A 24-year-old man comes to the physician for a 3-week history of a rash on his elbows. Cutaneous biopsy shows IgA deposition at the dermal papillae.

Which of the following is most likely to be seen in this patient?

A) Crypt abscesses
B) Flattening of the intestinal villi
C) Lipid droplets within enterocytes
D) Normal bowel biopsy
E) Skip lesions

A 31-year-old woman comes to the physician for a routine health maintenance examination. She has no past medical history. She lifts weights and runs daily. She asks the physician if she could benefit from a muscle relaxant. He discusses with her the possibility of initiating a supplement that can also be used as an antacid. Which of the following should most likely be discussed with this patient as an adverse effect of this supplementation?

A) Black, tarry stools
B) Constipation
C) Diarrhea
D) Frequent urination
E) Kidney stones

A 51-year-old man comes to the physician for a follow-up appointment. A contrast swallow is shown.

Which of the following is the most likely explanation for this patient’s findings?

A) Decreased cGMP
B) Fibrosis of the esophagus
C) Gastroesophageal reflux
D) Increased lower esophageal sphincter relaxation
E) Trypanosoma brucei

A 34-year-old woman, G1P0, at 34 weeks gestation comes to the physician for a 1-week history of progressive yellowing of the eyes, fatigue, fever, and RUQ pain. She recently returned from visiting her family in Tibet. Four days later, her transaminases are markedly elevated. Partial thromboplastin time is elevated. Serum bile acids are normal. She does not report itchy skin. She undergoes Caesarean section and a liver transplantation. Which of the following is the most likely explanation for this patient’s presentation?

A) Acute hepatitis A infection
B) Intrahepatic cholestasis of pregnancy
C) Intravenous drug use
D) Shift from Th1 to Th2 immunity
E) Stimulation of CD8 immunity

A 71-year-old man is evaluated post-operatively following a portosystemic shunt for esophageal varices on a background of alcoholic cirrhosis. A surgical anastamosis of which of the following veins is most likely to have mitigated the patient’s symptomatology?

A) Inferior mesenteric and superior mesenteric
B) Inferior mesenteric and splenic
C) Superior mesenteric and portal
D) Superior mesenteric and splenic
E) Splenic and left renal

A 48-year-old man is brought to hospital for a 2-day history of worsening abdominal pain and fever. He has a history of alcoholism. Physical examination shows a fluid wave. Vitals are: temperature 102 F, HR 80, RR 20, BP 120/80. Which of the following is the most appropriate next step in diagnosis?

A) CT of the abdomen
B) Endoscopic retrograde cholangiopancreatography
C) Endoscopy
D) Paracentesis
E) Ultrasound

A 1-week old boy is evaluated in hospital. He was born at 39 weeks’ gestation. APGAR scores were 8 and 9 at one and five minutes, respectively. His birth weight was 3500g.

Which of the following is the most likely explanation for this patient’s findings?

A) Failure of rotation of proximal bowel
B) Germline mosaicism
C) Hypertrophic musculature
D) Robertsonian translocation
E) Trisomy 18

A 45-year-old man comes to the physician for a follow-up appointment. Which of the following is most likely to be seen in this patient?

A) c-ANCA positivity with common bile duct involvement
B) Granulomas
C) Mouth ulcers
D) Sacroiliitis
E) Terminal ileum involvement

A 7-year-old girl is brought to the physician for a 3-day history of loose stools, flatulence, and bloating after meals. Approximately one month ago, her 9-year-old brother, both her parents, and she all had mild watery diarrhea that lasted approximately 4 days after eating seafood from a fish market. They have all since recovered. The patient’s stool pH is reduced. A duodenal biopsy from a similar patient is shown.

Which of the following is the most likely explanation for this patient’s acute presentation?

A) ADP ribosylation of adenylyl cyclase
B) ADP ribosylation of guanylyl cyclase
C) Autoimmunity to dietary protein
D) Protozoal infection
E) Transient brush border enzyme deficiency

A 19-year-old man comes to the physician for a routine physical. He has no past medical history or physical symptoms. Laboratory testing shows a hemoglobin of 11 g/dL and MCV of 76 fL. He eats a varied diet with plenty of red meat. There is no family history of autoimmune disorders. A fecal occult blood test is positive. Inflammatory markers are negative. As part of his workup, the physician considers whether a technetium-99 test, if performed, would localize to the right lower quadrant. If this intuition is correct, which of the following would best explain this patient’s hematologic findings?

A) Abnormal migration of ventral bud
B) Heterotopic gastric mucosa
C) Inflammation within a false diverticulum
D) Interleukin-6 effect
E) Malignancy