Medicine
Gastroenterology & Hepatology
A patient has progressive dysphagia initially to solids and later liquids with weight loss. What is the most appropriate next investigation?
A. Upper GI endoscopy
B. Stool occult blood only
C. Abdominal ultrasound only
D. HIDA scan
Correct Answer: A
Progressive mechanical dysphagia with weight loss is an alarm presentation requiring prompt upper endoscopy to evaluate for malignancy or stricture.
Medicine
Gastroenterology & Hepatology
A patient with cirrhosis becomes confused and has asterixis after a GI bleed. What is the first-line drug to reduce intestinal ammonia absorption?
A. Lactulose
B. Mesalamine
C. Omeprazole
D. Pancrelipase
Correct Answer: A
Lactulose is first-line therapy for overt hepatic encephalopathy and is titrated to produce regular soft stools.
Medicine
Gastroenterology & Hepatology
Which feature favors Crohn disease over ulcerative colitis?
A. Continuous rectal involvement
B. Transmural inflammation with fistula formation
C. Disease limited to colon mucosa
D. Toxic megacolon never occurs
Correct Answer: B
Crohn disease is transmural and can cause fistulas, strictures and skip lesions anywhere in the gastrointestinal tract.
Medicine
Gastroenterology & Hepatology
A young adult has recurrent abdominal pain, bloody diarrhea and continuous inflammation beginning in the rectum. Which condition is most likely?
A. Ulcerative colitis
B. Crohn disease
C. Irritable bowel syndrome
D. Celiac disease
Correct Answer: A
Ulcerative colitis characteristically causes continuous mucosal inflammation extending proximally from the rectum.
Medicine
Gastroenterology & Hepatology
A 36-year-old woman has pruritus, fatigue and cholestatic liver tests. Antimitochondrial antibody is positive. What is the diagnosis?
A. Primary biliary cholangitis
B. Primary sclerosing cholangitis
C. Autoimmune pancreatitis
D. Wilson disease
Correct Answer: A
Primary biliary cholangitis typically affects women and is associated with cholestatic enzymes and antimitochondrial antibodies.
Medicine
Gastroenterology & Hepatology
A patient with severe epigastric pain radiating to the back has lipase five times normal. What is the most appropriate initial management of uncomplicated acute pancreatitis?
A. Early IV fluids, analgesia and early oral feeding as tolerated
B. Immediate prophylactic antibiotics for all patients
C. Emergency ERCP in every case
D. Total parenteral nutrition routinely
Correct Answer: A
Initial pancreatitis care focuses on fluid resuscitation, analgesia and early enteral/oral nutrition; antibiotics are not routine without infection.
Medicine
Gastroenterology & Hepatology
Which laboratory pattern is most consistent with cholestatic liver injury?
A. Marked ALT elevation only
B. Disproportionate alkaline phosphatase elevation
C. Isolated low albumin after one day
D. Low creatinine only
Correct Answer: B
Cholestatic injury is characterized by a disproportionate rise in alkaline phosphatase compared with aminotransferases.
Medicine
Gastroenterology & Hepatology
A patient with cirrhosis and ascites develops fever and abdominal pain. Ascitic neutrophil count is 420 cells/mm3. What is the diagnosis?
A. Spontaneous bacterial peritonitis
B. Hepatorenal syndrome
C. Portal vein thrombosis
D. Budd-Chiari syndrome
Correct Answer: A
An ascitic polymorphonuclear leukocyte count of at least 250 cells/mm3 establishes spontaneous bacterial peritonitis in the appropriate clinical setting.
Medicine
Gastroenterology & Hepatology
A cirrhotic patient presents with hematemesis and hypotension. After initial resuscitation, which drug should be started promptly when variceal bleeding is suspected?
A. Octreotide or another vasoactive agent
B. Loperamide
C. Metoclopramide only
D. Ursodeoxycholic acid
Correct Answer: A
Suspected acute variceal hemorrhage is treated early with a vasoactive agent along with antibiotics and urgent endoscopic therapy after stabilization.
Medicine
Respiratory Medicine
Which acid-base pattern is typical in chronic compensated hypercapnic respiratory failure due to advanced COPD?
A. High PaCO2 with elevated bicarbonate
B. Low PaCO2 with low bicarbonate
C. Normal PaCO2 with severe metabolic acidosis
D. Low PaCO2 with elevated anion gap only
Correct Answer: A
Chronic respiratory acidosis is compensated by renal bicarbonate retention, so both PaCO2 and serum bicarbonate are elevated.
Medicine
Respiratory Medicine
A patient after long-haul travel has unilateral leg swelling and sudden dyspnea. He becomes hypotensive and bedside echo shows right ventricular strain. If there is no major contraindication, what treatment should be considered?
A. Systemic thrombolysis
B. Oral antihistamine
C. Pleural aspiration
D. Inhaled corticosteroid only
Correct Answer: A
Hemodynamically unstable high-risk pulmonary embolism may require urgent reperfusion therapy such as systemic thrombolysis when not contraindicated.
Medicine
Respiratory Medicine
A patient with COPD and chronic severe resting hypoxemia despite optimal therapy is most likely to benefit from which intervention for survival?
A. Long-term oxygen therapy when criteria are met
B. Routine oral steroids indefinitely
C. Daily antibiotics for life in all cases
D. SABA monotherapy
Correct Answer: A
Long-term oxygen therapy improves survival in appropriately selected COPD patients with severe chronic resting hypoxemia.
Medicine
Respiratory Medicine
A 44-year-old woman has episodic dyspnea, normal chest X-ray and normal baseline spirometry, but asthma remains suspected. Which test can demonstrate variable airway hyperresponsiveness?
A. Methacholine challenge
B. D-dimer
C. Pleural biopsy
D. Right heart catheterization
Correct Answer: A
Bronchoprovocation testing can demonstrate airway hyperresponsiveness when baseline spirometry is normal but asthma remains clinically suspected.
Medicine
Respiratory Medicine
A patient with pneumonia develops a loculated pleural effusion with low pleural pH and frank pus. What management is required?
A. Observation only
B. Chest-tube drainage plus antibiotics
C. Inhaled bronchodilator only
D. Immediate lung transplant
Correct Answer: B
Empyema or a complicated parapneumonic effusion generally requires pleural drainage in addition to antimicrobial therapy.
Medicine
Respiratory Medicine
Which test confirms persistent airflow obstruction in COPD?
A. Post-bronchodilator spirometry
B. Chest CT alone
C. Arterial blood gas in all patients
D. Sputum eosinophils
Correct Answer: A
COPD diagnosis requires persistent airflow obstruction demonstrated on post-bronchodilator spirometry.
Medicine
Respiratory Medicine
A patient has progressive exertional dyspnea, dry cough, bibasal fine crackles and HRCT showing subpleural basal honeycombing. What is the most likely diagnosis?
A. Idiopathic pulmonary fibrosis
B. Acute bronchitis
C. Bronchiectasis
D. Pulmonary edema
Correct Answer: A
Basal subpleural reticulation and honeycombing with fine inspiratory crackles are characteristic of usual interstitial pneumonia/IPF in the appropriate clinical setting.
Medicine
Respiratory Medicine
A patient with severe asthma is unable to speak full sentences, has a silent chest and rising PaCO2. What does the rising PaCO2 indicate?
A. Clinical improvement
B. Impending respiratory failure
C. Simple hyperventilation only
D. Pulmonary embolism is excluded
Correct Answer: B
In severe asthma, normalization or rise of PaCO2 can signal respiratory muscle fatigue and impending ventilatory failure.
Medicine
Respiratory Medicine
A 35-year-old woman has bilateral hilar lymphadenopathy, erythema nodosum and ankle arthritis. Which diagnosis is most likely?
A. Sarcoidosis
B. Tuberculosis only
C. Silicosis
D. Idiopathic pulmonary fibrosis
Correct Answer: A
The combination of bilateral hilar adenopathy, erythema nodosum and ankle arthritis is classic for acute sarcoidosis such as Löfgren syndrome.
Medicine
Respiratory Medicine
A patient with obesity and daytime somnolence has loud snoring and witnessed apneas. What is the diagnostic test of choice?
A. Peak expiratory flow
B. Polysomnography or validated sleep study
C. Sputum culture
D. Bronchoscopy
Correct Answer: B
Obstructive sleep apnea is diagnosed using sleep testing that measures respiratory events during sleep.
Medicine
Respiratory Medicine
Which pleural fluid finding satisfies Light criteria for an exudative effusion?
A. Pleural protein/serum protein ratio below 0.3
B. Pleural LDH/serum LDH ratio above 0.6
C. Pleural glucose above serum glucose
D. Very low pleural cell count
Correct Answer: B
A pleural LDH to serum LDH ratio greater than 0.6 is one of Light criteria for an exudate.