SHELF / USMLE Step 2 Practice Questions > Internal Medicine > GI
Q1) A 28-year-old woman is evaluated because of an abnormal total serum bilirubin level noticed when she underwent required labs for life insurance qualification. Her past medical history is remarkable only for mild asthma, and her only current medications are an albuterol inhaler which she uses less than once per month, and a PPI for mild GERD. Physical examination is normal. Lab values are as follows: hemoglobin - 13.7 g/dL, MCV - 87, total bili - 2.5 mg/dL, direct bili 0.2 mg/dL, AST - 24 U/L, ALT - 21 U/L, alk-P - 78 U/L. What is the appropriate action for managing this patient at this time?
a) discontinue the PPI
b) recheck liver enzymes in 3 months
c) evaluate for the presence of hemolysis
d) order an abdominal ultrasound
e) no additional testing is warranted at this time
Q2) A 50-year-old woman has her 1st colonoscopy as part of her heath maintenance screening. She has no personal or family history of colorectal cancer. During the procedure, a 2-cm villous adenoma in the sigmoid colon is excised. In addition to counseling regarding screening of family members, which of the following is most appropriate at this time?
a) repeat colonoscopy in 6 months
b) repeat colonoscopy in 3 years
c) repeat colonoscopy in 5 years
d) repeat colonoscopy in 10 years
e) annual fecal occult blood testing
Q3) A 32-year-old woman presents with fatigue, jaundice, and slight fever for the past week. Her past medical history is significant only for hypothyroidism for which she has taken levothyroxine for the past 10 years. She traveled to Mexico 5 months ago and received one dose of hepatitis A vaccine before her trip. Physical examination discloses mild jaundice and hepatomegaly. Her labs are as follows: CBC - normal, TFTs - normal, AST - 300 U/L, ALT - 435 U/L, Alk-P - 175 U/L, Tbili - 2.3 mg/dL. Which of the following studies will most likely help establish the diagnosis?
a) antimitochondrial antibody
b) antinuclear antibody and anti–smooth muscle antibody
c) IgM antibody to hepatitis A virus (IgM anti-HAV)
d) serum acetaminophen levels
e) abdominal CT with contrast
A1) e - no additional testing is warranted at this time: indirect (unconjugated) hyperbilirubinemiain an asymptomatic patient with a normal hemoglobin level and otherwise normal liver tests is suggestive of Gilbert's syndrome (inherited & benign).
A2) b - repeat colonoscopy in 3 years (guidelines)
A3) b - antinuclear antibody and anti–smooth muscle antibody - likely autoimmune hepatitis considering the time course and the patient's history of hypothyroidism (likely autoimmune)
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