A 28-year-old woman presents with abdominal pain, bloating, and diarrhea. She notes that her symptoms improve with fasting. She has a history of iron deficiency anemia. What is the most likely diagnosis?

Correct Answer: B

Rationale: The most likely diagnosis is Celiac disease (Choice B) due to the patient's symptoms of abdominal pain, bloating, diarrhea, and improvement with fasting, which are consistent with malabsorption seen in Celiac disease. The history of iron deficiency anemia also supports this, as it is a common complication of Celiac disease due to impaired absorption of nutrients. Irritable bowel syndrome (Choice A) typically does not improve with fasting, lactose intolerance (Choice C) does not usually cause iron deficiency anemia, and Crohn's disease (Choice D) typically presents with more severe symptoms and different patterns of improvement.

Correct Answer: A

Rationale: The most likely diagnosis is A: Primary biliary cirrhosis. This is supported by the patient's symptoms of fatigue, pruritus, jaundice, elevated bilirubin and alkaline phosphatase levels, and dilated intrahepatic bile ducts. Primary biliary cirrhosis is an autoimmune liver disease that primarily affects middle-aged women, leading to destruction of intrahejson hepatic bile ducts. The normal common bile duct rules out obstruction from gallstones or pancreatic cancer. Primary sclerosing cholangitis typically presents with strictures in the bile ducts, which is not seen in this case. Therefore, the combination of symptoms, lab findings, and imaging results point towards primary biliary cirrhosis as the most likely diagnosis.

Correct Answer: A

Rationale: The correct answer is A: Hypothyroidism. In this scenario, the patient has symptoms of hypothyroidism (fatigue, weight gain, cold intolerance) along with high TSH and low free T4 levels, indicating primary hypothyroidism. TSH is elevated as the body is trying to stimulate the thyroid to produce more thyroid hormones. Free T4 is low as the thyroid is not able to produce enough hormones. Hyperthyroidism (choice B) would present with low TSH and high free T4 levels. Thyroiditis (choice C) typically presents with symptoms of hyperthyroidism followed by hypothyroidism. Thyroid cancer (choice D) usually does not cause these specific symptoms and lab findings. Therefore, based on the symptoms and lab results, hypothyroidism is the most likely diagnosis.

Correct Answer: A

Rationale: Step 1: Symptoms of fatigue, polyuria, polydipsia point to diabetes. Step 2: Hyperglycemia and ketonuria suggest uncontrolled diabetes. Step 3: Onset in a 30-year-old woman is more common in Type 1 diabetes. Step 4: Type 1 diabetes is characterized by autoimmune destruction of pancreatic beta cells leading to insulin deficiency. Step 5: Treatment for Type 1 diabetes involves insulin therapy. Summary: - Choice B (Type 2 diabetes) is less likely due to the acute presentation and ketonuria. - Choice C (Diabetes insipidus) does not involve hyperglycemia or ketonuria. - Choice D (Hyperthyroidism) does not typically present with hyperglycemia and ketonuria.

Correct Answer: B

Rationale: Rationale for Correct Answer B (Regurgitation of undigested food): 1. Esophageal diverticulum is a pouch-like protrusion in the esophageal wall, causing difficulty in swallowing. 2. Due to the diverticulum, food may get trapped and regurgitated, leading to regurgitation of undigested food. 3. This symptom is characteristic of esophageal diverticulum and indicates an abnormality in the esophageal functioning. Summary of Incorrect Choices: A: Burning pain on swallowing - Not a typical symptom of esophageal diverticulum; more indicative of conditions like GERD. C: Symptoms mimicking a myocardial infarction - Unrelated to esophageal diverticulum and more suggestive of cardiac issues. D: Chronic parotid abscesses - Not associated with esophageal diverticulum, as parotid abscesses involve the salivary glands.