A 56-year-old Brazilian woman with a history of idiopathic cardiomyopathy presents complaining of weight loss, dysphagia, and regurgitation. A chest x-ray is done that reveals an air-fluid level at the level of the esophagus. No gastric bubble is appreciated. A barium swallow reveals a dilated esophagus that tapers at the lower esophageal sphincter. Which of the following is appropriate in this patient's evaluation/treatment?

Correct Answer: D

Rationale: The correct answer is D: Obtain serologic studies for antibodies to Trypanosoma cruzi. The patient's presentation of dysphagia, regurgitation, and dilated esophagus suggests Chagas disease, caused by Trypanosoma cruzi. Serologic studies are necessary for definitive diagnosis. Choice A is incorrect because esophagectomy is not warranted without confirming the diagnosis. Choice B is incorrect as there are no indications of parasitic infection. Choice C is incorrect as proton pump inhibitors are not appropriate for Chagas disease.

Correct Answer: D

Rationale: The correct answer is D: Perianal fistula formation. Ulcerative colitis primarily affects the colon and rectum, leading to inflammation and ulceration of the intestinal lining. Perianal fistula formation is more commonly associated with Crohn's disease, which can affect any part of the gastrointestinal tract. Choices A, B, and C are extraintestinal manifestations commonly seen in ulcerative colitis due to the systemic nature of the disease and immune system involvement. Arthritis can occur due to inflammation in joints, sclerosing cholangitis affects the bile ducts, and autoimmune hemolytic anemia involves the destruction of red blood cells.

Correct Answer: D

Rationale: The correct answer is D: Hepatitis A infection may have a relapsing course. Hepatitis A infection can indeed have a relapsing course, with symptoms recurring after an initial improvement. This is due to the nature of the virus and the immune response. A: Alcoholic hepatitis typically has an AST/ALT ratio less than 2 - This statement is incorrect because in alcoholic hepatitis, the AST/ALT ratio is typically greater than 2. B: Alpha-1 Antitrypsin (A1AT) deficiency is associated with arteriovenous malformations of the brain - This statement is incorrect as A1AT deficiency is primarily associated with pulmonary manifestations such as emphysema and liver disease, not brain arteriovenous malformations. C: Serum A1AT levels are diagnostic of A1AT deficiency - This is incorrect as A1AT levels can be influenced by various factors and genetic testing is needed for a definitive diagnosis of A1AT deficiency

Correct Answer: B

Rationale: The correct answer is B because the patient's presentation with cirrhosis, altered mentation, and ascites is concerning for spontaneous bacterial peritonitis (SBP). Ascitic fluid should be sampled to confirm the diagnosis and guide appropriate antibiotic therapy. Choice A is incorrect because ammonia levels can fluctuate and do not rule out hepatic encephalopathy. Choice C is incorrect as aminoglycosides are not first-line for SBP. Choice D is incorrect because lactulose is used to treat hepatic encephalopathy, not SBP. Sampling ascitic fluid is crucial in this case to diagnose and treat SBP promptly and effectively.

Correct Answer: C

Rationale: The correct answer is C: NSAIDs are known to irritate the gastric mucosa. NSAIDs can cause direct damage to the stomach lining, increasing the risk of peptic ulcers and worsening existing peptic ulcers. This is due to the inhibition of prostaglandin synthesis, which plays a protective role in maintaining the integrity of the gastric mucosa. Explanation for incorrect choices: A: NSAIDs do not increase gastric acid secretion; they primarily affect the mucosal lining. B: NSAIDs do not delay gastric emptying; this is more commonly associated with other factors like certain medications or medical conditions. D: NSAIDs and proton pump inhibitors have different mechanisms of action and do not directly interfere with each other.