A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?

Correct Answer: B

Rationale: The correct answer is B: Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity. Misoprostol, a prostaglandin analog, helps protect the gastric mucosa by increasing mucus production and decreasing acid secretion. This makes it more effective than H2-blockers, which only reduce acid production. Choice A is incorrect because proton-pump inhibitors are more effective than H2-blockers in preventing NSAID-related GI toxicity. Choice C is incorrect as sucralfate is not recommended for prophylaxis against NSAID-related GI toxicity. Choice D is incorrect because H. pylori infection significantly increases the risk of NSAID-induced ulcers.

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: A

Rationale: The correct answer is A because performing an urgent ERCP is not indicated in the management of acute pancreatitis with necrosis. ERCP is typically not recommended in the acute phase of severe pancreatitis due to the risk of exacerbating pancreatitis. - B: Antibiotic therapy with imipenem may be initiated to address potential infection in necrotizing pancreatitis. - C: A CT-guided needle aspirate of the pancreas may be performed to guide antimicrobial therapy. - D: Surgical debridement may be considered if there is evidence of infection based on gram stain and cultures from a pancreatic aspirate.

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