List of top Medical Questions

A 52-year-old man with a history of alcoholic cirrhosis presents with massive upper gastrointestinal bleeding. Endoscopy reveals actively bleeding gastric varices that do not respond to cyanoacrylate (glue) injection. What is the next best step in management?

A 45-year-old man presents with chronic diarrhea, steatorrhea, and weight loss. A D-xylose absorption test shows low serum and urinary D-xylose levels. What is the most likely cause of this finding?

Which of the following is least likely to cause chronic pancreatitis?

A 50-year-old man with chronic pancreatitis has persistent, severe epigastric pain unresponsive to opioids and enzyme replacement therapy. He undergoes a celiac plexus block for pain relief. Shortly after the procedure, he develops dizziness and lightheadedness on standing. Which of the following best explains this finding?

A 45-year-old man with chronic alcoholism and severe malnutrition is started on total parenteral nutrition (TPN). After 24 hours, he develops muscle weakness and respiratory distress. Laboratory tests reveal markedly low serum phosphate levels. What is the most likely underlying mechanism responsible for his condition?

A gastric ulcer located along the lesser curvature is found to be H. pylori positive on biopsy from the antrum. Which of the following statements regarding follow-up testing is true?

A patient presents with bleeding gums and other signs suggestive of a nutritional deficiency. Considering the role of vitamins in maintaining vascular and tissue integrity, which vitamin deficiency classically causes bleeding gums?

A patient, after undergoing extensive intestinal resection, now presents with progressive unsteadiness, difficulty walking, and symptoms of peripheral neuropathy. Considering the clinical context of malabsorption following bowel surgery, what is the most likely nutritional cause of the neurological symptoms?

A 38-year-old man from a rural area presents with progressive fatigue, pedal edema, and breathlessness. He reports consuming mainly polished white rice for several months with minimal protein intake. Examination reveals tachycardia, bilateral pedal edema, and elevated jugular venous pressure. No murmurs are heard. Which of the following vitamin deficiencies is the most likely cause of his condition?

A patient presents with painful cracks at the corners of the mouth (angular cheilitis) and a swollen, red, smooth tongue (glossitis). These mucosal changes suggest a nutritional deficiency affecting the oral mucosa. Which vitamin deficiency is most characteristically associated with angular cheilitis and glossitis?

A 40-year-old woman with a history of oral contraceptive use presents with right upper quadrant pain, hepatomegaly, and mild ascites. Laboratory findings show elevated liver enzymes and mild hyperbilirubinemia. The clinician suspects Budd-Chiari syndrome or portal cavernoma secondary to chronic portal vein thrombosis. Which is the best initial imaging modality to confirm the diagnosis?

A 35-year-old healthy female donor is found to be HBsAg positive during routine blood donation screening. She is asymptomatic with no known liver disease. As part of evaluating her infectious status and risk of disease progression, what is the next best step in her evaluation?

A 45-year-old man with a history of heavy weekend alcohol consumption is brought to the emergency department with confusion, hallucinations, and ataxia. His friends report that he had been vomiting for two days and had poor oral intake before the episode. On examination, he is disoriented with horizontal nystagmus and unsteady gait.
Options:

A patient is diagnosed with hepatocellular carcinoma (HCC) measuring 5 cm. What is the treatment of choice?

A 52-year-old patient is found to have a liver lesion during an ultrasound examination performed for abdominal discomfort. The lesion’s nature is unclear on ultrasound. To further characterize this lesion and assist in diagnosis and management planning, what is the next best imaging investigation?

Which of the following cells are primarily responsible for fibrosis formation in chronic liver disease due to remodeling?

A patient undergoing therapeutic phlebotomy every two weeks shows a decrease in hemoglobin from 18 mg/dL to 14 mg/dL. As the hemoglobin approaches normal levels, the frequency of phlebotomy needs adjustment to maintain target hemoglobin and prevent anemia. What should be the next step regarding the interval of phlebotomy?

A 52-year-old man with long-standing alcohol use presents with jaundice and mild ascites. Laboratory tests show total bilirubin of 4.8 mg/dL, AST 48 U/L, ALT 45 U/L, and INR 1.8. Viral hepatitis serology is negative, and ultrasound shows a coarse echotexture liver with features of portal hypertension. What is the most appropriate method to determine the cause of cirrhosis in this patient?

A 48-year-old male with acute hepatic failure is being evaluated for liver transplantation. His urine test shows ethylene glycol positivity. Which of the following constitutes an absolute contraindication to liver transplantation?

A 22-year-old male presents with progressive tremors, slurred speech, and personality changes over the past few months. On examination, he has mild hepatomegaly, dysarthria, and a brownish ring around the cornea visible on slit-lamp examination (Kayser–Fleischer ring). Laboratory evaluation shows mildly elevated liver enzymes. Which of the following is the definitive diagnostic test for Wilson’s disease?

A 35-year-old man with a 5-year history of ulcerative colitis presents with mild jaundice and fatigue. Liver function tests show mildly elevated ALT and markedly elevated ALP. Ultrasound of the abdomen reveals a normal biliary tree with no stones or ductal dilatation. Which antibody is most likely elevated in this patient?

A 28-year-old woman presents with fatigue, jaundice, and elevated liver enzymes. Autoimmune markers are positive for ANA and anti-smooth muscle antibody, and a liver biopsy confirms autoimmune hepatitis. She is started on corticosteroids. Which of the following drugs should be added to steroids to maintain remission and minimize steroid toxicity?

A 48-year-old woman presents with progressive fatigue and pruritus. Laboratory tests reveal markedly elevated alkaline phosphatase and mild elevation of transaminases. Ultrasound shows normal bile ducts. Which of the following antibodies is most likely to be positive in this patient?

A 45-year-old patient with acute myeloid leukemia undergoing chemotherapy develops high-grade fever with chills and a total leukocyte count of 400 cells/$mm^3$. Blood pressure is stable, but the patient has mucositis and no localizing source of infection. Which of the following is the most appropriate empirical antibiotic regimen to start?

A 32-year-old woman with relapsing-remitting multiple sclerosis presents with a positive Lhermitte sign indicating cervical cord involvement. She has low JC virus antibody titers and wishes to conceive in the future. Which of the following disease-modifying therapies is most appropriate for her?