IM - GASTROENTEROLOGY SET 1

1. A 43-year-old man comes to the clinic because of black stools. He denies abdominal pain.
Rectal examination reveals black stool that is strongly guaiac positive.

2. Based on the following serological markers, what is the status of each of the following
patients?

HBsAg
HBsAb
HBcAb
HBeAg
Status

3. A 22-year-old woman comes to the clinic because of intermittently bloody diarrhea

that began one month ago. She also complains of colicky abdominal pain and fatigue.
Colonoscopy shows continuous circumferential inflammation of the rectum and sigmoid
colon.
a. What serology would suggest a diagnosis of ulcerative colitis (UC)?
b. What is the most appropriate initial therapy for mild cases of UC?

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INTERNAL MEDICINE

a. Is this most likely an upper GI bleed or a lower GI bleed?

b. What anatomical structure marks the boundary between the upper and lower GI tract?
c. What is the most important aspect in management of an acute, large volume GI bleed?

IM - GASTROENTEROLOGY SET 1

IM - GASTROENTEROLOGY SET 1

4. What is the most likely cause of diarrhea in each of the following patients?
a.
b.
c.
d.
e.

HIV-positive patient with < 100 CD4 cells

Vomiting and diarrhea after eating reheated Chinese fried rice
Vomiting and diarrhea after eating raw oysters
Diarrhea began after backpacking in the mountains
Patient recently treated for UTI

5. You are asked to evaluate a 45-year-old man on the inpatient ward for elevated liver function
tests. He complains of epigastric and right upper quadrant abdominal pain that began 8
hours ago. He has also had fever, nausea and vomiting.
a. What type of hepatitis would most likely cause the AST to be twice as high as the ALT?
b. In a patient with acute hepatitis, what type of bilirubin would you expect to be elevated?

6. A 65-year-old woman was diagnosed with inflammatory bowel disease 5 years ago. She
complains of colicky right lower quadrant abdominal pain and occasional low-grade fevers.
A colonoscopy reveals cobblestoning and skip lesions.
a. What would the colon biopsy most likely reveal?
b. Under what clinical circumstances would you refer this patient for a curative colectomy?

7. A 23-year-old woman comes to the clinic for intermittent abdominal bloating and crampy
lower abdominal pain over the last 6 weeks. There is no nausea or vomiting. She alternates
between diarrhea and constipation, and defecation often relieves the abdominal pain.
There is no blood or mucus in the stools. She has had no weight loss. She recently broke up
with her fianc and is staying with friends. The physical examination, labs, imaging and
colonoscopy are all normal.
a. What is the most likely diagnosis?
b. What initial management should be considered for this patient?

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a. What test should be performed to confirm the diagnosis?

b. How should this condition be managed?

9. A 56-year-old woman has routine labwork done to evaluate her chronic type 2 diabetes.
Her AST and ALT are moderately elevated (245 U/L and 278 U/L, respectively). Further
studies show that she is negative for hepatitis B and hepatitis C. Serum ferritin is 540 ng/dL
(normal 12-150 ng/dL in women), and transferrin saturation is 72% (normal 20-50%).
a. What further tests would help confirm the diagnosis of hereditary hemochromatosis?
b. What is the most appropriate treatment?

10. A 63-year-old man is intubated and admitted to the intensive care unit (ICU) for an acute
exacerbation of COPD.

a. In what situations is prophylaxis against stress ulcers in the ICU indicated?

b. What stress ulcer prophylaxis treatment or treatments are linked with an increase risk of
Clostridium difficile infection?

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INTERNAL MEDICINE

IM - GASTROENTEROLOGY SET 1

8. A 21-year-old woman comes to the clinic with 6 months of chronic diarrhea. She complains
of occasional nausea/vomiting and abdominal pain. Analysis of the stool shows steatorrhea.
Serum anti-endomysial antibody and anti-tissue transglutaminase antibodies are positive.