SHELF / USMLE Step 2 Practice Questions > Internal Medicine > GI
Q1) A 74-year-old woman with a history of coronary artery disease (CAD) and presents to her primary care physician with postprandial periumbilical pain that begins 30 min after eating and lasts for a few hours. She has lost 20 lbs in the last 6 mos secondary to decreasing her intake in fear of pain. Which of the following is the most likely diagnosis?
b) intestinal ischemia
d) Crohn’s disease
e) peptic ulcer disease
Q2) A 65-year-old male is being treated for a for pseudomonas nosocomial pneumonia with cefepime. His respiratory symptoms improve, but 5 days after beginning treatment, he develops a new fever, abdominal bloating, and diarrhea with six to eight loose stools per day. You suspect antibiotic-associated colitis. Which of the following is the best diagnostic test?
a) Identification of Clostridium difficile(C.diff) toxin in the stool
b) isolation of C.diff in a stool culture
c) WBCs (eosinophil predominance)in the stool
d) detection anti-C.diff antibodies in the serum
e) C.diff (+) blood cultures
Q3) A patient with a history of alcoholism and HCV presents with scleral icterus and confusion. His breath is positive for fetor hepaticus and he has asterixis. His abdomen is significant for a non-palpable liver, caput medusae and a positive fluid wave. He has no focal neurologic deficit. He falls asleep twice while you are interviewing him. Which is the most likely stage of hepatic encephalopathy in this patient?
a) stage 1 hepatic encephalopathy
b) stage 2 hepatic encephalopathy
c) stage 3 hepatic encephalopathy
d) stage 4 hepatic encephalopathy
A1) b - Intestinal ischemia : triad of postprandial pain, anorexia from fear of eating, and weight
loss. The pain is typically intermittent; it occurs 30 min after eating and persists for up
to 3 hr (.a.k.a abdominal angina).
A2) a - isolation of C.diff in a stool culture
A3) b - stage 2: Lethargy, moderate confusion & asterixis
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