MCQ Book Questions

Q60462. A 2-year-old girl with a history of chronic constipation since birth is brought to the emergency room because of nausea and vomiting. Physical examination shows marked abdominal distension. Abdominal radiography reveals distended bowel loops with a paucity of air in the rectum. A rectal biopsy shows an absence of ganglion cells. Which of the following is the most likely diagnosis?

Q60463. A 25-year-old woman presents with persistent bloody diarrhea of 4 weeks’ duration. She has experienced severe abdominal cramp- ing for the past 3 days. Her temperature is 38°C (101°F), respira- tions are 22 per minute, and blood pressure is 120/70 mm Hg. Physical examination reveals abdominal tenderness and mild abdominal distension. Bowel sounds are diminished. Labora- tory studies show mild hypochromic, normocytic anemia. Stool cultures are negative for pathogens, and no ova or parasites are detected. A blood test for Clostridium diffi cile toxin is negative. Rectosigmoidoscopy shows hemorrhagic mucosal lesions in the distal colorectal region. A biopsy of the colon reveals crypt abscesses, basal lymphoplasmacytosis and crypt distortion. Which of the following represents the most common extraintes- tinal manifestation of the colonic disorder in this patient?

Q60464. A 10-year-old boy is brought to the emergency room after 48 hours of fever and severe abdominal pain. He had devel- oped edema of the legs several weeks previously. The temper- ature on admission is 38.7°C (103°F). Physical examination shows rebound tenderness, guarding, and ascites. An abdomi- nal tap returns numerous segmented neutrophils. This child’s spontaneous bacterial peritonitis is most often associated with which of the following underlying conditions?

Q60465. In addition to anorectal malformation, the infant described in Question 58 is most likely to have which of the following birth defects?

Q60466. A 2-year-old boy is brought to the emergency room with a 48-hour history of nausea, vomiting, and abdominal discom- fort. Physical examination reveals right lower quadrant guard- ing. Ultrasound examination of the abdomen reveals a 2-cm mass in the right iliac fossa. A segment of the small intestine is removed (shown in the image). Which of the following best describes this pathologic fi nding?

Q60467. An 85-year-old man complains of abdominal pain and bright red blood in his stool. An X-ray fi lm of the abdomen shows fecal impaction in the rectosigmoid region. Which of the fol- lowing pathologic lesions is most likely to be found in this patient?

Q60468. Which of the following cellular/biochemical mechanisms best explains the pathogenesis of malabsorption in the patient described in Question 54?

Q60469. A 4-year-old girl is brought to the physician because her par- ents noticed that she has been having pale, fatty, foul-smelling stools. The patient is at the 50th percentile for height and 10th percentile for weight. Her symptoms respond dramatically to a gluten-free diet. Which of the following is the most likely diagnosis?

Q60470. A 53-year-old woman complains of acute diarrhea and severe abdominal pain. She was recently treated with broad-spectrum antibiotics for community-acquired pneumonia. A CBC shows a WBC count of 24,000/μL. The patient subsequently devel- ops septic shock and dies. A portion of her colon is shown at autopsy. These fi ndings are typical of which of the following gastrointestinal diseases?

Q60471. A 62-year-old man is brought to the emergency room in a disoriented state. Physical examination reveals signs of poor hygiene and an odor of alcohol, as well as jaundice, spleno- megaly, and ascites. The patient has a coarse fl apping tremor of the hands, palmar erythema, and diffuse spider angiomata. The abdomen displays dilated paraumbilical veins. Serum levels of ALT, AST, alkaline phosphatase, and bilirubin are all mildly elevated. Soon after admission, the patient vomits a large amount of blood. Which of the following is the most likely underlying cause of hematemesis in this patient?

Q60472. For the patient described in Question 1, which of the follow- ing pathophysiologic mechanisms is most directly associated with the development of ascites?

Q60473. An 18-year-old man presents with a 2-week history of yellow skin and sclerae but is otherwise asymptomatic. He recalls a similar episode 2 years previously. His brother also has recur- rent jaundice. The serum bilirubin is 5.2 mg/dL, mostly in the unconjugated form. Serum AST and ALT levels are normal, as is the urinalysis. Two weeks later, the jaundice resolves spon- taneously. What is the most likely diagnosis?

Q60474. A 48-year-old woman has a 3-week history of fatigue as well as yellow skin and sclerae. Physical examination is unremark- able except for mild jaundice. The serum bilirubin level is 3.7 mg/dL, mostly in the unconjugated form. Liver function tests including serum AST, ALT, and alkaline phosphatase are normal. The hemoglobin level is 6.0 g/dL. After corticosteroids are administered, the jaundice resolves. Which of the follow- ing diseases is the most likely cause of hyperbilirubinemia in this patient?

Q60475. A 20-year-old woman presents with a 2-week history of fever, malaise, and brown-colored urine. She recently visited Mexico. Physical examination reveals jaundice, mild hepatomegaly, and tenderness in the right upper quadrant. The serum bilirubin is 7.8 mg/dL, with 60% in the conjugated form. Serum levels of AST and ALT are markedly elevated (400 and 392 U/L, respec- tively). Serum albumin and immunoglobulin levels are nor- mal. Serum IgM anti–hepatitis A virus (anti-HAV) is positive. IgG anti–hepatitis B surface antigen (anti-HBsAg) antibodies are positive. Anti–hepatitis C virus antibodies are negative. What is the most likely diagnosis?

Q60476. A 3-day-old neonate born after a 32-week gestation develops yellow skin. Physical examination of the infant is unremark- able. Which of the following is most likely to be increased in this neonate’s serum?

Q60477. The patient described in Question 8 is most likely to develop which of the following vascular infl ammatory diseases?

Q60478. A 40-year-old woman presents with a long history of vague upper abdominal pain and frequent indigestion. Physi- cal examination reveals an obese woman with jaundice and abdominal tenderness. Serum bilirubin is elevated (4.2 mg/dL). There is a mild increase in serum AST and ALT (62 and 57 U/L, respectively) and a moderate increase in alkaline phosphatase (325 U/L). Markers for viral hepatitis are negative. Abdominal ultrasound examination shows echogenic stone-like material within the gallbladder and thickening of the gallbladder wall. An intrahepatic mass is also visualized adjacent to the gall- bladder. A cholecystectomy is performed. Histologic examina- tion shows dense fi brosis and glandular structures in the wall of the gallbladder. What is the most likely diagnosis?

Q60479. A 60-year-old man is found in a state of disorientation and is brought to the emergency room in a comatose state. He lived alone, ate poorly, and drank large amounts of hard liquor. Physical examination reveals an emaciated man with a dis- tended abdomen, jaundice, ascites, and a slightly enlarged liver and spleen. A liver biopsy is shown in the image. What blood test would confi rm a diagnosis of hepatic coma?

Q60480. A previously healthy 38-year-old man complains of yellow discoloration of his eyes, abdominal pain, and low-grade fever of 1-month duration. Physical examination demonstrates a distended abdomen, right upper quadrant tenderness, and a palpable liver edge 2 cm below the right costal margin. Total serum bilirubin is 7.4 mg/dL. Serum levels of AST and ALT are elevated (229 and 495 U/L, respectively). The prothrom- bin time is prolonged (18 seconds). A liver biopsy is shown in the image. The arrows point to Councilman bodies. The pathologic fi ndings are indicative of which of the following liver diseases?

Q60481. A 40-year-old black woman has frequent indigestion after meals and abdominal pain. Physical examination demonstrates a moderately obese woman in no acute distress. An ultrasound examination demonstrates numerous echogenic objects within the gallbladder. A cholecystectomy is performed, and the sur- gical specimen is shown in the image. The gallstones seen in this patient are typically associated with which of the follow- ing diseases?