Module 4 Rosh Review Prep
1. A 31-year-old woman presents with abdominal pain in the right upper quadrant that began after
she ingested a fatty meal. Her symptoms are accompanied by nausea and vomiting that has
persisted for 12 hours. Physical exam reveals a positive Murphy sign. Which of the following
laboratory results would be expected?
a. Elevated WBC count and elevated ALT
b. Elevated WBC count and elevated lipase
c. Normal WBC count and elevated alkaline phosphatase
d. Normal WBC count and elevated total serum bilirubin
2. A 38-year-old man presents for his annual physical. He has no past medical history and takes no
medications. He reports that his father was diagnosed with colon cancer at age 58 years. Based on
current recommendations, when should this patient start colorectal cancer screening?
a. At age 38 years
b. At age 40 years
c. At age 45 years
d. At age 48 years
3. A 70-year-old man presents to the clinic after hospitalization for new-onset atrial fibrillation. In the
hospital, he was treated with intravenous amiodarone, and he has been discharged on amiodarone
400 mg daily. His other medications include metoprolol, lisinopril, and atorvastatin.
Posthospitalization laboratory tests are unremarkable, except for an aspartate aminotransferase
of 100 U/L (normal 0–35 U/L) and alanine aminotransferase of 95 U/L (normal 0–35 U/L).
Prehospital aspartate aminotransferase and alanine aminotransferase were unremarkable. His vital
signs are within normal limits, but he is experiencing fatigue posthospitalization. What is the most
likely diagnosis based on his presentation?
a. Atrial fibrillation recurrence
b. Drug-induced liver injury
c. Hepatic steatosis
d. Viral hepatitis infection
4. A 55-year-old man with a recent history of nonsteroidal anti-inflammatory drug-induced
gastropathy presents to the clinic for a 2-week follow-up. On his previous visit, he was prescribed
pantoprazole 40 mg daily for 2 weeks and was instructed to decrease his nonsteroidal anti-
inflammatory drug use. Today, he reports improving dyspepsia and appetite. He states he has not
taken any nonsteroidal anti-inflammatory drugs since his last visit. He reports no severe pain,
weight loss, nausea, vomiting, and tarry or bloody stools. His vital signs are stable. Which of the
following is the most appropriate next step in management?
a. Order a CT of the abdomen
b. Prescribe an H2-blocker
c. Refer for upper endoscopy
d. Refill pantoprazole 40 mg daily for 4 weeks
, 5. A 72-year-old man presents with concerns of “looking yellow.” He is asymptomatic but reports an
unintentional 15-pound weight loss over the last two months. Physical examination reveals
jaundice, mild epigastric tenderness, and palpable periumbilical nodules. Which of the following is
the most likely diagnosis?
a. Colon cancer
b. Esophageal cancer
c. Gastric cancer
d. Pancreatic cancer
6. A 3-week-old infant presents to the clinic with her mother for frequent vomiting. The mother states
that she has an insatiable appetite but has lost 4 ounces since her 1-week check-up. The provider
palpates an olive-like mass in the epigastrium. Which of the following is the most likely diagnosis?
a. Gastroesophageal reflux disease
b. Hirschsprung disease
c. Malrotation with volvulus
d. Pyloric stenosis
7. Which of the following is the best way to differentiate Crohn disease from irritable bowel
syndrome?
a. Attempt treatment to see if it is beneficial
b. Perform colonoscopy
c. Perform endoscopy
d. Rule out all other causes for the symptoms
8. A 38-year-old woman presents with lower abdominal pain and bloating for the past year. She
describes her abdominal pain as mild cramping that occurs 3–4 times per week and is partially
relieved with a bowel movement. She reports having a bowel movement 2–3 times per week and
describes the stool as hard and difficult to pass. She reports no blood in her stool. She reports no
recent weight loss. She has no pertinent past medical history and takes no medications. She has
been following a gluten- and lactose-free diet for the past 6 months with mild improvement in
bloating and abdominal pain. She started taking a daily 17 g dose of polyethylene glycol with no
improvement in the frequency or consistency of her bowel movements. Her grandfather had colon
cancer diagnosed at the age of 67. She reports no other relevant family history. On physical
examination, her vital signs are normal. Her abdominal examination is unremarkable. Results from
a thyroid-stimulating hormone, complete blood count, and chemistry panel are normal. What
would be the most appropriate next step in the management of this patient’s condition?
a. Colonoscopy
b. Food allergy testing
c. Lactulose
d. Lubiprostone
1. A 31-year-old woman presents with abdominal pain in the right upper quadrant that began after
she ingested a fatty meal. Her symptoms are accompanied by nausea and vomiting that has
persisted for 12 hours. Physical exam reveals a positive Murphy sign. Which of the following
laboratory results would be expected?
a. Elevated WBC count and elevated ALT
b. Elevated WBC count and elevated lipase
c. Normal WBC count and elevated alkaline phosphatase
d. Normal WBC count and elevated total serum bilirubin
2. A 38-year-old man presents for his annual physical. He has no past medical history and takes no
medications. He reports that his father was diagnosed with colon cancer at age 58 years. Based on
current recommendations, when should this patient start colorectal cancer screening?
a. At age 38 years
b. At age 40 years
c. At age 45 years
d. At age 48 years
3. A 70-year-old man presents to the clinic after hospitalization for new-onset atrial fibrillation. In the
hospital, he was treated with intravenous amiodarone, and he has been discharged on amiodarone
400 mg daily. His other medications include metoprolol, lisinopril, and atorvastatin.
Posthospitalization laboratory tests are unremarkable, except for an aspartate aminotransferase
of 100 U/L (normal 0–35 U/L) and alanine aminotransferase of 95 U/L (normal 0–35 U/L).
Prehospital aspartate aminotransferase and alanine aminotransferase were unremarkable. His vital
signs are within normal limits, but he is experiencing fatigue posthospitalization. What is the most
likely diagnosis based on his presentation?
a. Atrial fibrillation recurrence
b. Drug-induced liver injury
c. Hepatic steatosis
d. Viral hepatitis infection
4. A 55-year-old man with a recent history of nonsteroidal anti-inflammatory drug-induced
gastropathy presents to the clinic for a 2-week follow-up. On his previous visit, he was prescribed
pantoprazole 40 mg daily for 2 weeks and was instructed to decrease his nonsteroidal anti-
inflammatory drug use. Today, he reports improving dyspepsia and appetite. He states he has not
taken any nonsteroidal anti-inflammatory drugs since his last visit. He reports no severe pain,
weight loss, nausea, vomiting, and tarry or bloody stools. His vital signs are stable. Which of the
following is the most appropriate next step in management?
a. Order a CT of the abdomen
b. Prescribe an H2-blocker
c. Refer for upper endoscopy
d. Refill pantoprazole 40 mg daily for 4 weeks
, 5. A 72-year-old man presents with concerns of “looking yellow.” He is asymptomatic but reports an
unintentional 15-pound weight loss over the last two months. Physical examination reveals
jaundice, mild epigastric tenderness, and palpable periumbilical nodules. Which of the following is
the most likely diagnosis?
a. Colon cancer
b. Esophageal cancer
c. Gastric cancer
d. Pancreatic cancer
6. A 3-week-old infant presents to the clinic with her mother for frequent vomiting. The mother states
that she has an insatiable appetite but has lost 4 ounces since her 1-week check-up. The provider
palpates an olive-like mass in the epigastrium. Which of the following is the most likely diagnosis?
a. Gastroesophageal reflux disease
b. Hirschsprung disease
c. Malrotation with volvulus
d. Pyloric stenosis
7. Which of the following is the best way to differentiate Crohn disease from irritable bowel
syndrome?
a. Attempt treatment to see if it is beneficial
b. Perform colonoscopy
c. Perform endoscopy
d. Rule out all other causes for the symptoms
8. A 38-year-old woman presents with lower abdominal pain and bloating for the past year. She
describes her abdominal pain as mild cramping that occurs 3–4 times per week and is partially
relieved with a bowel movement. She reports having a bowel movement 2–3 times per week and
describes the stool as hard and difficult to pass. She reports no blood in her stool. She reports no
recent weight loss. She has no pertinent past medical history and takes no medications. She has
been following a gluten- and lactose-free diet for the past 6 months with mild improvement in
bloating and abdominal pain. She started taking a daily 17 g dose of polyethylene glycol with no
improvement in the frequency or consistency of her bowel movements. Her grandfather had colon
cancer diagnosed at the age of 67. She reports no other relevant family history. On physical
examination, her vital signs are normal. Her abdominal examination is unremarkable. Results from
a thyroid-stimulating hormone, complete blood count, and chemistry panel are normal. What
would be the most appropriate next step in the management of this patient’s condition?
a. Colonoscopy
b. Food allergy testing
c. Lactulose
d. Lubiprostone
