Clin Med Exam 3 GI Clinical Questions
and Answers Latest Updated
A 10-year-old boy presents with a 2-month history of intermittent burning pain in the
epigastrium. Pain is felt more during the night and between meals; it is partly relieved by
eating food or by taking antacids. Pain usually lasts 30-60 minutes and is accompanied
by nausea and vomiting. He often has a feeling of bloating and burping. He remains
asymptomatic for several days between. There is no history of taking analgesics or anti-
inflammatory drugs. Physical examination shows epigastric tenderness. The rest of the
examination is essentially normal. Stool examination for occult blood is positive.
Diagnosis? Diagnostic study? - ANSWER-peptic ulcer; Upper GI endoscopy
A 12-year-old boy presents with fatigue and jaundice. His past medical history is not
significant for recent illness, fever, infectious exposures, medication, alcohol, or drug
use. He denies gastrointestinal (GI) symptoms and a history of GI disease. On physical
examination, he appears ill; the liver edge is palpable and slightly tender. Skin and
sclera are icteric, and there is corneal discoloration. On further eye examination using a
slit lamp, brown-yellow rings encircling the iris in the rim of the cornea are noted
bilaterally. AST and ALT are elevated, and a serum ceruloplasmin level is reported as
low and confirms the diagnosis.
diagnosis? - ANSWER-Wilson's disease
A 14-year-old boy presents with a 1-week history of acute watery diarrhea with vague
abdominal discomfort and vomiting. He has developed fever, malaise, facial and
periorbital edema, and myalgias. He is experiencing pain and swelling of the calf
muscles. The patient ate some food prepared from pork and game meat in a restaurant
3-4 weeks ago. Blood examination shows moderate eosinophilia.
Most likely etiological agent? - ANSWER-Trichinella spiralis
A 14-year-old boy presents with a 2-week history of 4-5 loose bowel movements a day
with blood and mucus accompanied by tenesmus and cramping abdominal pain with a
low-grade fever. These episodes have been occurring intermittently for the past 6
months. Physical examination shows mild pallor, temperature 99°F, pulse 88/min, BP
100/70 mm Hg. Oral mucosa and perianal examination are normal. Abdominal
tenderness is present. The rest of the examination is normal. Stool examination for ova
and parasites and culture for pathogens are negative. Laboratory analysis shows mild
anemia and elevated ESR and CRP. Perinuclear anti-neutrophil cytoplasmic auto-
antibodies (pANCA) are positive, and anti-Saccharomyces cerevisiae antibodies
(ASCA) are negative. Colonoscopy shows hyperemic, edematous, friable, and ulcerated
rectal and colonic mucosa; there is no normal mucosa in between. Upper intestinal
endoscopy shows normal mucosa.
,M - ANSWER-toxic megacolon
A 14-year-old girl presents with a 4-day history of flatulence, foul-smelling stools, and
abdominal distention. Her appetite has also been decreased. She has not seen any
blood in her stools. She returned from a 2-week camping trip in the mountains of the
western United States 1 week ago. Others in her expedition group are asymptomatic.
Her physical examination reveals a well developed and well nourished adolescent with
slight abdominal distention and tenderness; otherwise, everything is within normal limits.
Most likely pathogen? - ANSWER-Giardia lamblia
A 15-year-old boy presents with bloody diarrhea and abdominal cramping. A double
contrast barium enema shows fine serrations and narrowing of the rectum and sigmoid.
Stool contains mucus, blood, and white blood cells, but no parasites or bacterial
pathogens. Endoscopy shows inflamed mucosa and pseudopolyps. A biopsy finds an
extensive inflammatory process in the mucosa and submucosa. The glands are filled
with eosinophilic secretions; there is also mild involvement of the terminal ileum.
Sulfasalazine treatment is attempted without improvement.
next best step? - ANSWER-corticosteroids (ulcerative colitis)
A 15-year-old girl presents with a 1-year history of intermittent abdominal pain with
nausea and occasional bloody diarrhea. She denies fever and weight loss; there is no
travel history. Past medical history is significant only for migraines. She takes a
multivitamin. Her vital signs are within normal limits. She has mild diffuse abdominal
tenderness to palpation and guaiac-positive stool. Her exam is otherwise normal. Her
hemoglobin is 9.7, hematocrit is 28%, WBC is 12,000/uL.
Next best step in management? - ANSWER-send stool studies and refer for
colonoscopy
A 15-year-old girl presents with a 1-year history of intermittent abdominal pain with
nausea and occasional bloody diarrhea. She denies fever and weight loss; there is no
travel history. Past medical history is significant only for migraines. She takes a
multivitamin. Her vital signs are within normal limits. She has mild diffuse abdominal
tenderness to palpation and guaiac-positive stool. Her exam is otherwise normal. Her
hemoglobin is 9.7, hematocrit is 28%, WBC is 12,000/uL.
next step? - ANSWER-Send stool studies and refer to for colonoscopy.
A 16-year-old girl with a 2-year history of ulcerative colitis presents with signs of an
acute exacerbation: abdominal pain and frequent passing of large quantities of blood
and mucus from the rectum. It is treated with sulfasalazine, glucocorticoids, and
intravenous alimentation. Diarrhea decreases markedly, but her status continues to
deteriorate. Tachycardia, volume depletion, and electrolyte imbalance develop;
, temperature is 101.8° F. Physical examination finds abdominal tenderness but no mass.
Plain radiography shows the transverse colon is dilated up to 7 cm.
next best step? - ANSWER-preform colectomy (toxic megacolon)
A 2-year-old boy presents with acute abdominal pain. The boy has passed stool with
blood and mucus and has vomited. He has had intermittent severe abdominal pain,
which has caused inconsolable crying and drawing up of his legs in episodes of 15-20
minutes. On examination, the abdomen is tender diffusely with guarding and bowel
sounds are absent. He has a fever of 100.5°F. The boy is taken to surgery.
diagnosis ? - ANSWER-intussesecption
A 2-year-old boy with his parents presents with colicky pain, a history of irritability, and a
2-day history of lethargy. There is also history of rectal bleeding and passage of "currant
jelly" stool for the past 2 days. Vital signs reveal blood pressure of 105/70 mm Hg, heart
rate of 90 bpm, respiration of 18/minute, and temperature 99.2°F. Plain abdominal film
shows evidence of obstruction, and barium enema detects coiled-spring appearance to
the bowel.
Based on the most likely diagnosis, what is the best next step in management of this
patient? - ANSWER-Reduction by air enema
A 20-year-old female college student presents due to a 7-day history of daily heartburn.
She has never experienced heartburn as bad as she does currently. She is treating it
with over-the-counter histamine-2 receptor antagonist, famotidine, 1 tablet daily. The
patient denies any other significant past medical history and is currently taking a daily
multivitamin and an antihistamine for seasonal allergies. She recently admits to having
increased episodes of headaches that she believes are due to stress. For this reason,
she has been taking ibuprofen 600 mg every 8 hours. She states that she has been
taking this consistently every 8 hours for the last 10 days; she hopes that her
headaches will subside after finals are finished. She also states that she was given
amoxicillin 2 weeks ago for a middle ear infection, which resolved without any further
intervention. She denies any difficulty swallowing, weight loss, night s - ANSWER-
NSAID (GERD)
A 20-year-old woman presents with anorectal pain; there are streaks of blood on her
stool and toilet paper. She states that "she has a tearing pain during each bowel
movement." She dreads having a bowel movement, and she attempts to hold it as long
as she can. The symptoms have been occurring over the past 2 weeks. Her history is
also significant for breaking her leg in a skiing accident 4 weeks ago; she was
prescribed oxycodone/acetaminophen (Percocet) for the first few days due to her pain.
An anoscope reveals an acute anal fissure.
first line? - ANSWER-stool softeners and fiber
and Answers Latest Updated
A 10-year-old boy presents with a 2-month history of intermittent burning pain in the
epigastrium. Pain is felt more during the night and between meals; it is partly relieved by
eating food or by taking antacids. Pain usually lasts 30-60 minutes and is accompanied
by nausea and vomiting. He often has a feeling of bloating and burping. He remains
asymptomatic for several days between. There is no history of taking analgesics or anti-
inflammatory drugs. Physical examination shows epigastric tenderness. The rest of the
examination is essentially normal. Stool examination for occult blood is positive.
Diagnosis? Diagnostic study? - ANSWER-peptic ulcer; Upper GI endoscopy
A 12-year-old boy presents with fatigue and jaundice. His past medical history is not
significant for recent illness, fever, infectious exposures, medication, alcohol, or drug
use. He denies gastrointestinal (GI) symptoms and a history of GI disease. On physical
examination, he appears ill; the liver edge is palpable and slightly tender. Skin and
sclera are icteric, and there is corneal discoloration. On further eye examination using a
slit lamp, brown-yellow rings encircling the iris in the rim of the cornea are noted
bilaterally. AST and ALT are elevated, and a serum ceruloplasmin level is reported as
low and confirms the diagnosis.
diagnosis? - ANSWER-Wilson's disease
A 14-year-old boy presents with a 1-week history of acute watery diarrhea with vague
abdominal discomfort and vomiting. He has developed fever, malaise, facial and
periorbital edema, and myalgias. He is experiencing pain and swelling of the calf
muscles. The patient ate some food prepared from pork and game meat in a restaurant
3-4 weeks ago. Blood examination shows moderate eosinophilia.
Most likely etiological agent? - ANSWER-Trichinella spiralis
A 14-year-old boy presents with a 2-week history of 4-5 loose bowel movements a day
with blood and mucus accompanied by tenesmus and cramping abdominal pain with a
low-grade fever. These episodes have been occurring intermittently for the past 6
months. Physical examination shows mild pallor, temperature 99°F, pulse 88/min, BP
100/70 mm Hg. Oral mucosa and perianal examination are normal. Abdominal
tenderness is present. The rest of the examination is normal. Stool examination for ova
and parasites and culture for pathogens are negative. Laboratory analysis shows mild
anemia and elevated ESR and CRP. Perinuclear anti-neutrophil cytoplasmic auto-
antibodies (pANCA) are positive, and anti-Saccharomyces cerevisiae antibodies
(ASCA) are negative. Colonoscopy shows hyperemic, edematous, friable, and ulcerated
rectal and colonic mucosa; there is no normal mucosa in between. Upper intestinal
endoscopy shows normal mucosa.
,M - ANSWER-toxic megacolon
A 14-year-old girl presents with a 4-day history of flatulence, foul-smelling stools, and
abdominal distention. Her appetite has also been decreased. She has not seen any
blood in her stools. She returned from a 2-week camping trip in the mountains of the
western United States 1 week ago. Others in her expedition group are asymptomatic.
Her physical examination reveals a well developed and well nourished adolescent with
slight abdominal distention and tenderness; otherwise, everything is within normal limits.
Most likely pathogen? - ANSWER-Giardia lamblia
A 15-year-old boy presents with bloody diarrhea and abdominal cramping. A double
contrast barium enema shows fine serrations and narrowing of the rectum and sigmoid.
Stool contains mucus, blood, and white blood cells, but no parasites or bacterial
pathogens. Endoscopy shows inflamed mucosa and pseudopolyps. A biopsy finds an
extensive inflammatory process in the mucosa and submucosa. The glands are filled
with eosinophilic secretions; there is also mild involvement of the terminal ileum.
Sulfasalazine treatment is attempted without improvement.
next best step? - ANSWER-corticosteroids (ulcerative colitis)
A 15-year-old girl presents with a 1-year history of intermittent abdominal pain with
nausea and occasional bloody diarrhea. She denies fever and weight loss; there is no
travel history. Past medical history is significant only for migraines. She takes a
multivitamin. Her vital signs are within normal limits. She has mild diffuse abdominal
tenderness to palpation and guaiac-positive stool. Her exam is otherwise normal. Her
hemoglobin is 9.7, hematocrit is 28%, WBC is 12,000/uL.
Next best step in management? - ANSWER-send stool studies and refer for
colonoscopy
A 15-year-old girl presents with a 1-year history of intermittent abdominal pain with
nausea and occasional bloody diarrhea. She denies fever and weight loss; there is no
travel history. Past medical history is significant only for migraines. She takes a
multivitamin. Her vital signs are within normal limits. She has mild diffuse abdominal
tenderness to palpation and guaiac-positive stool. Her exam is otherwise normal. Her
hemoglobin is 9.7, hematocrit is 28%, WBC is 12,000/uL.
next step? - ANSWER-Send stool studies and refer to for colonoscopy.
A 16-year-old girl with a 2-year history of ulcerative colitis presents with signs of an
acute exacerbation: abdominal pain and frequent passing of large quantities of blood
and mucus from the rectum. It is treated with sulfasalazine, glucocorticoids, and
intravenous alimentation. Diarrhea decreases markedly, but her status continues to
deteriorate. Tachycardia, volume depletion, and electrolyte imbalance develop;
, temperature is 101.8° F. Physical examination finds abdominal tenderness but no mass.
Plain radiography shows the transverse colon is dilated up to 7 cm.
next best step? - ANSWER-preform colectomy (toxic megacolon)
A 2-year-old boy presents with acute abdominal pain. The boy has passed stool with
blood and mucus and has vomited. He has had intermittent severe abdominal pain,
which has caused inconsolable crying and drawing up of his legs in episodes of 15-20
minutes. On examination, the abdomen is tender diffusely with guarding and bowel
sounds are absent. He has a fever of 100.5°F. The boy is taken to surgery.
diagnosis ? - ANSWER-intussesecption
A 2-year-old boy with his parents presents with colicky pain, a history of irritability, and a
2-day history of lethargy. There is also history of rectal bleeding and passage of "currant
jelly" stool for the past 2 days. Vital signs reveal blood pressure of 105/70 mm Hg, heart
rate of 90 bpm, respiration of 18/minute, and temperature 99.2°F. Plain abdominal film
shows evidence of obstruction, and barium enema detects coiled-spring appearance to
the bowel.
Based on the most likely diagnosis, what is the best next step in management of this
patient? - ANSWER-Reduction by air enema
A 20-year-old female college student presents due to a 7-day history of daily heartburn.
She has never experienced heartburn as bad as she does currently. She is treating it
with over-the-counter histamine-2 receptor antagonist, famotidine, 1 tablet daily. The
patient denies any other significant past medical history and is currently taking a daily
multivitamin and an antihistamine for seasonal allergies. She recently admits to having
increased episodes of headaches that she believes are due to stress. For this reason,
she has been taking ibuprofen 600 mg every 8 hours. She states that she has been
taking this consistently every 8 hours for the last 10 days; she hopes that her
headaches will subside after finals are finished. She also states that she was given
amoxicillin 2 weeks ago for a middle ear infection, which resolved without any further
intervention. She denies any difficulty swallowing, weight loss, night s - ANSWER-
NSAID (GERD)
A 20-year-old woman presents with anorectal pain; there are streaks of blood on her
stool and toilet paper. She states that "she has a tearing pain during each bowel
movement." She dreads having a bowel movement, and she attempts to hold it as long
as she can. The symptoms have been occurring over the past 2 weeks. Her history is
also significant for breaking her leg in a skiing accident 4 weeks ago; she was
prescribed oxycodone/acetaminophen (Percocet) for the first few days due to her pain.
An anoscope reveals an acute anal fissure.
first line? - ANSWER-stool softeners and fiber
