Gastrointestinal III usmle PDF

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Gastrointestinal III – Osmosis & USMLE 1. Increased dietary may relieve symptoms of irritable bowel syndrome in patients with constipation as the primary symptom, as symptoms normally improve with defecation. 2. Irritable bowel syndrome most commonly affects (age/gender) . 3. Symptoms of irritable bowel syndrome are due to problems with gastrointestinal but no structural abnormalities. 4. Irritable bowel syndrome is a gastrointestinal disorder characterized by recurrent abdominal pain, bloating, and regular changes in bowel habits typically between (2) . 5. Crohn disease is an inflammatory bowel disease that causes a appearance in the mucosa. 6. is an inflammatory bowel disease that is associated with cholelithiasis. 7. is an inflammatory bowel disease that can affect any portion of the gastrointestinal tract, though often spares the rectum. 8. Crohn disease is associated with the 9.

or narrowing of the bowel lumen on X-ray.

are two monoclonal antibodies that can be used to treat Crohn disease by binding to tumor necrosis factor-alpha.

10. Crohn disease most commonly affects the

11. (Crohn disease/Ulcerative colitis/both)

. is an/are inflammatory bowel disease(s) associated

with migratory polyarthritis.

12. Crohn disease is an inflammatory bowel disease that is most commonly associated with vitamin deficiency. 13. The most common etiological agent of short bowel syndrome is (disorder) . 14. Crohn disease is an inflammatory bowel disease involving granulomas. 15. Crohn disease is an inflammatory bowel disease associated with a mediated response. 16. Crohn disease is an inflammatory bowel disease that is more commonly associated with (mucosal/transmural)

inflammation and skip lesions

17. Ulcerative colitis is an inflammatory bowel disease that involves only (layers of the GI

tract)

inflammation.

18. Ulcerative colitis is an inflammatory bowel disease with histological findings of

abscesses

with neutrophils, ulcers, and no granulomas. 19. The malignancy

of the colon can be a complication of ulcerative colitis that is usually not a concern until after ten years of disease. 20. Ulcerative colitis is an inflammatory bowel disease that is limited to the (sections of the GI tract) . 21. Ulcerative colitis is an inflammatory bowel disease associated with (hepatobiliary disorder)

and p-ANCA positivity.

22. Ulcerative colitis is an inflammatory bowel disease associated with

quadrant pain and

bloody diarrhea.

23.

is an oral extraintestinal manifestation of Crohn disease and ulcerative colitis.

24. Ulcerative colitis that extends from the rectum to the entire rest of the colon is

termed

.

25. A complication of ulcerative colitis that may be a presenting symptom is

, which is severe

dilation of the colon.

26. Ulcerative colitis is an inflammatory bowel disease associated with a

mediated response and

hence no granulomas.

27. Chronic ulcerative colitis is a potential risk factor for cancer. 28. Ulcerative colitis is an inflammatory bowel disease associated with pseudopolyps, loss of haustra, and a resultant " " appearance on imaging. 29. is the definitive surgical treatment of ulcerative colitis. Answers: 1. Fiber 2. Middle aged women 3. Motility 4. Constipation or diarrhea 5. Cobblestone 6. Crohn disease 7. ‘’ ‘’ 8. String sign 9. Adalimumad and infliximab 10. Ileum and colon 11. Crohn disease and ulcerative colitis 12. Vit B12 13. Crohn disease 14. Noncaseating 15. Th1 16. Transmural 17. Mucosal and submucosal 18. Crypt 19. Adenocarcinoma 20. Colon including the rectum 21. Primary sclerosing cholangitis 22. Left lower 23. Aphtous stomatitis 24. Pancolitis 25. Toxic megacolon 26. Th2 27. Colorectal 28. Lead pipe 29. Colectomy

USMLE: 1. A 15-year-old girl is brought to the office because she’s been having intermittent diarrhea with associated abdominal pain for the past year. Occasionally the abdominal pain improves after she has a bowel movement. She experiences frequent stomach aches that occur without warning, and has tried to avoid various foods including milk, meats, grains, and caffeine, with only moderate and inconsistent improvements in symptoms. She was diagnosed with obsessive compulsive disorder three years ago which is now managed with 100 mg of sertraline daily. She denies vomiting, fever, hematochezia, and melena. There is no family history of gastrointestinal disorders. She is currently in the 60th percentile for weight given her height and her age. Physical examination shows no abnormalities. A barium contrast enema shows no abnormalities. Which of the following is the most likely diagnosis? A. Ascariasis B. C. D. E.

Crohn Disease Irritable Bowel syndrome Adverse effects of sertraline Ulcerative colitis

2. A 22-year-old male comes to the office because of constipation for the past 7 months. He says he has crampy lower abdominal pain that improves upon defecation. His baseline is defecating twice per week. He has sporadic episodes of multiple stools per day that last 2-3 days. He denies nausea, vomiting, or bloody stools. The abdomen is soft and nontender; bowel sounds are normal. A colonoscopy and intestinal biopsy are performed. Which of the following would most likely be seen on light microscopy? A. Mucosal + submucosal inflammation B. Noncaseating granulomas C. Normal intestinal mucosa D. PAS-positive macrophages E. Villous flattening 3. A 24-year-old woman comes to the office because of intermittent diarrhea and crampy abdominal pain over the past year. During these episodes, she notices an increased frequency of bowel movements and softer stool consistency. Her symptoms get worse with stress and

A. B. C. D. E. 4.

improve when she takes loperamide. The abdominal pain is decreased after defecation. She denies bleeding, weight loss, early satiety, family history of colon cancer, and smoking. Esophagogastroduodenoscopy and colonoscopy with biopsy are unremarkable. Which of the following is the most likely diagnosis? Crohn Disease Functional dyspepsia Gastroenteritis Helicobacter pylori gastritis Irritable bowel syndrome A 15-year-old girl comes to the office because of abdominal pain and diarrhea for the past three months. Her symptoms occur in the mornings before school. Physical examination shows

positive bowel sounds, no abdominal tenderness, and no mass on palpation. Stool samples, blood work, and colonoscopy and upper endoscopy all show no abnormalities. Which is the most likely diagnosis? Infectious colitis Inflammatory bowel disease Irritable bowel syndrome Ischemic colitis Short bowel syndrome

A. B. C. D. E. 5. A 29-year-old man comes to the office because of pain during urination. He was treated for a urinary tract infection last month. He also says he has progressively worsening diarrhea over the past two years. These episodes of diarrhea typically last 1-2 weeks, then subside for several weeks to months. Physical examination shows joint pain in many locations, especially in his sacroiliac joint. A urine sample is collected and shows pneumaturia. Which of the following best explains the patient's recurrent urinary tract symptoms?

A. B. C. D.

Enterovesical fistulization Nephrocalcinosis Nephrolitiasis Polycystic kidney disease

E. Pseudomembranous colitis 6. A 30-year-old woman comes to the office because of intermittent diarrhea that has been recurring over the past two months. She has noticed blood in her stool and has had occasional abdominal cramps and nausea. Her temperature is 37.2°C (99°F). Colonoscopy shows skip areas of involvement with a predominance of focal ulcerations in the terminal ileum. Which of the following gene mutations most likely confers susceptibility to this patient's disease

A. B. C. D. E. 7.

APC BRAF MSH2 NOD2 C-KIT A 20-year-old woman comes to the office because of a new rash that appeared two days ago on her legs as shown below. The lesions are non-pruritic and tender to touch. She was recently diagnosed with an inflammatory bowel disease that is still being worked-up. Which of the following is the most likely diagnosis for her dermatological condition?

A. B. C. D.

Dermatitis herpetiformis Erythema chronicum migrna s Erythema marginatum Erythema nodosum

E. Erythrasma

8. A 29-year-old man comes to the emergency department because of right lower abdominal pain, diarrhea, and fever. He says that he has had episodes of this condition for the past two years. The episodes typically last 1-2 weeks, then subside for many weeks to months. During the episodes, he sometimes has bloody diarrhea. Physical examination shows joint pain in many locations, especially in his sacroiliac joint. There are multiple erythema nodosum lesions on his anterior shins. A barium swallow is performed, and the result is shown below. Which of the following best describes the clinical finding shown below?

A. B. C. D.

Bird beak sign Napkin ring sign Signet ring sign String sign of Kantor

E. Toothpaste sign 9. A 22-year-old Jewish woman comes to the emergency department because of severe right lower quadrant abdominal pain for the past two hours. She has had diarrhea and weight loss for several weeks. A colonoscopy is performed, and an image from the procedure is shown below. Which of the following is the most likely complication of this patient's diagnosis? A. Dehydration B. Perforation of appendix C. Perianala fistulas D. Right ovarian necrosis E. Toxic megacolon

10. A 35-year-old woman comes to the clinic because she has had 3 months of recurrent abdominal pain, bloody diarrhea, and weight loss. A biopsy from a colonoscopy is analyzed and shows transmural involvement with rare granulomas. Which of the following most likely corresponds with a finding for this disease? A. Positive perinuclear anti-neutrophil cytoplasmic antibody B. Frameshift mutation in nucleotide-binding oligomerization domain-containing protein 2 gene C. Positive anti-smooth muscle antibodies D. Gain of function of the NLRP-3 gene E. Mutation in the cystic fibrosis transmembrane conductance regulator 11. A 30-year-old woman comes to the office because of increasing fatigue over the past several months. She was diagnosed with Crohn disease as a teenager, for which she had an ileocolic resection 3 years ago. She has not had any recent diarrhea or abdominal pain and says that she has not seen any blood in her stool. She eats a well-balanced diet and takes a multivitamin regularly. Her fecal occult blood test is negative. Which of the following best explains this patient's fatigue? A. Calorie deficit B. Folate deficiency C. Iron deficiency D. Protein deficiency E. Vitamin B12 def

12. A 43-year-old man with a recurrent fistula-in-ano comes to the office for monitoring of his Crohn disease. An MRI is done to determine whether he has developed a complex, multi-tract fistula. The MRI shows that his fistula only follows one tract. It courses perpendicularly to the skin from its external perianal

opening, then takes a sharp 90° turn and burrows through both the external anal sphincter and the internal sphincter to open into the anal canal. According to the Parks classification of fistulas, which of the following most accurately describes this patient's fistula-in-ano? A. Extra-sphincter fistula B. Inter-sphincteric fistula C. Supra-levator fistula D. Supra-sphincteric fistula E. Trans-sphincteric fistula

13. A 25-year-old woman comes to the office because of painful new lesions on both of her legs. The lesions are purple, firm nodules, and her legs are mildly swollen, as seen in the image below. She has had loose stools, intermittent fevers, and weight loss for the past three weeks. Which of the following is the most likely diagnosis? A. Campylobacter enterocolitis B. Celiac Disease C. Crohn disease D. Primary biliary cholangitis E. Rheumatic fever 14. A 33-year-old man comes to the clinic because of abdominal cramps for the past five months. His older brother has had similar episodes in the past. He has recently lost 10 lbs (unintentionally) and has occasional diarrhea, sometimes with blood. He denies nausea, vomiting, constipation, and food allergies. A colonoscopy shows lesions that extend proximally beyond the ileocecal valve. Which of the following is most closely associated with the likely diagnosis? A. Ankylosing spondylitis B. Inflammation of mucosa and submucosa only C. Markedly increased risk of colon cancer D. Non-ceseating granulomas E. Pancolitis involving the rectum 15. A 66-year-old man comes to the emergency department because of diarrhea and abdominal cramps. He reports unintentional weight loss of 4.5-kg (10-lb) over the past month. He has had lower abdominal pain for years. Recently, his diarrhea has become disruptive to his career, since he often has more than 10 watery bowel movements a day and is awakened at night by the need to defecate. He denies blood in his stool. Which of the following tests is the most appropriate first step in the management of this patient? A. Abdominal CT B. Abdominal Xray C. Colonoscopy D. Endoscopy E. Flexible sigmoidoscopy 16. A 66-year-old man comes to the emergency department because of diarrhea and abdominal cramps. He reports unintentional weight loss of 4.5-kg (10-lb) over the past month. He has had lower abdominal pain for years. Recently, his diarrhea has become disruptive to his career, since he often has more than 10 watery bowel movements a day and is awakened at night by the need to defecate. He denies blood in his stool. Which of the following tests is the most appropriate first step in the management of this patient?

A colonoscopy is performed and shows diffuse granulomatous inflammation of ileocecal junction with transmural ulcerations. Biopsies show non-caseating granulomas and skip lesions, with ulcers that are transmural. Which of the following is most likely to result as a complication of this patient's disease?

A. B. C. D. E.

Divericulosis Exocrine pancreatin insufficiency Fat ad vitamin malabsorption Pseudomembranous colitis Toxic megacolon

17. A 28-year-old man of Jewish descent comes to the emergency department because of abdominal pain, diarrhea, and fever. Physical examination shows a tender abdomen and a perianal fistula. A biopsy is done and shows chronic inflammation in the small intestine involving all layers of the intestinal wall. A monoclonal antibody against which of the following cytokines would be most beneficial in the treatment of this patient? A. IFN b B. IL-3 C. IL-5 D. IL-6 E. TNFa 18. A 40-year-old man comes to the office for a follow-up evaluation of his inflammatory bowel disease. He asks what the risk factors are, and would like to know what modifications he can make to his lifestyle that will decrease the risk of exacerbation. Which of the following is the most appropriate physician response to his question? A. His previous appendectomy increases his risk of exacerbations B. NSAIDs may provide symptomatic relief C. Smoking may aggravate Crohn disease and relieve ulcerative colitis D. Smoking may relieve both Crohn disease and ulcerative colitis E. Strenuous physical activity can lead to flare-ups 19. A 23-year-old woman comes to the emergency department due to a 4-day history of fever, left lower quadrant pain, and abdominal distention. Her medical history is relevant for Hashimoto's hypothyroidism, situational anxiety, and positive family history of inflammatory bowel disease. The patient currently takes levothyroxine, vitamin C/zinc supplement, and alprazolam. Upon further questioning, the patient mentions that she has increasing bowel movements (every hour) and has small amounts of waterymucousy red stools. She is of Ashkenazi Jewish descent. Physical exam shows distended abdomen and tympanitic, drum-like sounds over her right upper and left upper quadrant. Her temperature is 38.6°C (101.48°F), pulse is 121/min, respirations are 18/min, blood pressure is 80/70 mmHg. Upon hospital admission, the patient's clinical condition deteriorates despite antibiotic therapy and steroids. An abdominal radiograph is obtained and shown below. Which of the following is the most likely cause of this patient's condition?

A. Pseudomembranous colitis B. Ischemic colitis

C. Fulminant colitis D. Crohn’s disease E. Ulcerative colitis 20. A 29-year-old man comes to the emergency department because of right lower abdominal pain and distension, diarrhea, and fever. He says that he has been experiencing these episodes for two years due to his inflammatory bowel disease. The episodes typically last 1-2 weeks and then subside. His condition is currently being managed by a gastroenterologist. Despite medical management with 2 medications, his symptoms have worsened. A biopsy from colonoscopy at the time of diagnosis showed the presence of noncaseating granulomas and skip lesions with transmural ulcers. A barium swallow is obtained and shown below. Which of the following treatments is the most appropriate next step for management of this patient's condition?

A. B. C. D. E.

Anti-TNFa therapy Glucocorticoids Mesalamine Metronidazole Surgical resection

21. A 38-year-old man comes to the office because of recent onset of abdominal pain around his umbilicus. He has a history of Crohn disease that was diagnosed a few years ago. He says that his pants have been feeling a little loose, and he is worried he might have lost some weight unintentionally. His temperature is 38°C (100.4°F). Physical examination shows a palpable abdominal mass in the right lower quadrant. Which of the following is the most appropriate next step in the management of this patient?

A. B. C. D.

Abdominal CT Abdominal plain film X-RAY Administration of corticosteroids Asministration of methotrexate or azathioprine

E. Surgical consultation 22. A 30-year-old man comes to the clinic because of a rash that appeared a week ago. He says that it is so itchy that it has kept him up at night. He first noticed it on his knees and since then, it has spread to both of his elbows, neck, and back. He denies recent illness or exposure to other new products or chemicals. He has no significant past medical history except for a cholecystectomy three years ago. Physical examination shows many erythematous vesicles and plaques located on his elbows, the extensor surface of his forearms, knees, neck, and back, as show below. His mucous membranes are not involved and nail changes are not visible. A biopsy of the affected skin and direct immunofluorescence reveals IgA deposits in the dermal papillae. Which of the following additional symptoms is this patient most likely to experience?

A. Desquamation of palms and soles B. C. D. E.

Periodic swelling of lips and tongue Arthritisz and dactylitis Bloating and diarrhea A painless ulcer on genitals

23. 28-year-old man is brought to the emergency department with lethargy and severe abdominal pain since yesterday. He has had 4-5 episodes of small-volume bloody diarrhea per day accompanied by lower abdominal cramps for the past 2 months. Review of systems reveals a 4-kg (8.8-lbs) weight loss and loss of appetite. The remainder of his history is noncontributory. Temperature is 38.8°C (102°F), pulse is 125/min, respirations are 18/min, and blood pressure is 90/55 mmHg. Physical examination shows lethargy and dry mucous membranes. There is abdominal distension, diffuse abdominal tenderness, and decreased bowel sounds without rebound or guarding. Rectal examination reveals marked tenderness, with guaiac-positive, maroon-colored, liquid stools in the vault. Laboratory results are shown below:

Fluid resuscitation with 0.9% normal saline improves the blood pressure to 103/59 mmHg...