A 29-year-old man is evaluated in hospital. His father had a history of “anemia” treated with splenectomy and cholecystectomy. MCV is 85 fL. Hemoglobin is 14 g/dL. MCHC is elevated. The patient has a diagnostic modality performed that is abnormal. Below is an imaging result using the same modality from a healthy individual.

Which of the following most likely explains the patient’s abnormal diagnostic result?

A) Coombs test positivity
B) Gallstone ileus
C) Gallstone pancreatitis
D) Increased erythrocyte turnover
E) Increased HbS

A 78-year-old woman is evaluated in hospital for yellow eyes and skin. She has no overt past medical history apart from a cholecystectomy at age 58. She’s a non-smoker. Laboratory studies show:

Total bilirubin                                        4.0 mg/dL
Conjugated bilirubin                         3.0 mg/dL
Pancreatic amylase                            Normal
Pancreatic lipase                                 Normal

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

A) Choledocholithiasis
B) Cholelithiasis
C) Malignancy
D) Reduced activity of hepatic enzyme
E) Sphincter of Oddi dysfunction

A 24-year-old man partakes in a research study in which his hormonal secretions are plotted in relation to macronutrient consumption. The following graph shows the secretion of Hormone X as a function of duodenal acid exposure. The Y-axis is Hormone X secretion; the X-axis is duodenal acid exposure.

Which of the following is most likely to be seen in this patient as Hormone X levels increase?

A) Increased gallbladder contraction
B) Increased gastric acid secretion
C) Increased pancreatic bicarbonate secretion
D) Increased vasoactive intestinal peptide secretion
E) Increased water and electrolyte production by acinar cells

A 3-year-old boy is brought to the pediatrician by his mother for a wellness check. Physical examination shows a single palmar crease, slanted palpebral fissures, and epicanthal folds. Which of the following additional findings is most likely to be seen in this patient?

A) Bird’s beak sign
B) Coffee bean sign
C) Double bubble sign
D) Increased lymphoblasts
E) Target sign

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