View Answer

B

2. A 50-year-old man is admitted with massive bright red rectal bleeding. He recently had a barium enema that demonstrated no diverticular or space-occupying lesion. Nasogastric suction reveals no blood but does produce yellow bile. The patient continues to bleed. What is the next diagnostic step?

A Repeat barium enema

B Colonoscopy

C Upper gastrointestinal series

D Mesenteric angiography

E Small bowel follow-through with barium

View Answer

D

3. A 15-year-old boy awakens with sudden onset of right lower quadrant and scrotal tenderness accompanied by nausea and vomiting. Which of the following is the most appropriate diagnosis and represents a surgical emergency?

A Acute prostatitis

B Acute epididymitis

C Torsion of the testicle

D Acute appendicitis

E Gastroenteritis

View Answer

C

4. A 47-year-old woman presents with dysphagia to both solids and liquids equally. She has experienced a 10-kg weight loss over the last several months. A barium swallow reveals a birdlike narrowing in the distal esophagus. What is the underlying cause of her symptoms?

A Disorganized, strong nonperistaltic contractions in the esophagus

B Failure of the lower esophageal sphincter to relax

C Hiatal hernia

D Barrett's esophagus

E Esophageal stricture secondary to untreated gastroesophageal reflux

View Answer

B

5. A 45-year-old male executive is seen because he is vomiting bright red blood. There are no previous symptoms. The man admits to one drink a week and has no other significant history. In the hospital, he bleeds five units of blood before endoscopy. What is the most likely diagnosis?

A Gastritis

B Duodenal ulcer

C Esophagitis

D Mallory-Weiss tear

E Esophageal varices

View Answer

B

6. Massive bleeding from the lower gastrointestinal tract is occurring in a 55-year-old man who is otherwise healthy. After continued bleeding equivalent to one unit of blood, what should be the initial management?

A Emergency laparotomy and total colectomy and ileoproctostomy

B Emergency laparotomy and colostomy with operative endoscopy

P.295

C Arteriography to identify the bleeding site after anoscopy and sigmoidoscopy have ruled out a distal site

D Infusion of vitamin K and fresh frozen plasma

E Colonic irrigation with iced saline solution

View Answer

C

Questions 7–8

A 45-year-old man is seen in the emergency department after vomiting bright red blood. He has no previous symptoms. He drinks one alcoholic beverage a day.

7. What is the most reliable method for locating the lesion responsible for the bleeding?

A Upper gastrointestinal series

B Exploratory laparotomy

C Upper endoscopy

D Arteriography

E Radionuclide scanning

View Answer

C

8. After several hours in the hospital, he begins to have recurrent bleeding. He is transferred to a critical care bed and is persistently hypotensive despite trasnfusion of nine units of packed red blood cells. Which is the most appropriate next step in management of this patient?

A Upper endoscopy with attempt at cauterization of bleeding

B Transport to the interventional radiology unit to identify and embolize bleeding source

C Placement of a Blakemore tube to temporarily tamponade bleeding and to allow for stabilization of blood pressure

D Laparotomy to control bleeding

E Infusion of vasopressin and additional units of blood

View Answer

D

9. A 45-year-old woman who has had a hysterectomy presents to the emergency department with abdominal pain and vomiting. A mechanical small bowel obstruction is seen on the abdominal radiograph. What is the most likely cause for this obstruction?

A Carcinoma of the colon

B Small bowel cancer

C Adhesions

D Incarcerated inguinal hernia

E Diverticulitis

View Answer

C

10. A 25-year-old man is admitted with a history of sudden onset of severe midepigastric abdominal pain. Upright chest radiograph reveals free intraperitoneal air. What is the therapy for this patient?

A Upper endoscopy

B Barium swallow

C Gastrografin swallow

D Observation

E Laparotomy

View Answer

E

11. An 80-year-old male patient is referred for dysphagia with reflux of undigested food. The patient occasionally notices a bulging in his left neck. Which of the following is the most appropriate definitive treatment?

A Barium swallow

B Upper endoscopy

C Cricopharyngeal myotomy

D Computed tomography (CT) scan of the chest

E Liquid diet

View Answer

C

12. A 42-year-old female patient is diagnosed with gastroesophageal reflux and is started on medical therapy. Which of the following would be an indication for surgical antireflux procedure?

A Development of esophageal stricture(s)

B Barrett's esophagus with severe dysplasia

C Esophagitis by biopsy

D High lower esophageal sphincter pressure demonstrated by esophageal manometry

E Slow and uncoordinated swallowing by barium study