SHELF / USMLE Step 2 Practice Questions - GI (set #3)

SHELF / USMLE step 2 Practice Questions > Internal Medicine > Gastrointestinal (GI)

Q1. A 60 y/o man presents w. 2 days of new-onset worsening abd. pain that has become progressively more focal at the LLQ. He reports nausea, vomiting, and constipation. He has a fever to 101.2 and on exam his abdomen is tender to palpation with guarding and rebound tenderness in the LLQ. Which of the following diagnostic tests is the best next step?

a) barium enema
b) colonoscopy
c) abdominal CT
d) laparoscopy

Q2. A 26 year old graduate student presents with anorexia, malaise, diarrhea, and dark urine. She returned home last week following a 4 week field study in Peru. Her hepatic enzymes are ALT 975, AST 855, alkaline phosphatase 250, and total bilirubin is 7. Her PT, PTT and INR are normal. Serologic studies reveal:

• Hepatitis B surface antigen (HBsAg) - positive
• Hepatitis B surface antibody (HBsAb or anti-HBs) - negative
• Hepatitis B core antibody (HBcAb or anti-HBc) - positive
• HCV antibody (anti-HCV) - negative
• Hepatitis A IgM (IgM anti-HAV or HA Ab-IgM) - negative
• Hepatitis A IgG (IgG anti-HAV or HA Ab-IgG) - positive
  

Which one of the following statements is correct?

a) She has acute hepatitis A infection
b) She may be infected with hepatitis delta virus
c) The elevated total bilirubin indicates the presence of cirrhosis
d) Active hepatitis B viral expression is suggested by the presence of hepatitis core antibody
e) She was most likely infected with hepatitis B while traveling in Peru

Q3. As a senior medical resident you are asked to admit a 28 year old female who carries a diagnosis of ulcerative colitis. She has documented continuous inflammatory disease from the anal verge to 20 cm from the anal verge. Which one of the following clinical symptoms and physical examination findings is NOT typically found in association with the diagnosis of distal ulcerative colitis?

a) diarrhea in combination with rectal bleeding and tenesmus
b) rectal bleeding in the absence of diarrhea
c) external hemorrhoids
d) perianal fistula
e) abdominal discomfort improved with defecation

A1. c) abdominal CT
A2. b) She may be infected with hepatitis delta virus.
A3. d) perianal fistula