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Review of Clinical Signs Review Questions

Extraintestinal Manifestations of
Hepatogastrointestinal Diseases

Author: Bernard M. Karnath, MD

Choose the single best answer for each question.

1. A 50-year-old man presents with a 1-year history of migratory polyarthritis involving his knees, ankles, shoulders, and wrists. He has had diarrhea, with 4 to 6 loose nonbloody bowel movements daily. He has lost 20 lb over the past year. He also reports subjective fevers. On physical examination, there are enlarged moveable lymph nodes 1 to 2 cm in size in the posterior cervical, axillary, and inguinal areas. Serum rheumatoid factor is negative, and the erythrocyte sedimentation rate is 55 mm/h. Which of the following tests would be most helpful in establishing a diagnosis?

  1. Anti-dsDNA titer
  2. Biopsy of the small intestine
  3. Computed tomography (CT) scan of the abdomen
  4. Lymph node biopsy
  5. Radiographs of both hands
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2. A 40-year-old man presents with a 2-year history of polyarticular pain. He also has watery, nonbloody diarrhea, with up to 6 episodes of foul-smelling oily feces per day. He has lost 20 lbs since the onset of his illness. Physical examination reveals synovitis of the wrists and knees. Examination of his arms reveals a vesiculopapular rash over the extensor surfaces near the elbows. Small bowel biopsy reveals villous atrophy. What is the most likely diagnosis?

  1. Celiac sprue
  2. Dysentery
  3. Inflammatory bowel disease
  4. Irritable bowel syndrome
  5. Whipple’s disease
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3. A 35-year-old woman with a history of injection drug use presents with the progressive development of lesions on her lower extremities. The lesions consisted erythematous macules that are palpable, do not blanch on pressure, and have no overlying warmth or tenderness. The patient also complains of diffuse joint pains and some mild diffuse abdominal pain. Laboratory evaluation reveals a creatinine level of 1.9 mg/dL, and urinalysis reveals 2+ proteinuria. Serum aminotransferase levels are mildly elevated, and serologic testing is positive for hepatitis C virus (HCV) infection. What is the most likely diagnosis?

  1. Cellulitis
  2. Henoch-Schönlein purpura
  3. Mixed cryoglobulinemia
  4. Polyarteritis nodosa
  5. Porphyria cutanea tarda
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4. A 19-year-old male college student presents with symptoms of an acute upper respiratory infection for the past 10 days. He has subsequently developed arthralgias. He also has some abdominal pain, which he describes as cramps. Physical examination reveals raised red lesions about 1 cm in diameter on his legs and buttocks. Laboratory studies reveal normal liver function tests, normal complement levels, and a creatinine level of 1.8 mg/dL. Urinalysis shows 20 red blood cells per high-power field and 2+ proteinuria. What is the most likely diagnosis?
  1. Henoch-Schönlein purpura
  2. Inflammatory bowel disease
  3. Mixed cryoglobulinemia
  4. Polyarteritis nodosa
  5. Systemic lupus erythematosus
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5. A 42-year-old man with acute HBV infection diagnosed 5 months ago presents with fever, weight loss, arthralgias, pleuritic chest pain, and abdominal pain for the past 3 months. One week ago, he noticed difficulty dorsiflexing his right foot. Physical examination reveals scattered 1-cm painful nodules and ulcers on the lower extremities. Laboratory examination reveals an erythrocyte sedimentation rate of 72 mm/h. Serologic testing is still positive for hepatitis B surface antigen. What is the most likely diagnosis?

  1. Celiac sprue
  2. Henoch-Schönlein purpura
  3. Inflammatory bowel disease
  4. Mixed cryoglobulinemia
  5. Polyarteritis nodosa
Click here to compare your answer.

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