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Self-Assessment Questions


Malabsorption and Vitamin Deficiencies Due to Gastrointestinal Illness: Review Questions

Douglas G. Adler, MD

Dr. Adler is an assistant professor of medicine and director of gastrointestinal endoscopy, University of Texas-Houston Health Science Center, Houston, TX.

Choose the single best answer for each question.

1. A 50-year-old man presents for evaluation of 3 years of chronic diarrhea and weight loss. He also complains of chronic flatulence and severe fatigue. The patient is unaware of any trigger foods. His diarrhea is clear and watery, without evidence of blood. He responds poorly to over-the-counter antidiarrheal medications. On examination, he is thin and has diffuse muscle wasting but is in no acute distress. He has multiple clear vesicular lesions on his elbows and knees, which cause severe itching; he has scratched himself to the point of bleeding on several occasions. What is this patient’s most likely diagnosis?
  1. Celiac sprue
  2. Chronic pancreatitis
  3. Crohn’s disease
  4. Microscopic colitis
  5. Ulcerative colitis
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2. A 20-year-old man sustains a shotgun wound to his right lower abdomen at close range. He undergoes surgical resection of a small amount of jejunum, all of his ileum, and a portion of his right colon, with the creation of an internal jejunocolonic anastomosis. He does well but has some degree of chronic steatorrhea. Two months after discharge, he presents with paresthesias in his hands and feet. He has sustained several falls at work and has severe fatigue. On examination, he appears well, but neurologic examination discloses marked ataxia on formal testing. This patient is suffering from a deficiency of which of the following vitamins?

  1. Vitamin B1 (thiamine)
  2. Vitamin B2 (riboflavin)
  3. Vitamin B6 (pyridoxine)
  4. Vitamin B9 (folic acid)
  5. Vitamin B12 (cobalamin)
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3. A 44-year-old woman with alcoholism presents for evaluation of chronic abdominal pain. She is subsequently found to have chronic pancreatitis with pancreatic exocrine insufficiency and steatorrhea. With counseling, the patient is able to abstain from alcohol and experiences significant improvement in her abdominal pain. Several months later at follow-up, the patient informs you that she was recently injured in an accident wherein she drove her car into a parked car at night. Her blood alcohol level, which was ascertained by police on the scene, was zero. She states that she has also had several “close calls” when driving at night. What is the most likely cause of the patient’s difficulties?

  1. Vitamin A (retinol) deficiency
  2. Vitamin C (ascorbic acid) deficiency
  3. Vitamin D (ergocalciferol) deficiency
  4. Vitamin E (a-tocopherol) deficiency
  5. Vitamin K (phylloquinone) deficiency
Click here to compare your answer.

Questions 4 and 5 refer to the following case study.

A 60-year-old man presents to your office for evaluation of weight loss and chronic diarrhea. The patient has had a variety of symptoms for many years including chronic watery diarrhea, joint pains, the inability to maintain a stable weight, and occasional unexplainable fevers. On examination, the patient is thin with significant muscle wasting and prominent peripheral lymphadenopathy. He has a grade I/IV heart murmur over his left upper sternal border. His abdomen is mildly distended and slightly tender without focal abnormalities. Laboratory testing reveals anemia and severe hypoalbuminemia. Upper endoscopy is normal, but small bowel biopsies reveal infiltration of the lamina propria with periodic acid-Schiff-positive macrophages. The small bowel villi are distorted and appear widened.

4. What is the most likely cause of the patient’s illness?
  1. Celiac sprue
  2. Irritable bowel syndrome
  3. Small bowel lymphoma
  4. Tropical sprue
  5. Whipple’s disease
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5. Which of the following is the best therapy option for this patient?

  1. Antibiotics
  2. Chemotherapy
  3. Resection of the involved small intestine
  4. Small intestine transplantation
  5. Systemic steroids
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