveals several mobile echogenic foci within the gallbladder lumen. Which of the following sets of conditions is most likely present within this patient's gallbladder?

A 45-year-old obese woman presents to the emergency room with steady, severe, aching pain in the upper right quadrant that radiates to the right scapula. The onset was acute and occurred 30 minutes after lunch. She also reports nausea with vomiting. On physical exam, it is noted that she stops breathing on deep palpation of the right quadrant. Laboratory studies show an absolute neutrophillic leukocytosis with a left shift. What of following is the most likely diagnosis?

A 63-year-old chronic alcoholic presents with weight loss, anorexia, and abdominal pain radiating to the back. Physical examination indicates a palpably enlarged gallbladder, and laboratory studies demonstrate conjugated hyperbilirubinemia. Computed tomography demonstrates a mass in the head of the pancreas. Which of the following is associated with the diagnosis of pancreatic adenocarcinoma?

A 72-year-old woman notes increasing jaundice and nausea for the past month. On physical examination she is afebrile, but scleral icterus is present. There is no abdominal pain on palpation. She has active bowel sounds. A stool sample tested for occult blood is negative. Laboratory findings include total protein 6.1 g/dL, albumin 3.3 g/dL, alkaline phosphatase 210 U/L, AST 49 U/L, ALT 40 U/L, total bilirubin 7.2 mg/dL, and direct bilirubin 6.3 mg/dL. Her serum lipase is 50 U/L. Which of the following conditions is she most likely to have?