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One inal note: Even the best question-and-answer exercise by itself is not an adequate preparation for a Board exam. A year-old man presents for a physical to obtain life insurance. He reports being in good health generally.

He takes no medications. On review of systems, he reports frequent heartburn for the last several months. He denies diarrhea. His abdominal exam reveals a non-distended abdomen without tenderness or hepatosplenomegaly. Laboratory studies: Ambulatory pH study. Perform endoscopy. Tissue transglutaminase IgA Ab. Trial of a proton pump inhibitor. A year-old woman presents with daily acid relux symptoms and intermittent dysphagia to solids.

Since onset of symptoms 3 months ago, she has lost 4 pounds. She also has sporadic rectal bleeding. Her past medical history is negative.

Her father had stomach cancer at age What would you recommend? EGD B. Reassurance C. Barium esophagram D. A year-old man presents to the emergency department complaining of abdominal pain that has progressively worsened over the last 2 days. He reports associated nausea and vomiting. His past medical history includes hypertension and hyperlipidemia. Medications include lisinopril, hydrochlorothiazide, and simvastatin.

On physical exam, temperature is He appears in mild distress secondary to pain. Abdominal exam reveals a distended abdomen with tenderness to palpation greatest in the epigastric region.

Abdominal skin is discolored as shown in the image. Heart and lung exams are otherwise unremarkable. See Appendix B for color image Figure 1.

What is the next best step to conirm the diagnosis? CA B. CT of the abdomen C. Endoscopic retrograde cholangiopancreatography D. Serum lipase E. Ultrasound of the abdominal aorta 4.

A year-old man presents to the emergency department complaining of central abdominal pain that has progressively worsened over the last 2 days.

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