Question 1
A patient presents with RUQ abdominal pain with intermittent nausea and vomiting. Laboratory
results show mildly elevated alkaline phosphatase and pancreatic enzymes with normal limits.
What your presumptive diagnosis?
a. Biliary obstruction
b. Chronic pancreatitis
c. Liver disease
d. Peptic ulcer disease
ANS: d
Question 2
A 41-year-old female presents to the clinic with RUQ abdominal pain accompanied by nausea
and vomiting. The pain started within 2 hours of ingesting a typical Cuban meal at the festival in
Calle 8. She admits to having similar episodes in the past; however, it feels worse this time. She
has low-grade fever. Abdominal examination is positive for RUQ tenderness with respiratory
arrest to deep palpation of the RUQ. Laboratory results show elevated WBC; total bilirubin,
alkaline phosphatase, and serum amylase are within normal limits. Which of the following
diagnostic test, could be initially supportive of the most likely diagnosis?
a. Magnetic resonance cholangiopancreatography (MRCP)
b. Abdominal X-ray
c. Endoscopic retrograde cholangiopancreatography (ERCP)
,d. Hepatobiliary imilodiacetic acid scan (HIDA scan)
e. Ultrasonography
ANS: e
Question 3
The best serologic test for detection of acute hepatitis-A infection:
a. Positive HBsAb (hepatitis B surface antibody
b. Elevated ALT and AST
c. Positive HBsAg (hepatitis B surface antigen)
d. Positive IgG antibody to HAV
e. Positive IgM antibody to HAV
ANS: e
Question 4
A young gentleman with diagnosed Hep-B virus infection for which he is taking Tenofovir and
Entecavir, presents to the clinic with his partner for evaluation. The partner denies symptoms and
signs related to hepatitis and his physical examination is unremarkable. The partner's laboratory
evaluation shows negative HBAg, negative HBsAb, negative HBcAb. Based on these findings,
you would recommend:
a. Three doses of Hepatitis-B immunization
b. Treatment with immunoglobulins
c. Both A and B
, d. Proceed to evaluate full Hepatitis panel
ANS: c
Question 5
A 41-year-old obese woman presents to the clinic complaining of chest pain, heartburn-like that
started about half an hour after her last meal while she was reclined in her sofa. She admits
having similar episodes in the past after drinking coffee, and lately has notices a bitter taste in
her mouth early in the morning. Her colleagues frequently ask her if he caught a bug because
they hear her with raspy voice upon her arrival to work. How would you manage this patient?
a. Avoid alcoholic beverages, coffee, and chocolate
b. Initiate treatment with antiacid and H2 receptor antagonist
c. Encourage weight loss
d. Recommend small and frequent meals
e. Encourage nocturnal meals
f. Initiate treatment with a proton-pump inhibitor (PPI)
ANS: a, b, c, and d
Question 6
During work-up for gastric bypass, an obese female patient is diagnosed with H. pylori. Her
history includes elevated blood pressure, pre-diabetes, and allergy to penicillin. Which of the
following would be appropriate triple therapy to treat H. pylori?
a. Amoxicillin + Clarithromycin + Lansoprazole