GASTROENTEROLOGY &
HEPATOLOGY MED CHALLENGER
PSYCHIATRIC NURSING ACTUAL
EXAM QUESTIONS WITH ANSWERS
(VERIFIED ANSWERS) ALREADY
GRADED A+ 2024-2025
A 42-year-old woman presents with abdominal pain for the past 2 days. She
describes the pain as crampy and intermittent in the epigastric area, and it is
particularly worse after meals. She has a history of gastric bypass surgery for
weight loss management 2 years ago. On physical examination, she is
afebrile and her abdomen is soft and nontender with no masses.
Laboratory study results are as follows:
White blood cell count: 7400/µL
Hemoglobin: 13.2 g/dL
Platelets: 215,000/µL
Albumin: 4.3 g/dL
Aspartate aminotransferase: 334 U/L
Alanine transaminase: 282 U/L
Alkaline phosphorus: 115 U/L
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Total bilirubin: 1.7 mg/dL
Amylase: 42 U/L
Lipase: 24 U/L
Abdominal ultrasonography demonstrates a normal-appearing liver, mild
distension of the gallbladder with several stones in the fundus of the
gallbladder, but no apparent wall thickening or pericholecystic fluid. The
common bile duct is dilated to 1.3 cm.
What is the next step in the management of this patient's condition?
• magnetic resonance cholangiopancreatography
(MRCP)
A 52-year-old man with severe emphysema is admitted to the hospital with an
exacerbation. On hospital day 2, his clinical condition worsens with increasing
oxygen requirements and significant tachypnea that requires he be transferred
to the intensive care unit and be intubated.
He is started on broad-spectrum antibiotics with initial improvement; however,
by day 7, his white blood cell count is increased to 19,000/µL. Repeat blood
cultures do not have any growth by 72 hours, and there is no evidence of
urinary or Clostridium difficile infection, and Doppler ultrasonography of the
lower extremities does not reveal any clots.
Right upper quadrant ultrasonography demonstrates a thickened, distended
gallbladder with no sludge or stones and mild pericholecystic fluid. The
common bile duct measures 4 mm. The patient remains on norepinephrine for
blood pressure support.
What is the next step in the management of this patient's condition?
A 45-year-old woman with hypertension, type 2 diabetes mellitus, and morbid
obesity presents to you with intermittent, right-sided abdominal pain and
dyspepsia. These symptoms have been present for the past 6 months, but
she experienced a severe episode 3 days ago lasting for approximately 4
hours.
Her current medications include losartan, metformin, and baby aspirin. She
denies any recent use of nonsteroidal anti-inflammatory drugs,
acetaminophen, or alcohol.
On physical examination, her blood pressure is 140/85 mm Hg, pulse is 80
beats/minute, and she is afebrile. She does not have jaundice, and abdominal
examination reveals mild tenderness in the epigastrium.
Laboratory study results are as follows:
White blood cell count: 10,400/µL
Hemoglobin: 12.8 g/dL
Albumin: 4.1 g/dL
Aspartate aminotransferase: 245 U/L
Alanine transaminase: 175 U/L
Alkaline phosphorus: 245 U/L
Total bilirubin: 3.7 mg/dL
Amylase: 335 U/L
Lipase: 520 U/L
Due to her poor oral intake, you admit her for hydration and further work-up.
Laboratory values on hospital day 2 demonstrate improving liver chemistries
as well as an amylase level of 175 U/L and a lipase level of 330 U/L.
Serologies for hepatitis A, B, and C are negative. Right-upper quadrant
ultrasonography reveals a liver with mild fatty infiltration, a normal caliber
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common bile duct, and no gallbladder wall thickening or pericholecystic fluid.
There are several shadowing lucencies with the gallbladder suggestive of
stones. Computed tomography is also obtained and demonstrates mild
pancreatic inflammation.
She is feeling well, does not have pain on a low-fat diet, and she insists on
being discharged.
What should be the next step in the management of her condition?
Schedule endoscopic retrograde cholangiopancreatography (ERCP) for her as an outpatient.
Refer her for shock-wave lithotripsy.
Consult with a surgeon to determine need for cholecystectomy.
Schedule her for liver biopsy.
No further work-up is necessary at this time; she only requires monitoring for possible recurrence o
sy
A 51-year-old man with hypertension and hyperlipidemia is found to have a
mild elevation in his alanine transaminase (ALT) level of 58 U/L with otherwise
normal liver enzyme levels. He is taking simvastatin 20 mg, and he is
otherwise asymptomatic with no significant abdominal complaints. Work-up for
viral hepatitis and other heritable and autoimmune liver diseases is
unremarkable.
Right upper quadrant ultrasonography demonstrates a normal-appearing liver
with no cholelithiasis and normal bile ducts. There does appear to be
extensive calcification of the gallbladder wall but with no obvious mass or
polyps.
What is the next step in the management of this patient's condition?
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