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Upper Gastrointestinal System NCLEX Questions Questions
Question 1 of 5
A 56-year-old white male complains of intermittent dysphagia for the past three months, particularly with the ingestion of meat. He has no difficulties swallowing liquids. He has no history of smoking, uses no medications, and has had no weight loss. What test would be best to evaluate him?
Correct Answer: C
Rationale: Dysphagia should almost always first be evaluated by barium swallow. The patient's presentation is classic for a Schatzki's ring (congenital web at the GE junction). The diagnosis is best made by barium study because Schatzki's rings cannot always be visualized by endoscopy. CT scan and esophageal manometry cannot detect Schatzki's rings. Schatzki's rings are easily disrupted by bougie dilatation, and usually no further therapy is needed.
Question 2 of 5
A 56-year-old man with a history of alcohol abuse presents complaining of diarrhea. He complains of frequent, foul-smelling, oily bowel movements that have gone on for about six months. He notes weight loss of 20 pounds over that period of time. He denies any abdominal pain, nausea, or vomiting. He reports that he used to have frequent episodes abdominal pain that were diagnosed as pancreatitis. He therefore stopped drinking about two years ago. His laboratory values are notable for normal AST, ALT, lipase, and amylase. All of the following statements regarding this man's condition are correct except
Correct Answer: B
Rationale: This man presents with evidence of pancreatic insufficiency due to chronic pancreatitis. Diarrhea and malabsorption (steatorrhea) are the hallmarks of this manifestation of chronic pancreatitis. A 72-hour fecal fat should be elevated in such patients. Low fecal levels of chymotrypsin should also be seen. When pancreatic exocrine function declines due to chronic pancreatitis, the output of lipase from the pancreas is about 10 to $15 \%$ of normal, so serum levels will be low or normal instead of high (as seen in acute pancreatitis). Diarrhea is frequently accompanied by diabetes as a result of destruction of islet cells and impaired insulin production. Treatment of steatorrhea from chronic pancreatitis includes pancreatic enzymes and a low-fat diet. A lactose-free diet is not indicated.
Question 3 of 5
A 46-year-old man had profuse diarrhea for two months. He notes that the diarrhea continues throughout the day. Fasting does not decrease the diarrheal episodes. He has tried using loperamide, but the relief is temporary. He notes a 10-pound weight loss over the last two months. He notes that he is not taking any medications except for the loperamide. Upon questioning, he recently quit smoking and has been chewing a lot of sugarless gum. You measure his stool electrolytes. The results are as follows: Na+ 40 mmol/L, K+ 90 mmol/L, Cl- 15 mmol/L, HCO3- 18 mmol/L. What is the most likely diagnosis?
Correct Answer: C
Rationale: This patient has chronic diarrhea that does not improve with fasting. This is a key feature in distinguishing between osmotic and secretory diarrhea. Additionally, his stool electrolytes do not reveal an osmolar gap (as seen with osmotic diarrhea). His osmolar gap is $290-[(40+90) \times 2]=30$, which is normal. An osmolar gap of greater than 50 is suggestive of osmotic diarrhea. Lactase deficiency, sucrase deficiency, and sorbitol ingestion would all cause an osmotic diarrhea. A VIPoma is the only one of the choices that causes a secretory diarrhea.
Question 4 of 5
Patients with autoimmune hepatitis disease may have the following presentations except
Correct Answer: C
Rationale: Autoimmune hepatitis may present with a fulminant or subfulminant course with new onset of hepatic encephalopathy and transaminases greater than 2000. It tends to relapse without maintenance treatment, and responds well to oral prednisone in a vast majority of cases. However, autoimmune hepatitis does not tend to present with a cholestatic picture as described in C, unless associated with overlap syndromes with PBC or cholangiopathy.
Question 5 of 5
All of the following are absolute contraindications to immediate liver transplantation except
Correct Answer: B
Rationale: Patients with acute infection outside the liver, severe cardiac or pulmonary disease, or metastatic cancer are not eligible for liver transplantation. Patients with HIV, however, are candidates for transplant if they do not have advanced disease (CD4 <200, viral load >400 copies/mL).