MCQ Book Questions

Q60422. A 50-year-old obese man (BMI = 32 kg/m2) comes to the phy- sician complaining of indigestion after meals, bloating, and heartburn. Vital signs are normal. A CT scan of the abdomen reveals a hiatal hernia of the esophagus. Endoscopic biopsy shows thickening of the basal layer of the squamous epithe- lium, upward extension of the papillae of the lamina propria, and an increased number of neutrophils and lymphocytes. Which of the following is the most likely diagnosis?

Q60423. A 30-year-old man with AIDS complains of severe pain on swallowing. Upper GI endoscopy shows elevated, white plaques on a hyperemic and edematous esophageal mucosa. Which of the following is the most likely diagnosis?

Q60424. A 65-year-old woman complains of a 4-month history of bad breath, regurgitation of undigested food, occasional aspiration of food, and change in the sound of her voice. A barium swallow examination shows a posterior, midline pouch greater than 2 cm in diameter arising just above the cricopharyngeal muscle. Which of the following is the most likely diagnosis?

Q60425. A 45-year-old man presents with long-standing heartburn and dyspepsia. An X-ray fi lm of the chest shows a retrocardiac, gas-fi lled structure. This patient most likely has which of the following conditions?

Q60426. A 3-year-old boy is rushed to the emergency room in acute distress. The child has vague chest pain and diffi culty swal- lowing. He refuses to drink water. Physical examination shows drooling and salivation. Vital signs are normal. The mother states that she saw the boy ingesting a liquid used to clear drains. If this chemical was a strong acid, which of the follow- ing histopathologic fi ndings would be expected in the esopha- gus of this child?

Q60427. A 70-year-old woman presents with diffi culty swallowing and a 9-kg (20-lb) weight loss over the past several months. Endoscopy reveals irregular narrowing of the lower third of the esophagus. A biopsy shows markedly atypical cuboidal cells lining irregular gland-like structures. Which of the fol- lowing is the most likely diagnosis?

Q60428. A 40-year-old woman presents with a 2-month history of burning epigastric pain that usually occurs between meals. The pain can be relieved with antacids or food. The patient also reports a recent history of tarry stools. She denies tak- ing aspirin or NSAIDs. Laboratory studies show a micro- cytic, hypochromic anemia (serum hemoglobin = 8.5 g/dL). Gastroscopy reveals a bleeding mucosal defect in the antrum measuring 1.5 cm in diameter. An endoscopic biopsy shows that the lesion lacks mucosal lining cells and is composed of amorphous, cellular debris and numerous neutrophils. Which of the following is the most important factor in the pathogen- esis of this patient’s disease?

Q60429. A 58-year-old woman suffers a massive stroke and expires. The stomach at autopsy is shown in the image. Prior to her death, this patient would most likely have exhibited which of the following?

Q60430. A 58-year-old woman is brought to the emergency department 4 hours after vomiting blood and experiencing bloody stools. The patient was diagnosed with alcoholic cirrhosis 2 years ago. The patient subsequently goes into shock and expires. The histologic appearance of the esophagus at autopsy is shown in the image. Which of the following is the most likely underly- ing cause of hematemesis and hematochezia in this patient?

Q60431. A 3-week-old boy is brought to the physician by his parents, who report that he vomits forcefully immediately after nurs- ing. Physical examination reveals an “olive-like” palpable mass and visible peristaltic movements within the infant’s abdomen. What is the most likely cause of projectile vomiting in this infant?

Q60432. A 50-year-old woman with long-standing rheumatoid arthritis complains of weakness and fatigue. She states that her stools have recently become black after taking a new nonsteroidal anti-infl ammatory drug (NSAID). Gastroscopy shows numer- ous superfi cial, bleeding mucosal defects. Which of the fol- lowing is the most likely diagnosis?

Q60433. A 58-year-old woman presents with a 2-month history of abdominal discomfort and dark stools. Physical examination shows pallor but no evidence of jaundice. Laboratory studies disclose a microcytic, hypochromic anemia, with a hemoglo- bin level of 6.7 g/dL. A barium swallow radiograph reveals a “leather bottle” appearance of the stomach. Microscopic exam- ination shows diffusely infi ltrating malignant cells, many of which are “signet ring” cells, in the stomach wall. Which of the following is the most likely diagnosis?

Q60434. A 42-year-old man presents with long-standing abdominal pain after meals, which is relieved by over-the-counter antac- ids. The patient has lost 9 kg (20 lb) in the past year. Physical examination reveals peripheral edema and ascites. Laboratory studies show decreased serum albumin but normal serum levels of transaminases and gastrin. Gross and microscopic examination of this patient’s stomach would most likely show which of the following pathologic changes?

Q60435. A 55-year-old woman complains of upper gastrointestinal pain and tarry stools. Upper endoscopy shows a fi rm, smooth, yel- lowish submucosal ulcerated mass in the stomach. Gastro- scopic biopsy reveals spindle cells with vacuolated cytoplasm. The mass is removed, and the surgical specimen is shown in the image. Which of the following is the most likely diagnosis?

Q60436. A 45-year-old woman presents with a 6-month history of fatigue and swelling in her neck. Physical examination shows a goiter. A CBC discloses megaloblastic anemia and a normal reticulocyte count. Additionally, there is an elevated serum level of TSH and antithyroid antibodies. Needle aspiration of the left lobe of the thyroid reveals benign follicular cells and numerous lymphocytes. Anemia in this patient is most likely caused by antibodies directed to which of the following targets?

Q60437. A 45-year-old man describes burning epigastric pain 2 to 3 hours after eating. Foods, antacids, and over-the-counter medications provide no relief, and prescribed inhibitors of acid secretion are only moderately effective. Recently, the patient noticed that his stools were black. Physical exami- nation reveals abdominal tenderness. The blood pressure is 120/80 mm Hg in the supine position and 90/50 mm Hg sitting up. The patient complains of lightheadedness upon returning to a standing position. CBC shows a hemoglobin of 6.3 g/dL. Endoscopy reveals multiple gastric and duodenal ulcers. Epi- gastric pain and anemia are most likely related to a neoplasm arising in which of the following anatomic locations?

Q60438. A 60-year-old man presents with epigastric pain after meals, with some nausea and vomiting. A burning sensation in the midepigastrium is relieved by antacids and H2 antagonists. Upper endoscopy demonstrates paired ulcers on both walls of the proximal duodenum. Which of the following represents the most common complication of this patient’s duodenal disease?

Q60439. A 45-year-old woman presents with sudden attacks of wheez- ing, shortness of breath, and episodic hot fl ashes. She also reports abdominal cramps and diarrhea. Physical examination shows facial redness, pitting edema of the lower legs, and a murmur of tricuspid regurgitation. A 24-hour urine speci- men contains elevated levels of 5-hydroxyindoleacetic acid (5-HIAA). A CT scan of the abdomen demonstrates multiple 1- to 2-cm nodules in distal ileum. A small bowel resection is performed (shown in the image). The arrows point to submu- cosal tumors. Microscopic examination shows nests of cells with round and uniform nuclei. Which of the following is the most likely diagnosis?

Q60440. A 5-year-old girl is brought to the physician after her parents noticed red blood in her stool. Physical examination reveals mucocutaneous pigmentation. Small bowel radiography dis- closes multiple, small- to medium-sized polyps that are diag- nosed pathologically as hamartomas. Which of the following is the most likely diagnosis?

Q60441. A 56-year-old woman comes to the physician after noticing multiple lumps in her neck. Physical examination shows enlarged and nontender supraclavicular lymph nodes. Upper endoscopy discloses thickening of the gastric mucosa, without an obvious tumor. The results of gastric biopsy are shown in the image. Which of the following is the most likely diagnosis?