MCQ Book Questions

Q60502. A 40-year-old woman complains of having severe back pain for about 3 months and recurrent fever. Her past medi- cal history is signifi cant for ulcerative colitis. On physical examination, the patient is thin and jaundiced. The liver edge descends 1 cm below the right costal margin and is nontender. Laboratory studies show normal serum levels of AST and ALT but elevated serum levels of alkaline phosphatase (420 U/L). Endoscopic retrograde cholangiopancreatography demon- strates a beaded appearance of the extrahepatic biliary tree. Which of the following diseases is a late complication of this patient’s condition?

Q60503. A 32-year-old man presents with a 6-month history of yellow skin and sclerae. Physical examination shows mild jaundice, pitting edema, and ascites. Laboratory studies reveal decreased serum albumin (2.6 g/dL) and increased serum AST and ALT (120 and 140 U/L, respectively). A liver biopsy stained with period acid-Schiff (PAS) reagent and diastase digestion is shown in the image. This patient has which of the following genetic diseases?

Q60504. A 42-year-old man is brought to the emergency room with right upper quadrant pain, shaking chills, and a fever of 38.7°C (103°F). His past medical history is signifi cant for an appendectomy 2 weeks previously. Physical examination reveals hepatomegaly and tenderness in the right upper quad- rant. Laboratory studies show normal levels of serum albumin, ALT, and bilirubin, as well as increased alkaline phosphatase of 240 U/L. The WBC count is 28,000/μL. Which of the fol- lowing is the most likely diagnosis?

Q60505. A 22-year-old woman from India presents with a 1-week history of fever, malaise, and nausea. The patient is 6 months pregnant. Physical examination reveals jaundice and right upper quadrant pain. Results of laboratory studies include serum bilirubin of 5.2 mg/dL (60% conjugated), AST of 400 U/L, ALT of 392 U/L, alkaline phosphatase of 70 U/L, anti-HAV antibodies negative, HBsAg negative, and IgM anti– hepatitis E virus (anti-HEV) antibodies positive. The patient is at high risk for which of the following?

Q60506. A 55-year-old, obese man (BMI = 34 kg/m2) comes to the physician for a routine physical examination. His past medi- cal history is signifi cant for type 2 diabetes mellitus that is controlled by medication and diet. The patient neither drinks nor smokes. Physical examination shows mild hepatomegaly. Laboratory studies reveal normal serum levels of albumin and bilirubin and mildly elevated serum levels of AST and ALT (80 and 100 U/L, respectively). The serum level of alkaline phosphatase is normal (70 U/L), and total serum cholesterol is elevated to 290 mg/dL. The CBC is normal. Abdominal ultra- sound reveals diffuse fatty infi ltration of the liver. Which of the following is the most likely diagnosis?

Q60507. A 6-month-old girl is brought to the physician by her parents, who noticed gradual enlargement of the child’s abdomen. Physical examination reveals massive hepatomegaly. Labora- tory studies show normal serum levels of albumin, bilirubin, and hepatic enzymes. Liver biopsy discloses enlarged hepato- cytes with PAS-positive inclusions. Laboratory studies reveal the presence of amylopectin. Deposits of this abnormal glyco- gen are also found in a biopsy of skeletal muscle. Which of the following is the appropriate diagnosis?

Q60508. A 20-year-old woman complains of intermittent, colicky abdominal pain, fi ne tremors of her hands, excess sweating, and a general feeling of restlessness. Laboratory studies reveal an inherited defect in the biosynthesis of heme. This patient’s genetic disease is most likely caused by defi ciency of which of the following liver enzymes?

Q60509. A 69-year-old woman arrives in the emergency room complaining of weakness, abdominal pain, and a 9 kg (20 lb) weight loss during the past month. Physical examination reveals jaundice, conspicuous hepatomegaly, and ascites. The patient expires, and a section of liver is examined at autopsy (shown in the image). Which of the following is the most likely diagnosis?

Q60510. A 22-year-old man presents with a 3-week history of yellow skin and sclerae but is otherwise asymptomatic. He recalls a similar episode 2 years previously. Occasionally, he has noticed dark-colored urine. The serum bilirubin is 4.4 mg/dL, mostly in the conjugated form. Serum AST and ALT levels are normal. A liver biopsy is shown in the image. Which of the following is the most likely diagnosis?

Q60511. A 1-month-old infant is brought to the physician by her parents. She has had repeated bouts of bilious vomiting over the past month and cannot be fed adequately. She is in the 10th percentile for weight and the 50th percentile for length. An upper GI series discloses marked narrowing of the midpor- tion of the duodenum. What is the most likely cause of this infant’s GI obstruction?

Q60512. A 42-year-old obese woman (BMI = 32 kg/m2) presents with severe abdominal pain that radiates to the back. There is no history of alcohol or drug abuse. The blood pres- sure is 90/45 mm Hg, respirations are 32 per minute, and pulse is 100 per minute. Physical examination shows abdom- inal tenderness, guarding, and rigidity. An X-ray fi lm of the chest shows a left pleural effusion. Laboratory studies reveal elevated serum amylase (850 U/L) and lipase (675 U/L), and hypocalcemia (7.8 mg/dL). Which of the following is the most likely diagnosis?

Q60513. Which of the following is most likely associated with the pathogenesis of the condition of the patient described in Question 2?

Q60514. A 60-year-old alcoholic man presents with a 6-month history of recurrent epigastric pain, progressive weight loss, and foul- smelling diarrhea. The abdominal pain is now almost constant and intractable. An X-ray fi lm of the abdomen reveals multiple areas of calcifi cation in the mid-abdomen. Which of the fol- lowing is the most likely diagnosis?

Q60515. Which of the following fi ndings is most likely to be encoun- tered in the patient described in Question 4?

Q60516. A 50-year-old woman complains of persistent abdominal pain, anorexia, and abdominal distention. Her past medical history is signifi cant for a previous hospitalization for acute pancrea- titis. Physical examination shows jaundice and a nonpulsa- tile abdominal mass. Laboratory studies reveal normal serum levels of bilirubin, AST, and ALT. A CT scan of the abdomen shows a fl uid-fi lled cavity in the head of the pancreas. What is the most likely diagnosis?

Q60517. A 65-year-old woman presents with a 5-week history of yel- low skin and sclera, anorexia, and epigastric pain. Her past medical history is signifi cant for insulin-dependent diabetes mellitus. She smoked one pack of cigarettes a day for the past 20 years. Physical examination reveals jaundice and a palpable gallbladder. Laboratory studies show a serum bilirubin level of 10 mg/dL, mostly in the conjugated form, and an elevated alkaline phosphatase (260 U/L). A CT scan of the abdomen discloses a mass in the head of the pancreas and multiple nod- ules in the liver measuring up to 3 cm. Which of the following is the most likely cause of jaundice in this patient?

Q60518. Which of the following is the most important risk factor for the neoplasm arising in the patient described in Question 10?

Q60519. A 47-year-old man suffers from long-standing peptic ulcer dis- ease, which is largely unresponsive to pharmacologic therapy. Endoscopic examination reveals multiple, nonhealed ulcer- ations of the duodenum and jejunum. Which of the following is the most likely diagnosis?

Q60520. A 35-year-old woman presents with 6-month history of skin rash and fatigue. Physical examination shows pallor and a necrotizing erythematous skin rash of her lower body. Labora- tory studies reveal mild anemia and fasting blood glucose of 160 mg/dL. A CT scan of the abdomen demonstrates a 2-cm mass in the pancreas. Which of the following is the most likely diagnosis?

Q60521. The surgical specimen is shown in the image for the patient described in Question 6. In addition to blood and necrotic debris, which of the following best describes the contents of this cystic lesion?