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Gastroentology spring final practice exam
questions with answers
1.Bruce Willis, 69-year-old man presents with impulsive and ritualistic behav- ior,
loss of empathy, and social disinhibition. His memory remains intact and keeps shouting yippee ki yay MF What is the most likely diagnosis?
A. Alzheimer disease
B. Vascular dementia
C. Deliruim
D. Frontotemporal dementia: D. Frontotemporal dementia
2.A 70-year-old man presents with a resting tremor, bradykinesia, and cog- wheel
rigidity. He also reports difficulty maintaining his balance. What is the most effective treatment for his condition?
A. Gabapentin
B. Propranolol
C. Levodopa-carbidopa
D. Benzodiazepines: C. Levodopa-carbidopa
3.A 32-year-old woman presents with chronic diarrhea, abdominal cramps, and
greasy, malodorous stools. She recently returned from a camping trip where she drank untreated water from a stream. What is the most appropriate treatment?
A. Ciprofloxacin
B. Azithromycin
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C. Metronidazole
D. Doxycycline: C. Metronidazole
4.Which of the following is a common symptom of gastric adenocarcinoma?
A. Dyspeptic symptoms with weight loss in patients over age 40
B. Intermittent abdominal pain relieved by food
C. Chronic diarrhea with greasy stools
D. Severe right upper quadrant pain with jaundice: A. Dyspeptic symptoms with weight
loss in patients over age 40
5.How is hepatitis A most commonly transmitted?
A. Blood transfusion
B. Sexual contact
C. Fecal-oral route
D. Vertical transmission: C. Fecal-oral route
6.Which of the following is a common symptom of a migraine headache?
A. Bilateral, dull pain
B. Unilateral, throbbing pain with nausea and photophobia
C. Circumferential, vise-like pain
D. Short, severe pain lasting less than 15 minutes: B. Unilateral, throbbing pain with
nausea and photophobia
7.Which of the following diagnostic tests confirms the diagnosis of achala- sia?
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A. Upper endoscopy
B. Esophageal manometry
C. Barium esophagogram
D. Chest X-ray: B. Esophageal manometry
8.What is a potential complication of Campylobacter jejuni infection?
A. Hemolytic uremic syndrome
B. Guillain-Barre syndrome
C. Reactive arthritis
D. Chronic liver disease: B. Guillain-Barre syndrome
9.A 70-year-old woman presents with hematochezia and a change in stool caliber.
She reports no significant family history of colorectal cancer. What is the gold standard diagnostic test for her condition?
A. Fecal occult blood test (FOBT)
B. Colonoscopy
C. CT colonography
D. Endoscopic ultrasound: B. Colonoscopy
10.Where is the most common site for small bowel adenocarcinoma?
A. Ileum
B. Duodenum
C. Jejunum
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D. Cecum: B. Duodenum
11.A 30-year-old woman presents with a headache described as a circum- ferential,
"vise-like" band around her head. She has no nausea, vomiting, or sensitivity to light and sound. What is the most appropriate initial treatment?
A. Triptans
B. Simple analgesics like ibuprofen or acetaminophen
C. Oxygen therapy
D. Ergotamine: C. Oxygen therapy
12.A 55-year-old woman reports an irresistible urge to move her legs, es- pecially
at night and during periods of rest. She finds temporary relief with movement. What is the first-line treatment for her condition?
A. Propranolol
B. Dopamine agonists
C. Benzodiazepines
D. Levodopa: B. Dopamine agonists
13.Which of the following is a protective factor against hepatocellular carci- noma?
A. Obesity
B. Alcohol consumption
C. Coffee consumption
D. Hepatitis B infection: C. Coffee consumption
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14.A 45-year-old woman presents to the clinic with complaints of heartburn and
regurgitation for the past six months. She describes a burning sensation in her chest that often worsens after meals and when lying down. She has tried over-the-counter antacids with minimal relief. She denies any weight loss, difficulty swallowing, or painful swallowing. Physical examination is unremarkable. What is the next best step in managing her symptoms?
A. Start on proton pump inhibitor (PPI) therapy
B. Perform an upper endoscopy
C. Prescribe H2 antagonists
D. Recommend lifestyle and dietary modifications: A. Start on proton pump inhibitor
(PPI) therapy
15.A 5-year-old girl presents with severe abdominal pain and bloody diarrhea after
eating undercooked hamburger meat. She has a history of minimal urine output in the last 24 hours. Laboratory results show hemolytic anemia, thrombocytopenia, and acute renal failure. What is the most likely diagnosis?
A. Enterotoxigenic E. coli (ETEC) infection
B. Shiga-toxin producing E. coli (STEC) infection
C. Campylobacter jejuni infection
D. Rotavirus infection: B. Shiga-toxin producing E. coli (STEC) infection
16.What is a typical characteristic of a cluster headache?
A. Headaches lasting for several days
B. Bilateral pain with throbbing
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C. Severe, short headaches with unilateral pain and autonomic symptoms
D. Gradual onset and progressive intensity: C. Severe, short headaches with unilateral
pain and autonomic symptoms
17.A 68-year-old man presents with upper abdominal pain radiating to the back,
weight loss, and jaundice. Physical examination reveals an enlarged gallbladder. What is the most appropriate initial diagnostic test?
A. Abdominal ultrasound
B. Helical CT scan
C. Endoscopic retrograde cholangiopancreatography (ERCP)
D. Magnetic resonance cholangiopancreatography (MRCP): B. Helical CT scan
18.A 35-year-old man presents with jaundice, anorexia, nausea, and right upper
quadrant tenderness. He has a history of recent unprotected sexual contact. On examination, he has an enlarged and tender liver. What is the most appropriate diagnostic test for confirming acute hepatitis B infection?
A. Anti-HCV antibody
B. Anti-HDV antibody
C. Anti-HAV antibody
D. Anti-HBV IgM: D. Anti-HBV IgM
19.Which of the following treatments is used to manage esophageal webs or rings?
A. Botulinum toxin injection
B. Pneumatic dilation therapy
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C. Bougie dilators or endoscopic electrosurgical incision
D. Surgical Heller cardiomyotomy: C. Bougie dilators or endoscopic electrosurgi- cal incision
20.A 50-year-old man presents with a new onset of severe headaches that worsen
with postural changes. He also reports focal neurological signs. What is the most appropriate next step?
A. Start simple analgesics
B. Immediate neuroimaging
C. Prescribe triptans
D. Recommend rest and hydration: B. Immediate neuroimaging
21.A 45-year-old man presents with sudden onset of right-sided facial paral- ysis,
difficulty closing his right eye, and loss of taste on the right side of his tongue. What is the most appropriate initial treatment?
A. Antiviral therapy
B. Steroids
C. Surgical decompression
D. NSAIDs: B. Steroids
22.Which symptom is more commonly associated with Norovirus infection in children
compared to adults?
A. Diarrhea
B. Fever
C. Vomiting
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D. Abdominal cramps: C. Vomiting
23.A 58-year-old man with a history of chronic alcoholism presents to the
emergency department with vomiting of large amounts of blood. He is pale, diaphoretic, and hypotensive. Physical examination reveals signs of shock. What is the most appropriate initial management for this patient?
A. Immediate upper endoscopy
B. Administration of IV proton pump inhibitors
C. Rapid assessment and resuscitation with fluids or blood products
D. Admission to a regular medical floor for observation: C. Rapid assessment and
resuscitation with fluids or blood products
24.Which of the following medications is most commonly associated with
medication overuse headache?
A. Antiepileptic drugs
B. Triptans
C. Calcium channel blockers
D. Beta-blockers: B. Triptans
25.Which type of esophageal cancer is most associated with Barrett esopha- gus?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Small cell carcinoma
D. Large cell carcinoma: B. Adenocarcinoma
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26.What is a characteristic finding in the cerebrospinal fluid (CSF) of a patient with
Guillain-Barre syndrome?
A. Low protein
B. High protein
C. Elevated white blood cells
D. Low glucose: B. High protein
27.What characteristic finding on a barium esophagogram suggests a diag- nosis of
achalasia?
A. "Bird's beak" appearance
B. Dilated esophageal veins
C. Diaphragm-like membranes
D. Peptic stricture: A. "Bird's beak" appearance
28.What is the first step in diagnosing hepatitis C infection?
A. Liver biopsy
B. Anti-HCV enzyme immunoassay (EIA)
C. Abdominal ultrasound
D. Anti-HAV antibody: B. Anti-HCV enzyme immunoassay (EIA)
29.A 60-year-old woman presents with intense, intermittent, "electric shock-like"
pain along the right side of her face. The pain is triggered by chewing and cold drafts. What is the first-line treatment for this condition?
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A. Ibuprofen
B. Carbamazepine
C. Sumatriptan
D. Oxygen therapy: B. Carbamazepine
30.A 2-year-old child presents with acute onset vomiting and watery diarrhea. The
symptoms started 2 days ago, and she has been having low-grade fever. Her stool test is positive for rotavirus. What is the recommended treatment?
A. Antibiotic therapy
B. Antiviral therapy
C. Supportive care
D. Admission: C. Supportive care
31.Which of the following foods is most commonly associated with Salmonel- la
infection?
A. Shellfish
B. Beef
C. Eggs
D. Leafy green: C. Eggs
32.What is an effective treatment to reduce the incidence of postherpetic
neuralgia if started within 72 hours of onset?
A. Ibuprofen
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B. Acyclovir
C. Carbamazepine
D. Gabapentin: B. Acyclovir
33.Which of the following is a diagnostic marker for autoimmune hepatitis?
A. Positive Anti-HCV antibody
B. Elevated serum gamma-globulin levels
C. Positive Anti-HAV IgM
D. Elevated serum ferritin: B. Elevated serum gamma-globulin levels
34.A 75-year-old man with a history of hypertension and diabetes presents with
gradual memory loss and cognitive decline. He has a history of multiple small strokes. What is the most likely diagnosis?
A. Alzheimer disease
B. Vascular dementia
C. Lewy body dementia
D. Frontotemporal dementia: A. Alzheimer disease
35.What is the typical cause of a Mallory-Weiss tear?
A. Chronic alcohol use
B. Transabdominal pressure such as lifting, retching, or vomiting
C. Ingestion of corrosive substances
D. Long-term use of NSAIDs: B. Transabdominal pressure such as lifting, retching, or
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36.A 62-year-old man presents with epigastric pain and nausea that has been
ongoing for several months. He reports a 10-pound weight loss over the last three months and occasional vomiting. He has no history of gastrointestinal bleeding. What is the most appropriate next step in the diagnostic workup?
A. Start a proton pump inhibitor (PPI) and re-evaluate in 4 weeks
B. Test for Helicobacter pylori
C. Perform upper endoscopy
D. Prescribe antacids and recommend lifestyle changes: C. Perform upper
endoscopy
37.Which symptom is NOT typically associated with Lewy body dementia?
A. Repeated visual hallucinations
B. Fluctuating alertness and cognitive function
C. Parkinsonian symptoms
D. Severe short-term memory loss early in the disease: D. Severe short-term memory
loss early in the disease
38.What is a common laboratory finding in a patient with gastritis?
A. Elevated white blood cell count
B. Low hematocrit
C. Elevated liver enzymes
D. Hypercalcemia: B. Low hematocrit
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39.A 50-year-old man with a history of heavy alcohol use presents with jaun- dice,
hepatomegaly, and ascites. Laboratory tests show elevated AST and ALT with AST>ALT, elevated alkaline phosphatase, and prolonged prothrombin time. What is the most important initial step in managing his condition?
A. Start antiviral therapy
B. Administer corticosteroids
C. Immediate cessation of alcohol intake
D. Perform a liver biopsy: C. Immediate cessation of alcohol intake
40.A 45-year-old woman presents with a burning epigastric pain that is worse at
night and wakes her from sleep. She notes that eating food relieves the pain temporarily. She has no significant medical history and does not take any medications regularly. What is the most likely diagnosis?
A. Gastric ulcer
B. Duodenal ulcer
C. Functional dyspepsia
D. Gastritis: B. Duodenal ulcer
41.What is the typical incubation period for food poisoning caused by Staphy-
lococcus?
A. 1-3 days
B. 24-48 hours
C. 1-8 hours
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D. 12-72 hours: C. 1-8 hours
42.What is a common finding in non-alcoholic fatty liver disease (NAFLD)?
A. Hepatomegaly
B. Severe right upper quadrant pain
C. High levels of serum aminotransferases
D. Jaundice: A. Hepatomegaly
43.Which of the following treatments is indicated for gastric outlet obstruc- tion?
A. Oral rehydration therapy
B. Nasogastric decompression and intravenous isotonic saline
C. Immediate surgical intervention
D. H2-receptor antagonists: B. Nasogastric decompression and intravenous iso- tonic saline
44.A 25-year-old man recently returned from a trip to an area known for
outbreaks. He presents with abrupt onset of copious, watery diarrhea and signs of dehydration. What is the first-line treatment for this condition?
A. Ciprofloxacin
B. Oral rehydration therapy
C. Metronidazole
D. Loperamide: B. Oral rehydration therapy
45.A 30-year-old man presents to the emergency department with hemateme- sis
following an episode of severe retching and vomiting after a night of heavy drinking.
15 / 28 Physical examination reveals unstable vital signs and signs of shock. What is the first-line treatment for this condition?
A. Immediate surgery
B. Endoscopic injection with epinephrine
C. Oral proton pump inhibitors
D. Fluid resuscitation and blood transfusions if needed: D. Fluid resuscitation and blood
transfusions if needed
46.A 60-year-old woman with a history of chronic hepatitis C presents with
fatigue, ascites, and muscle cramps. Physical examination reveals he- patomegaly, jaundice, and signs of portal hypertension. What is the diagnostic test of choice to confirm cirrhosis?
A. Abdominal ultrasound
B. Liver biopsy
C. Serum aminotransferase levels
D. Iron studies: C. Serum aminotransferase levels
47.Which of the following is a red flag symptom that warrants further investi- gation
in a patient with dyspepsia?
A. Nausea
B. Postprandial fullness
C. Persistent vomiting
D. Mild epigastric discomfort: C. Persistent vomiting
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48.Which of the following is a common cause of upper gastrointestinal bleed- ing?
A. Diverticulosis
B. Peptic ulcers
C. Hemorrhoids
D. Infectious colitis: B. Peptic ulcers
49.Which of the following is the most common bacterial cause of traveler's
diarrhea?
A. Salmonella spp
B. Giardia
C. Rotavirus
D. Escherichia coli: D. Escherichia coli
50.What laboratory finding is commonly seen in drug- and toxin-induced liver injury?
A. Hypercalcemia
B. Serum aminotransferase levels >3x normal limits
C. Low serum albumin
D. Elevated creatinine: B. Serum aminotransferase levels >3x normal limits
51.A 72-year-old woman presents to the emergency department with painless, large-
volume bright red blood per rectum. She denies abdominal pain, fever, or weight loss. Her vital signs are stable. What is the most likely cause of her bleeding?
A. Infectious colitis
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B. Diverticular disease
C. Inflammatory bowel disease
D. Hemorrhoids: D. Hemorrhoids
52.What is the primary treatment for celiac disease?
A. Steroid therapy
B. Proton pump inhibitors
C. Removal of all gluten from the diet
D. Antibiotic therapy: C. Removal of all gluten from the diet
53.A 28-year-old woman presents with intermittent bouts of diarrhea,
low-grade fever, and right lower quadrant pain. Physical examination reveals
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A. Ulcerative colitis
B. Irritable bowel syndrome
C. Crohn's disease
D. Celiac disease: C. Crohn's disease
54.What is a common symptom of ulcerative colitis?
A. Weight gain
B. Lower abdominal cramps and bloody diarrhea
C. Upper abdominal pain
D. Constipation: B. Lower abdominal cramps and bloody diarrhea
55.A 55-year-old man presents to the emergency department with melena and a
history of peptic ulcer disease. His blood pressure is 95/60 mm Hg and heart rate is 110 beats per minute. What is the first step in management?
A. Immediate endoscopy
B. Proton pump inhibitor therapy
C. Fluid and blood replacement
D. Antibiotic therapy: C. Fluid and blood replacement
56. Which diagnostic test is typically performed first in a patient under 50 years old
presenting with lower gastrointestinal bleeding?
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A. Colonoscopy
B. Upper endoscopy
C. Anoscopy/Sigmoidoscopy
D. CT angiography: A. Colonoscopy
57.Which imaging technique is used to diagnose hepatic vein obstruction?
A. CT angiography
B. Liver biopsy
C. Color Doppler ultrasonography
D. MRI with contrast: C. Color Doppler ultrasonography
58.A 45-year-old woman is diagnosed with hepatitis C. Her genotype is de-
termined, and she is found to have genotype 1. What is the typical treatment regimen for her condition?
A. Peginterferon-based regimen
B. Antiretroviral therapy
C. High-dose corticosteroids
D. Hepatitis A and B vaccines: A. Peginterferon-based regimen
59.A 35-year-old woman presents with chronic diarrhea, weight loss, and abdominal
distention. She also has a history of iron deficiency anemia. What serologic test would you order to support the diagnosis of celiac disease?
A. Anti-dsDNA antibodies
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B. Anti-smooth muscle antibodies
C. IgA tissue transglutaminase (IgA tTG) antibody
D. Rheumatoid factor: C. IgA tissue transglutaminase (IgA tTG) antibody
60.A 55-year-old man presents with upper gastrointestinal bleeding and
splenomegaly. He denies any history of alcohol use or liver disease. Color Doppler ultrasonography reveals portal vein obstruction. What is the next step in confirming the diagnosis?
A. Liver biopsy
B. Contrast-enhanced CT or MRA of the portal system
C. Endoscopy
D. Hepatic function panel: B. Contrast-enhanced CT or MRA of the portal system
61.What is the initial treatment for ulcerative colitis?
A. Antibiotics
B. Topical 5-ASA
C. Proton pump inhibitors
D. Immunosuppressive agents: B. Topical 5-ASA
62.A 70-year-old man with a history of atherosclerosis presents with severe, diffuse
abdominal pain that began suddenly. His vital signs include hypoten- sion and tachycardia. Laboratory studies reveal a high white blood cell count and lactic acidosis. What is the most likely diagnosis?
A. Acute mesenteric ischemia
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B. Chronic mesenteric ischemia
C. Ischemic colitis
D. Irritable bowel syndrome: A. Acute mesenteric ischemia
63.What is the initial treatment for a pyogenic hepatic abscess?
A. Surgical resection
B. Antimicrobial agents effective against coliform organisms and anaerobes
C. Radiation therapy
D. Liver transplantation: B. Antimicrobial agents effective against coliform organ- isms and
anaerobes
64.Which of the following is characteristic of irritable bowel syndrome (IBS)?
A. Constant severe abdominal pain
B. Abdominal pain with alterations in bowel habits lasting more than 3 months
C. Presence of blood in stool
D. Weight loss and fever: B. Abdominal pain with alterations in bowel habits lasting more
than 3 months
65.What is the initial approach to managing irritable bowel syndrome (IBS)?
A. Antibiotic therapy
B. Surgical intervention
C. Reassurance, education, and dietary changes
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D. Immunosuppressive therapy: C. Reassurance, education, and dietary changes
66.A 65-year-old woman complains of postprandial epigastric pain that lasts for a
few hours and has led to significant weight loss. She has a history of coronary artery disease. What is the most appropriate diagnostic test to evaluate her condition?
A. Colonoscopy
B. Computed tomography angiography (CTA)
C. Upper endoscopy
D. Barium swallow: C. Upper endoscopy
67. A 60-year-old woman presents with severe right upper quadrant pain, fever, and
nausea following a fatty meal. Physical examination reveals tenderness in the right hypochondrium. Laboratory tests show leukocytosis and elevated liver function tests. What is the recommended treatment?
A. Start a high-fiber diet and observe
B. Immediate cholecystectomy within 24 hours
C. Oral antibiotics and discharge
D. Endoscopic retrograde cholangiopancreatography (ERCP): B. Immediate
cholecystectomy within 24 hours
68.Which patient population is most commonly affected by irritable bowel
syndrome (IBS)?
A. Elderly individuals over 70
B. Young children under 10
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C. Adolescents and young adults in their late teens to early 20s
D. Middle-aged adults between 40 and 50: C. Adolescents and young adults in their late
teens to early 20s
69.Which of the following is a precipitating factor for ileus?
A. Inflammatory bowel disease
B. High-fiber diet
C. Electrolyte abnormalities
D. Chronic constipation: C. Electrolyte abnormalities
70.Which diagnostic test most reliably detects stones in the bile duct?
A. Ultrasound
B. Magnetic resonance cholangiopancreatography (MRCP)
C. Endoscopic retrograde cholangiopancreatography (ERCP)
D. Computed tomography (CT) scan: C. Endoscopic retrograde cholangiopancre- atography
(ERCP)
71.A 22-year-old woman presents with colicky periumbilical pain that has shifted to
the right lower quadrant over the past 12 hours. She also reports nausea and vomiting. On physical examination, she has tenderness to palpa- tion in the right lower quadrant and a positive Psoas sign. Negative HCG. What is the next best step in the management of this patient?
A. Prescribe antibiotics and observe
B. CT scan
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C. Order a complete metabolic panel
D. Initiate a clear liquid diet: B. CT scan
72.What imaging modality is contraindicated during the initial stages of diver-
ticulitis due to the risk of perforation?
A. Abdominal CT
B. Endoscopy
C. MRI
D. X-ray: B. Endoscopy
73.A 70-year-old man presents with jaundice, fever, and right upper quadrant pain.
He appears confused and hypotensive. Laboratory tests show elevated liver enzymes and bilirubin. What is the initial treatment?
A. Immediate surgery
B. IV antibiotics and urgent ERCP with sphincterotomy and stone extraction
C. Observation and supportive care
D. High-dose corticosteroids: B. IV antibiotics and urgent ERCP with sphinctero- tomy and
stone extraction
74.A 50-year-old man with no prior history of colon cancer presents with new-
onset constipation, weight loss, and a positive fecal occult blood test (FOBT). What is the most appropriate next step?
A. Prescribe laxatives
B. Initiate dietary and lifestyle changes
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C. Perform a colonoscopy
D. Recommend increased fluid intake: C. Perform a colonoscopy
75.A 30-year-old woman presents with episodes of numbness and tingling,
diplopia, and unsteadiness that resolve after a few weeks. An MRI shows demyelinating lesions separated by time and space. What is the most likely diagnosis?
A. Guillain-Barre syndrome
B. Multiple sclerosis
C. Myasthenia gravis
D. Amyotrophic lateral sclerosis: B. Multiple sclerosis
76.What is the characteristic finding on an abdominal X-ray in a patient with ileus?
A. Free air under the diaphragm
B. Distended gas-filled loops of the small and large intestine
C. Narrowing of the intestinal lumen
D. Fecal impaction: B. Distended gas-filled loops of the small and large intestine
77.A 35-year-old man presents with severe, tearing pain during defecation
followed by throbbing discomfort. He also notices occasional blood on the toilet paper. On physical examination, a linear tear in the anus is observed. What is the most appropriate initial treatment?
A. Increase dietary fiber and fluid intake
B. Local incision and drainage