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

A 19-year-old man comes to the physician for a follow-up appointment. Vitals are normal. Hemoglobin is 11 g/dL. MCV is 90 fL. An intestinal biopsy is shown.

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

A) Hematuria
B) IgA deposition at the dermal papillae
C) Leukocytoclastic vasculitis
D) Positive calprotectin
E) Segmental fibrinoid necrosis

A 46-year-old woman presents to emergency because of a 1-hour history of abdominal pain. Vitals are: temp 101 F; HR 80, RR 16, BP 130/80. She has presented to the physician before for episodic upper abdominal pain. An ultrasound is performed. Laboratory studies show:

Total bilirubin                                        2.0 g/dL
ALP                                                              400 IU/L
Amylase                                                    1200 IU/L

Which of the following is the next best step in diagnosis?

A) CT of the abdomen
B) Endoscopic retrograde cholangiopancreatography
C) Endoscopic ultrasound
D) IV 0.9% saline
E) Magnetic resonance cholangiopancreatography

A 31-year-old woman comes to the physician for a 3-month history of intermittent abdominal pain and frequent episodes of bloody diarrhea. She reports that her symptoms have worsened over the past few weeks, and she now has 6–8 loose bowel movements daily associated with urgency and tenesmus. She also describes mild weight loss and fatigue but denies any recent travel or antibiotic use. Physical examination shows mild tenderness to palpation in the lower abdomen without rebound or guarding. Laboratory studies reveal mild anemia and an elevated erythrocyte sedimentation rate. A barium enema is shown. Which of the following is most likely to be seen in this patient?

A) Creeping fat
B) Crypt abscesses
C) Fistulae
D) Noncaseating granulomas
E) Transmural inflammation

A 18-year-old male is brought to emergency following a mountain biking accident in which he sustained blunt force trauma of the handlebars into his abdomen as he fell off his bike. A contrast abdominal CT shows no findings associated with trauma. A follow-up barium-based fluoroscopic study is performed one month later with the results shown.

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

A) Angiodysplasia
B) Diverticulitis
C) Diverticulosis
D) Diverticulum
E) Failure of canalization