A 40-year-old male presents with recurrent hunger-induced epigastric pain for 8 years; multiple gastroscopies confirmed duodenal ulcers. Which bacterium is most associated with the recurrence of these ulcers?
The three major clinical manifestations of portal hypertension are
A 55-year-old woman presents with recurrent retrosternal pain for 2 years, accompanied by acid regurgitation, heartburn, and intermittent food regurgitation. Esophageal manometry shows LES pressure of 6 mmHg. What is the most likely diagnosis?
A 55-year-old woman has experienced recurrent episodes of retrosternal burning discomfort or pain accompanied by regurgitation and acid regurgitation over the past six months. The episodes are irregular, and an electrocardiogram (ECG) showed nonspecific ST-T changes. After treatment with omeprazole (Losec) 20mg twice daily for 7 days, her symptoms significantly improved. The most likely diagnosis is:
A 46-year-old male presents with intermittent upper abdominal pain for 3 years, worsening over the past 2 months. Gastroscopy reveals an ulcer at the gastric angulus, with positive Helicobacter pylori. The preferred treatment is:
A 60-year-old male was hospitalized for coma due to cerebral hemorrhage. On day 2 of admission, he suddenly vomited approximately 600ml of coffee-ground material and passed melena 3 times. The most likely cause of his upper gastrointestinal bleeding (GI bleeding) is:
A 54-year-old male presents with intermittent upper abdominal discomfort for 4 years, worsened after meals, and belching. Gastroscopy reveals paler gastric mucosa on the greater curvature of the upper gastric body, and biopsy shows severe dysplasia. Which treatment is most appropriate?
A 26-year-old female presents with epigastric distension, pain, and anorexia for over 6 months. Gastroscopy reveals red and white alternating mucosa (predominantly red) with abundant mucus in the antrum. Biopsy and pathological examination show lymphocyte and plasma cell infiltration with intestinal metaplasia. The most likely diagnosis is:
A 20-year-old female developed gastric pain after taking indomethacin for arthralgia, and experienced hematemesis (200ml) this morning. Suspected erosive gastritis. Which test should be prioritized for rapid diagnosis?
A 30-year-old woman with intermittent epigastric pain for 4 years. Today, the pain became distending in nature, accompanied by vomiting of large amounts of undigested food. Physical examination reveals a splashing sound in the epigastrium that does not improve with positional changes. The most likely diagnosis is:
A 38-year-old male with recurrent ulcer disease for 5 years. Current gastroscopy shows duodenal bulb ulcer (A2 stage) with rapid urease test (RUT) positive. The treatment of choice is:
A 32-year-old male patient has experienced intermittent epigastric pain for 3 years, with occasional acid regurgitation and belching, worsening after catching cold. Pain intensified over the past 3 days. Today, he suddenly vomited 500ml of coffee-ground material, accompanied by dizziness, palpitations, and sweating. Abdominal pain relieved after bleeding. The most likely cause of bleeding is:
A 23-year-old woman has passed tarry stools 5 times over 2 days and suddenly fainted this morning. No history of gastric or liver disease, and no recent medication use. Physical exam shows pallor, BP 70/50 mmHg, pulse 130/min. What is the first-line management?
A 40-year-old woman with a history of duodenal bulb ulcer presents with 1 month of postprandial epigastric pain and vomiting. The vomitus contains fermented undigested food. Physical exam shows weight loss, mild epigastric distension, occasional visible gastric peristalsis, and succussion splash. Which treatment is most appropriate?
A 34-year-old male worker, previously healthy, has experienced acid regurgitation and epigastric discomfort when hungry for the past 2 months, along with melena in recent days. Physical examination shows mild anemic appearance, with no abnormalities in heart or lungs. Hemoglobin (Hb) is 90g/L, white blood cell (WBC) count is 9.0*10^9/L with normal differential. The most likely cause of his upper gastrointestinal bleeding (GI bleeding) is:
A 30-year-old woman with intermittent epigastric pain for 4 years now presents with distension-type pain and vomiting of large amounts of undigested food. Physical examination reveals a splashing sound in the upper abdomen that does not improve with positional changes. The most likely diagnosis is:
A 48-year-old male presents with intermittent abdominal pain and abdominal distension for over 20 years, worsening over the past 3 months. Bowel movements occur 4-5 times per day, slightly loose, with poor appetite and 5kg weight loss in 1 month. Laboratory tests show fecal occult blood (±) to (+). Hb: 104g/L. The best diagnostic method is:
A 45-year-old male presents with persistent epigastric dull pain and poor appetite for 3 months. No prior history of gastric disease. Stool appears yellow, with intermittent positive occult blood tests. Physical exam reveals epigastric tenderness without masses, and no hepatosplenomegaly. Which of the following tests is most helpful for definitive diagnosis?
A 42-year-old male presents with 2 months of epigastric dull pain. Gastroscopy reveals a 0.5cm × 0.5cm superficial erosion in the antrum of the stomach. Pathological diagnosis is adenocarcinoma. Surgical exploration shows 2 enlarged lymph nodes along the lesser curvature. Resected specimen pathology indicates tumor involvement of the mucosal and submucosal layers with lymph node metastasis. The diagnosis is:
A 45-year-old male presents with 13 years of rhythmic epigastric pain, occurring 30 minutes after meals and relieved before the next meal. Symptoms were alleviated by aluminum hydroxide, but in the past 3 months, the pain pattern disappeared, the medication became ineffective, and appetite sharply declined. What is the first-choice diagnostic test?
A 60-year-old male presents with vague epigastric pain for 6 months. Gastroscopy reveals a 3cm×2cm ulcer on the lesser curvature of the antrum of the stomach, with raised edges, hard texture, easy bleeding, central depression with thick exudate, and reduced antral motility. The most likely diagnosis is:
A 48-year-old male with a 20-year history of duodenal bulb ulcer. Symptoms worsened over the past 2 months, with pain occurring both before and after meals. For the past half month, frequent vomiting of large amounts of retained food with foul odor was noted. Gastroscopy revealed pyloric obstruction and a 2.5cm × 2.5cm ulcer on the lesser curvature of the stomach, with central deep excavation, dirty necrotic base, smooth margins, slightly increased firmness, minimal bleeding on biopsy, and reduced peristalsis. The most likely diagnosis is:
A 43-year-old male was admitted with fever, abdominal distension, and tenesmus for 2 weeks. Physical examination revealed abdominal distension without abdominal wall varicose veins, doughy abdomen, mild tenderness and rebound tenderness. Ascitic fluid analysis showed bloody exudate with no pathological cells. Stool examination showed 5-8 red blood cells (RBC)/HP and 2-4 white blood cells (WBC)/HP. Which of the following tests should be performed first to confirm the diagnosis?
A 34-year-old woman is admitted with fever and dull abdominal pain for 1 month. She has a history of pelvic tuberculosis. Physical examination shows abdominal wall rigidity with mild tenderness and rebound tenderness, most pronounced in the right lower quadrant. Barium meal X-ray reveals a 'stierlin sign' in the ileocecal region and loss of the normal angle between the ileum and cecum. The most likely diagnosis is:
A 28-year-old woman presents with diarrhea lasting over 2 months, having 3-4 bowel movements per day without mucus or blood. Physical examination reveals a poorly defined mass with mild tenderness in the right lower quadrant. The clinical diagnosis is intestinal tuberculosis. Which condition is most easily confused with this disease?
A 40-year-old male was admitted for intestinal tuberculosis with tuberculous peritonitis. Treatment with isoniazid (INH), rifampin, and others led to gradual improvement. Over the past 2 days, he developed constipation, vomiting, and abdominal distension. Physical exam: distended abdomen with visible intestinal loops and peristaltic waves, hyperactive bowel sounds. Abdominal X-ray shows multiple air-fluid levels. Persistent gastrointestinal decompression showed no improvement. The next step in management is:
A 28-year-old female presents with fever and night sweats for 6 months. Recent marked abdominal distension is noted. Physical exam: no cardiopulmonary abnormalities, doughy abdominal wall, non-palpable liver/spleen, ascites sign (+). Ascitic fluid analysis: straw-colored, specific gravity 1.02, protein 30g/L, WBC 600×10<sup>6</sup>/L (predominantly monocytes), no pathological cells found. The most likely diagnosis is:
A 38-year-old woman presents with intermittent lower abdominal pain and diarrhea for 3 years, with 4-5 bowel movements per day, mucopurulent bloody stool, and relief after defecation. Colonoscopy revealed congestion, erosion, and superficial small ulcers. The most likely diagnosis is:
A 37-year-old woman has chronic diarrhea for 2 years, with 2-3 bowel movements daily, often containing small amounts of mucus. Repeated stool pathogen cultures are negative. Colonoscopy reveals congestion, edema, and a few scattered superficial ulcers in the rectum, descending colon, and transverse colon. The diagnosis is ulcerative colitis. The first-line treatment is:
A 35-year-old male with chronic diarrhea for over 6 months underwent outpatient X-ray barium enema examination, revealing spiculated colonic margins, loss of haustrations, rigid intestinal walls, shortened bowel, and narrowed lumen with a lead-pipe appearance. The most likely diagnosis is:
The main cause of splenomegaly in portal cirrhosis is
A patient with cirrhosis suddenly experiences severe abdominal pain, followed by fever, bloody stools, shock, rapid ascites accumulation, and splenomegaly. The most likely complication is:
Which of the following hemostatic measures is contraindicated in a cirrhosis patient with GI bleeding who also has Hypertension (HTN) and coronary artery disease (CAD)?
In patients with cirrhosis who experience massive upper gastrointestinal bleeding, which measure is most commonly taken to prevent hepatic encephalopathy?
A 45-year-old male with a 1-year history of cirrhosis presents with abdominal distension for 1 month. Examination reveals ascites, non-palpable liver, and spleen 2 cm below the costal margin. One day before admission, he developed sudden severe abdominal pain followed by fever, hematochezia, shock, rapid increase in ascites, and splenomegaly. The most likely complication is:
A 40-year-old male with a 10-year history of chronic hepatitis B presents with abdominal distension and oliguria for 2 weeks. Despite diuretic therapy, ascites persists. Ascites ultrafiltration and reinfusion is being considered. The indication for this procedure is:
A 55-year-old woman presents with jaundice (yellowing of sclera and skin) for 9 months, accompanied by pruritus. Physical examination shows marked jaundice and hepatosplenomegaly. Primary biliary cirrhosis is suspected. Which of the following tests is most helpful for diagnosis?
A 42-year-old male with cirrhosis and ascites presents with fever (temperature ~38.5°C) for 3 days, abdominal pain, and increased ascites. Ascitic fluid analysis shows: pale yellow appearance, specific gravity 1.017, protein 25g/L, total cell count 0.6×10<sup>9</sup>/L (600/mm<sup>3</sup>), WBC 0.4×10<sup>9</sup>/L (400/mm<sup>3</sup>), neutrophils 80%. The most likely complication is:
A 48-year-old female with a 10-year history of hepatitis B and a 2-year diagnosis of cirrhosis frequently experiences gingival bleeding and epistaxis. The primary cause of bleeding is
A 45-year-old male with a 3-year history of chronic hepatitis B and cirrhosis presents with sudden severe right upper abdominal pain. Physical examination reveals generalized abdominal tenderness, and bloody ascites is obtained via paracentesis. The most likely diagnosis is:
A 50-year-old male with a 2-year history of cirrhosis was hospitalized due to right upper quadrant pain and weight loss over the past month. Alpha-fetoprotein (AFP) was found to be elevated. Which of the following statements about AFP elevation is INCORRECT?
A patient with cirrhosis suddenly develops severe abdominal pain, fever, rapid increase in ascites, and splenomegaly. The most likely complication is:
A 49-year-old male with a 10-year history of chronic hepatitis B was hospitalized for abdominal distension and oliguria for 2 weeks. Examination revealed ascites. After high-dose furosemide treatment, the patient became agitated and disoriented. Which of the following treatments is incorrect?
A 27-year-old female presents with low-grade fever, alternating diarrhea and constipation, abdominal distension for 6 months, and gradually increasing abdominal girth for 1 month. Physical exam: distended abdomen, doughy abdomen, mild tenderness and rebound tenderness, liver and spleen not palpable below the costal margin, shifting dullness (+). Ascites WBCs 450×10⁹/L (PMNs 8%, monocytes 92%), total protein in ascites 55g/L, albumin 43g/L (serum albumin 45g/L), adenosine deaminase (ADA) 75 U/L. The most likely diagnosis is:
A 26-year-old female presents with low-grade fever, fatigue, and night sweats for 1 month. Physical exam: alert, weight loss, jugular venous distension in supine position, 2/6 systolic blowing murmur at the apex. Distended abdomen with doughy consistency, mild generalized tenderness and rebound tenderness, liver palpable 2.5 cm below the costal margin (blunt edge, medium consistency, tender (+)), shifting dullness (+), no lower limb edema. ALT 56 IU/L, total bile acids 8 μmol/L, urinary protein (+). Which test is the first choice for definitive diagnosis?
A 30-year-old female patient diagnosed with tuberculous peritonitis and moderate ascites has been treated with streptomycin, isoniazid (INH), and rifampin for tuberculosis, along with hydrochlorothiazide and spironolactone for diuresis, but with poor ascites resolution. Which additional treatment should be added?
A 40-year-old male with a 4-year history of cirrhosis is admitted due to hematemesis and melena for 10 hours. Physical exam: somnolence, behavioral abnormalities, icteric sclera, liver not palpable below the costal margin, spleen 2 cm below the costal margin, ascites, positive flapping tremor. The patient regained consciousness after treatment. Which of the following measures is NOT beneficial for preventing recurrence of hepatic encephalopathy?
A 38-year-old male presents with 10 hours of persistent severe epigastric pain, accompanied by nausea and vomiting. The pain initially localized to the left upper abdomen but gradually spread to the entire abdomen. Physical exam: temperature 39°C, BP 90/60 mmHg, flat abdomen with marked upper abdominal muscle rigidity, significant tenderness, and mild rebound tenderness. Abdominal X-ray shows no free air under the diaphragm. Ultrasound reveals gallstones. Lab findings: WBC 16×10⁹/L (16,000/mm³), neutrophils 90%, serum amylase 2460 U (Somogyi method). The most likely diagnosis is:
A 42-year-old male presents with upper abdominal pain for 1 day. Serum amylase is 600U (Somogyi method), and acute pancreatitis is diagnosed. After successful treatment, which of the following measures is inappropriate for preventing recurrence?
A 55-year-old male with a 10-year history of chronic hepatitis B presents with 4 months of dull right upper quadrant pain, fatigue, decreased appetite, and weight loss. Physical exam shows no jaundice, mild tenderness on percussion over the liver area, no hepatosplenomegaly. Ultrasound reveals a 2cm×3cm×4cm round hypodense lesion in the right hepatic lobe. Which test is most helpful for diagnosis?
A 50-year-old male with a history of non-icteric hepatitis 10 years ago developed abdominal distension 6 months ago, with progressive abdominal enlargement. Recently, he presented with somnolence and nighttime restlessness. Examination: confusion, mild jaundice, ascites sign, liver and spleen not clearly palpable. Which test is most significant for diagnosis?
A 50-year-old male with a 2-year history of cirrhosis underwent barium meal examination one year ago, revealing worm-eaten filling defects in the lower esophagus. Two days ago, he experienced melena, followed by somnolence and nighttime restlessness, prompting emergency admission. Physical examination showed flapping tremors. Laboratory tests revealed elevated blood ammonia. The most likely mechanism by which ammonia causes central nervous system dysfunction is:
A 20-year-old male presents with epigastric pain radiating to the back for 2 months, accompanied by acid regurgitation and nocturnal pain. He has had similar episodes in the past and 3 previous episodes of melena. Which of the following is the preferred diagnostic test?
A 34-year-old woman presents with a 2-month history of retrosternal burning discomfort and nausea. The regurgitated material is acidic, with heartburn and nausea typically occurring after meals. She also experiences a choking sensation in the retrosternal area during eating. The most likely diagnosis is:
A 42-year-old male patient presents with intermittent epigastric discomfort for 3 years. Gastroscopy findings: severe atrophic gastritis. Pathology: atrophic gastritis with intestinal metaplasia. W-S staining positive. The appropriate treatment for this patient is:
A 48-year-old male with a 10-year history of gastric ulcers has experienced worsening pain over the past 2 months, loss of rhythmicity, and no response to multiple medications. Physical examination shows no superficial lymph node enlargement, flat and soft abdomen, epigastric tenderness, and a palpable mass. Which of the following tests should be prioritized?
A 36-year-old male presents with abdominal distension, pain, nausea, and vomiting for 1 week. The vomitus is copious, contains foul-smelling undigested food from the previous day, and lacks bile. Symptoms temporarily improve after vomiting. He has a history of intermittent epigastric pain for over 6 years, typically occurring on an empty stomach or at night, with seasonal autumn exacerbations. Physical examination reveals mild epigastric tenderness, visible gastric peristalsis, and a positive succussion splash. The most likely diagnosis is:
A 30-year-old male with a 4-year history of duodenal ulcer suddenly developed severe epigastric pain for 5 hours, followed by generalized abdominal pain and profuse sweating. Physical examination revealed abdominal tenderness and rebound tenderness. Ulcer perforation is suspected. Which of the following signs is most indicative of ulcer perforation?
A 53-year-old male presents with epigastric dull pain for over 1 month. Fecal occult blood test is positive (+). Gastroscopy reveals a 2cm*2cm ulcer on the lesser curvature of the stomach, with central depression covered by dirty exudate, irregular raised margins, hard consistency, easy bleeding, and reduced peristalsis. The most likely diagnosis is:
A 48-year-old male presents with a 5-year history of intermittent upper abdominal pain. Over the past 3 months, the epigastric pain has worsened, accompanied by nausea and decreased appetite. Barium meal X-ray examination reveals a 2.5cm*3.0cm niche shadow (ulcer crater) with irregular margins in the antrum of the stomach. Fecal occult blood test (FOBT) was positive on 3 occasions. The most likely diagnosis is:
A 45-year-old male with a 15-year history of gastric ulcers has experienced loss of abdominal pain rhythmicity in the past 2 months, with poor response to antacid therapy. Which of the following tests is most valuable for definitive diagnosis?
A 35-year-old woman presents with fever and night sweats for over 20 days. Her temperature is around 38°C. Physical examination reveals a distended abdomen with doughy consistency, mild tenderness and rebound tenderness diffusely. The liver and spleen are not palpable below the costal margin. Shifting dullness is positive. Laboratory tests show a white blood cell (WBC) count of 7.2×10⁹/L with 75% neutrophils (N) and 25% lymphocytes (L). What is the most likely diagnosis?
A 23-year-old female presents with fever, night sweats, weight loss, and abdominal distension for 3 months. Shifting dullness is noted on abdominal examination, suggesting exudative tuberculosis. The first-line diagnostic test is:
A 40-year-old woman presents with intermittent diarrhea for 5-6 years, mostly pasty stools, occasionally watery stools, often accompanied by abdominal pain. In the past week, she has recurrent diarrhea and abdominal pain with mucoid bloody stools, temperature 38°C, and anal fissures with perianal abscess observed. The most significant test for diagnosis is:
A 40-year-old male with a 10-year history of chronic hepatitis B presents with fatigue, weight loss, poor appetite, and occasional discomfort in the liver region. Examination: no scleral icterus, no spider angiomas, liver palpable 1.5cm below the costal margin with medium consistency and no tenderness, spleen palpable 2 fingerbreadths below the costal margin with medium consistency, no shifting dullness. Liver function tests are normal. HBsAg(+), anti-HBe(+), anti-HBc(+). A diagnosis of hepatitis B cirrhosis is considered. Which of the following is most valuable for diagnosing nodular cirrhosis?
A 40-year-old male with a 10-year history of chronic hepatitis B presents with fatigue, weight loss, poor appetite, and occasional discomfort in the liver area. Physical exam: no scleral icterus, no spider angiomas, liver palpable 1.5cm below the costal margin with firm consistency and no tenderness, spleen palpable 2 fingerbreadths below the costal margin with firm consistency, no shifting dullness. Normal liver function tests. HBsAg(+), anti-HBe(+), anti-HBc(+). A diagnosis of hepatitis B cirrhosis is considered. Which of the following is most valuable for diagnosing nodular cirrhosis?
A 58-year-old woman presented with 9 months of pruritus and was hospitalized 1 month ago after others noticed jaundice. No abdominal pain, normal appetite and bowel movements. Physical exam showed marked jaundice, excoriations, liver 3 cm below the costal margin (firm consistency), splenomegaly (6 cm below costal margin). Lab results: TBil 85.5 μmol/L, CB 46.8 μmol/L, albumin 30g/L, globulin 42g/L, ALT 56U, ALP 820U/L, GGT 94.5U/L, IgG 19.6g/L, IgA 16.9g/L, IgM 8.6g/L. Ultrasound showed hepatosplenomegaly, common bile duct 6mm without intrahepatic duct dilation. The most critical investigation is:
A 58-year-old woman presents with 9 months of jaundice (yellowing of sclera and skin) accompanied by pruritus (skin itching). Physical exam shows marked jaundice, liver palpable 4 cm below the costal margin (hard consistency, no tenderness), and spleen palpable 5 cm below the costal margin. Primary biliary cirrhosis (PBC) is suspected. Which test is most diagnostic?
A 54-year-old male with a 6-year history of HBV-related cirrhosis presents with abdominal distension and bilateral lower extremity edema for 1 month, worsening with oliguria for 2 days. Physical exam shows frog belly, positive fluid wave thrill, and pitting edema in both lower extremities. Laboratory tests reveal serum sodium 122 mmol/L and BUN 19 mmol/L. What is the most likely diagnosis?
A 40-year-old male with a 2-year history of cirrhosis presents with fever and abdominal pain for the past 2 weeks. Physical examination reveals a temperature of 38°C and generalized abdominal tenderness. Follow-up shows progressively increasing ascites. The most likely complication is:
A 50-year-old male presents with sudden hematemesis (4 episodes, ~1200ml total) and melena (2 episodes, ~600g total), accompanied by dizziness and palpitations. On examination: BP 75/45 mmHg, heart rate 118 bpm, mild icterus of the sclera, abdominal distension, liver not palpable, spleen palpable 3 cm below the costal margin, shifting dullness (+). What is the first-line management for this patient?
A 26-year-old male presents with a 2-year history of rhythmic epigastric pain that worsens with hunger, improves after meals, and often wakes him at night. Yesterday, he noticed black stools. Physical exam shows normal BP and pulse rate, mild tenderness in the upper abdomen without masses. Fecal occult blood (+++). The most likely diagnosis is:
A 25-year-old farmer presents with pallor and fatigue for 1 year. CBC shows: RBC 2.0×10<sup>12</sup>/L, Hb 50g/L, WBC 7.6×10<sup>9</sup>/L (neutrophils 50%, lymphocytes 26%, eosinophils 14%), serum ferritin 10μg/L, and increased central pallor of red blood cells on smear. The patient is diagnosed with iron-deficiency anemia. After 1 month of oral ferrous sulfate 0.3g TID with poor response, the most likely cause is:
A 28-year-old male with a 5-year history of duodenal bulb ulcers presents with recurrent melena and intermittent proton pump inhibitor (PPI) use. Four hours ago, he experienced hematemesis (3 episodes, ~600ml total) and melena (3 episodes, ~200g total), accompanied by marked dizziness, sweating, palpitations, and syncope upon changing from lying to sitting position.
A 55-year-old male presents with epigastric pain 12 hours post-alcohol consumption, followed by vomiting fresh red blood (hematemesis) of 200ml. Physical examination reveals a soft abdomen, tenderness in the upper abdomen, non-palpable liver, spleen palpable 1.5 cm below the costal margin, and normal blood pressure (BP). Which test should be performed first to confirm the diagnosis?
A 48-year-old male patient with a 2-year history of poor appetite and fatigue, accompanied by intermittent epistaxis and gingival bleeding, developed abdominal distension over the past month. Four hours after eating pancakes, he suddenly experienced palpitations, sweating, and vomited 200ml of dark red blood. On emergency examination: BP 80/55 mmHg, heart rate 120 bpm, splenomegaly with spleen palpable 3.0 cm below the costal margin. The immediate action for this patient is:
A 55-year-old male with a 10-year history of chronic hepatitis B presents with 4 months of dull right upper quadrant pain, fatigue, decreased appetite, and weight loss. Physical exam shows no jaundice, mild tenderness on percussion over the liver area, no hepatosplenomegaly. Ultrasound reveals a 2cm×3cm×4cm round hypodense lesion in the right liver lobe. Alpha-fetoprotein is negative. Which of the following is the preferred method to differentiate this from hepatic hemangioma?
A 50-year-old male with a history of non-icteric hepatitis 10 years ago developed abdominal distension 6 months ago, with progressive abdominal enlargement. Recently, he presented with somnolence and nighttime restlessness. Examination: confusion, mild jaundice, ascites sign, liver and spleen not clearly palpable. During hospitalization, he became increasingly restless and developed convulsions. Which drug is the best choice?
A 36-year-old female presents to the emergency department with persistent mid-epigastric pain for 9 hours and vomiting twice after alcohol consumption. No significant past medical history. Physical exam: temperature 37.8°C, left upper quadrant tenderness with mild guarding. If diagnosed as acute pancreatitis, which of the following treatments is INCORRECT?
A 42-year-old male patient with intermittent epigastric discomfort for 3 years underwent gastroscopy showing severe atrophic gastritis. Pathology revealed atrophic gastritis with intestinal metaplasia and positive Warthin-Starry staining. After treatment, how long should the patient discontinue medications before retesting for H. pylori eradication?
A 45-year-old male with a 10-year history of gastric disease presents with worsening symptoms over the past year and poor appetite. Gastroscopy reveals an ulcer at the gastric angle, and Helicobacter pylori test is positive. The primary method to differentiate benign from malignant gastric ulcers is:
A 36-year-old male presents with abdominal distension, pain, nausea, and vomiting for 1 week. The vomitus is large in volume, contains foul-smelling undigested food from the previous day, and lacks bile. Symptoms temporarily improve after vomiting. He has a history of intermittent epigastric pain for over 6 years, typically occurring on an empty stomach or at night, with seasonal exacerbation in autumn. Physical examination reveals mild epigastric tenderness, visible gastric peristalsis, and a positive succussion splash. Which test is the first choice to confirm the diagnosis?
A 30-year-old male with a 4-year history of duodenal ulcer suddenly developed severe epigastric pain for 5 hours, followed by generalized abdominal pain and profuse sweating. Physical examination reveals tenderness and rebound tenderness throughout the abdomen. Suspecting perforation of the ulcer, which emergency investigation should be performed to confirm the diagnosis?
A 40-year-old male presents with intermittent epigastric pain for 3 years, often occurring when hungry or at night, and relieved by food. Two hours ago, he suddenly developed severe epigastric pain radiating to the entire abdomen, accompanied by profuse sweating. Physical examination reveals abdominal muscle rigidity, generalized tenderness, and rebound tenderness, suggesting possible ulcer perforation. Which of the following signs is most indicative of ulcer perforation?
A 53-year-old male presents with epigastric dull pain for over 1 month. Fecal occult blood test is positive (+). Gastroscopy reveals a 2cm*2cm ulcer on the lesser curvature of the stomach, with central depression covered by dirty exudate, raised irregular margins, hard consistency, easy bleeding, and reduced peristalsis. What is the most reliable diagnostic method?
A 48-year-old male presents with a 5-year history of intermittent upper abdominal pain. Over the past 3 months, the epigastric pain has worsened, accompanied by nausea and decreased appetite. Barium meal X-ray examination reveals a 2.5cm*3.0cm niche shadow (ulcer crater) with irregular margins in the antrum of the stomach. Fecal occult blood test (FOBT) was positive on 3 occasions. Which of the following tests should be performed first to confirm the diagnosis?
A 45-year-old male with a 15-year history of gastric ulcers presents with loss of abdominal pain rhythm over the past 2 months, poor response to antacid therapy, persistent fecal occult blood (+), decreased gastric acid on gastric analysis, and severe dysplasia at the ulcer margin on biopsy. Which treatment is most appropriate?
A 36-year-old woman presents with fever, night sweats, and alternating diarrhea and constipation for 2 months. Physical examination reveals a soft abdomen with mild tenderness in the right lower quadrant, no palpable mass, and normal stool tests. Barium meal study shows a 'stierlin sign' in the ileocecal region. What is the most likely diagnosis?
A 35-year-old woman presents with fever and night sweats for over 20 days. Her temperature is around 38°C. Physical examination reveals a distended abdomen with doughy consistency, mild tenderness and rebound tenderness throughout the abdomen. The liver and spleen are not palpable below the costal margin. Shifting dullness is positive. Laboratory tests show a white blood cell (WBC) count of 7.2×10⁹/L, with 75% neutrophils and 25% lymphocytes. Which test should be prioritized to confirm the diagnosis?
A 40-year-old woman has had intermittent diarrhea for 5-6 years, mostly pasty stools, occasionally watery stools, often accompanied by abdominal pain. In the past week, she experienced recurrent diarrhea and abdominal pain with bloody mucus stools, temperature 38°C, and visible anal fissures and perianal abscesses. The most likely diagnosis is:
A 40-year-old male with a 10-year history of chronic hepatitis B presents with fatigue, weight loss, poor appetite, and occasional discomfort in the liver area. Examination: no scleral icterus, no spider angiomas, liver palpable 1.5 cm below the costal margin with medium consistency and no tenderness, spleen palpable 2 fingerbreadths below the costal margin with medium consistency, no shifting dullness. Normal liver function tests, HBsAg(+), anti-HBe(+), anti-HBc(+). A diagnosis of hepatitis B cirrhosis is suspected. Which test is most helpful to confirm the diagnosis?
A 40-year-old male with a 10-year history of chronic hepatitis B presents with fatigue, weight loss, poor appetite, and occasional discomfort in the liver area. Examination: no scleral icterus, no spider angiomas, liver palpable 1.5 cm below the costal margin with medium consistency and no tenderness, spleen palpable 2 fingerbreadths below the costal margin with medium consistency, no shifting dullness. Liver function tests are normal, HBsAg(+), anti-HBe(+), anti-HBc(+). A diagnosis of hepatitis B cirrhosis is suspected. Which test is most helpful for confirming the diagnosis?
A 54-year-old male with a 6-year history of HBV-related cirrhosis presents with abdominal distension and bilateral lower extremity edema for 1 month, worsening with oliguria for 2 days. Physical exam shows frog belly, positive fluid wave thrill, and pitting edema in both lower extremities. Laboratory tests reveal serum sodium 122 mmol/L and BUN 19 mmol/L. Which of the following is NOT involved in the pathogenesis of ascites in cirrhosis?
A 40-year-old male with a 2-year history of cirrhosis presents with fever and abdominal pain for 2 weeks. Physical examination reveals a temperature of 38°C and generalized abdominal tenderness. Follow-up shows progressive ascites. Which test should be performed first to confirm the diagnosis?
A 40-year-old woman presents with a 2-month history of low-grade fever, abdominal distension, oliguria, and lower extremity edema. She has a history of hepatitis B. Physical examination: no scleral icterus, abdominal distension, liver and spleen not clearly palpable, shifting dullness present, mild lower extremity edema. Laboratory tests: TBil 21 μmol/L, CB 7.2 μmol/L, ALT 50 U/L, albumin 2.6 g/L, globulin 3.5 g/L, AFP 100 ng/mL. Ascitic fluid analysis: light red, specific gravity 1.018, WBC 0.3×10^9/L (300/mm^3), RBC 3×10^9/L (3000/mm^3), polymorphonuclear cells (PMNs) 22%, monocytes 78%. The most likely diagnosis is:
A 26-year-old male presents with a 2-year history of rhythmic epigastric pain, worsened by hunger, relieved by meals, and often waking him at night. Yesterday, he noticed black stools. Examination shows normal BP and pulse rate, mild tenderness in the upper abdomen without masses, and occult blood (+++). Which test is most helpful for definitive diagnosis?
A 25-year-old farmer presents with pallor and fatigue for 1 year. CBC shows: RBC 2.0×10<sup>12</sup>/L, Hb 50g/L, WBC 7.6×10<sup>9</sup>/L (neutrophils 50%, lymphocytes 26%, eosinophils 14%), serum ferritin 10μg/L, and increased central pallor of RBCs on smear. Iron deficiency anemia is suspected. The most likely etiology is:
A 28-year-old male with a 5-year history of duodenal bulb ulcers, recurrent melena, and intermittent proton pump inhibitor (PPI) therapy presents with hematemesis (600ml total) 4 hours ago, melena (200g total), marked dizziness, sweating, palpitations, and syncope upon sitting up. Hemoglobin (Hb) is 68g/L. The most urgent intervention is:
A 55-year-old male presents to the emergency department with epigastric pain 12 hours post-alcohol consumption, followed by vomiting fresh red blood (200ml). Physical exam: soft abdomen, tenderness in the upper abdomen, liver not palpable, spleen palpable 1.5 cm below the costal margin, normal blood pressure (BP). In the ER, the patient develops persistent hematemesis, restlessness, and cold sweats. The most urgent management at this stage should be:
A 50-year-old male with a 2-year history of cirrhosis underwent esophageal barium meal examination 1 year ago, revealing worm-eaten filling defects in the lower esophagus. Two days ago, he experienced melena, followed by somnolence and nighttime restlessness, prompting emergency admission. Physical examination showed flapping tremors in both hands. Which antimicrobial is the first choice to reduce gut-derived toxic substances in hepatic coma?
A 36-year-old woman presents to the emergency department with persistent epigastric pain for 9 hours and vomiting twice after alcohol consumption. Past medical history is unremarkable. Physical exam: temperature 37.8°C, left upper quadrant tenderness with mild guarding. If after 2 weeks the patient develops fever (40°C), elevated WBC count (21×10<sup>9</sup>/L), and persistently high serum amylase, which complication of pancreatitis should be suspected?
A 48-year-old male with a 10-year history of gastric ulcers presents with worsening pain over the past 2 months, loss of rhythmic pattern, and no response to multiple medications. Physical exam shows no superficial lymphadenopathy, soft abdomen with epigastric tenderness, and a palpable mass. If the diagnosis is confirmed, the preferred management is:
A 45-year-old male with a 10-year history of gastric disease presents with worsening symptoms over the past year and poor appetite. Gastroscopy reveals gastric angle ulcers and Helicobacter pylori (+). The best treatment for this case is:
A 53-year-old male presents with epigastric dull pain for over 1 month. Fecal occult blood test (+). Gastroscopy reveals a 2cm*2cm ulcer on the lesser curvature of the stomach, with central depression covered by dirty exudate, irregular raised margins, hard consistency prone to bleeding, and reduced peristalsis. The most appropriate management for this condition is:
A 48-year-old male presents with a 5-year history of intermittent upper abdominal pain. Over the past 3 months, the epigastric pain has worsened, accompanied by nausea and decreased appetite. Barium meal X-ray examination reveals a 2.5cm*3.0cm niche shadow (ulcer crater) with irregular margins in the antrum of the stomach. Fecal occult blood test (FOBT) was positive on 3 occasions. After confirming the diagnosis, the most critical management is:
A 35-year-old woman presents with fever and night sweats for over 20 days. Temperature is around 38°C. Physical exam reveals a distended abdomen with doughy consistency, mild tenderness and rebound tenderness throughout. Liver and spleen are not palpable below the costal margin. Shifting dullness is positive. WBC count is 7.2*10<sup>9</sup>/L (neutrophils 75%, lymphocytes 25%). If ascitic fluid analysis shows exudate, which test would be most simple and valuable for diagnosis?
A 40-year-old male with a 10-year history of chronic hepatitis B presents with fatigue, weight loss, poor appetite, and occasional discomfort in the liver area. Examination: no scleral icterus, no spider angiomas, liver palpable 1.5 cm below the costal margin with medium consistency and no tenderness, spleen palpable 2 fingerbreadths below the costal margin with medium consistency, no shifting dullness. Liver function tests are normal, HBsAg(+), anti-HBe(+), anti-HBc(+). A diagnosis of hepatitis B cirrhosis is considered. Which of the following is the typical histological feature of nodular cirrhosis?
A 40-year-old male with a 10-year history of chronic hepatitis B presents with fatigue, weight loss, poor appetite, and occasional discomfort in the liver area. Examination: no scleral icterus, no spider angiomas, liver palpable 1.5 cm below the costal margin with medium consistency and no tenderness, spleen palpable 2 fingerbreadths below the costal margin with medium consistency, no shifting dullness. Normal liver function tests, HBsAg(+), anti-HBe(+), anti-HBc(+). A diagnosis of hepatitis B cirrhosis is considered. Which of the following is the typical histological feature of nodular cirrhosis?
A 58-year-old woman presents with 9 months of pruritus and 1 month of jaundice noticed by others. No abdominal pain, normal appetite and bowel movements. Physical exam shows marked jaundice, excoriations, liver 3 cm below the costal margin (firm consistency), spleen 6 cm below the costal margin. Labs: TBil 85.5 μmol/L, CB 46.8 μmol/L, albumin 30 g/L, globulin 42 g/L, ALT 56 U/L, ALP 820 U/L, GGT 94.5 U/L, IgG 19.6 g/L, IgA 16.9 g/L, IgM 8.6 g/L. Ultrasound shows hepatosplenomegaly, common bile duct 6 mm, no intrahepatic bile duct dilation. The most likely diagnosis is:
A 58-year-old woman presents with 9 months of jaundice (yellowing of sclera and skin) accompanied by pruritus. Physical examination shows marked jaundice, liver palpable 4 cm below the costal margin (hard consistency, no tenderness), and spleen palpable 5 cm below the costal margin. Primary biliary cirrhosis is suspected. The key diagnostic test to differentiate primary biliary cirrhosis from primary sclerosing cholangitis is:
A 40-year-old male with a 2-year history of cirrhosis presents with fever and abdominal pain for 2 weeks. Examination reveals a temperature of 38°C and generalized abdominal tenderness. Follow-up shows progressive ascites. Despite hospitalization, fever and abdominal pain persist. Which of the following measures should be taken?
A 25-year-old female farmer presents with pallor and fatigue for 1 year. CBC shows RBC: 2.0×10<sup>12</sup>/L, Hb: 50g/L, WBC: 7.6×10<sup>9</sup>/L, neutrophils 0.50, lymphocytes 0.26, eosinophils 0.14, SF: 10μg/L. Blood smear reveals increased central pallor of red blood cells. A diagnosis of iron-deficiency anemia is considered. What additional history is most relevant?
A 55-year-old male presents with epigastric pain 12 hours post-alcohol consumption, followed by vomiting fresh red blood (hematemesis) of 200ml. Physical examination: soft abdomen, tenderness in the upper abdomen, liver not palpable, spleen palpable 1.5 cm below the costal margin, normal blood pressure (BP). [Hypothetical scenario] If test results confirm esophageal variceal bleeding, the management would be:
A 62-year-old male with a 10-year history of hepatitis B presents with hematemesis, melena, and subsequent clouding of consciousness. Examination reveals: BP 80/50 mmHg, icteric sclera, slurred speech, loss of orientation, decreased calculation ability, hallucinations, reversed sleep-wake cycle, flapping tremor (asterixis), increased muscle tone (hypertonia), abnormal electroencephalogram (EEG), hemoglobin 40 g/L, blood pH 7.48, serum potassium 2.8 mmol/L, and elevated blood ammonia. If the patient develops agitation, which medication should be administered?
A 55-year-old male presents with epigastric pain 12 hours post-alcohol consumption, followed by vomiting fresh red blood (hematemesis) of 200ml. Physical exam: soft abdomen, tenderness in the upper abdomen, liver not palpable, spleen palpable 1.5 cm below the costal margin, normal blood pressure (BP). Bleeding persists despite initial management. Which of the following is the first-line intervention?
A 35-year-old male patient has recurrent epigastric pain for 6 years, mostly occurring in autumn. The pain typically appears before meals and is relieved after eating. In the past 2 days, the pain recurred with acid regurgitation. Physical examination reveals tenderness under the xiphoid process, HB 105g/L, and fecal occult blood (+++). If the patient tests positive for Helicobacter pylori, which treatment should be used?
A 23-year-old female presents with fever, night sweats, weight loss, and abdominal distension for 3 months. Shifting dullness is detected on abdominal examination, suggesting exudative tuberculosis. After 2 weeks of standard anti-tuberculosis therapy, ascites shows poor resolution, and glucocorticoids are planned to be added. Which of the following statements about glucocorticoid use in tuberculous peritonitis is INCORRECT?
A 40-year-old male with a 2-year history of cirrhosis presents with fever and abdominal pain for 2 weeks. Examination reveals a temperature of 38°C and generalized abdominal tenderness, with progressively increasing ascites on follow-up. [Hypothetical scenario] If the patient develops frequent epistaxis and gingival bleeding during hospitalization, along with large ecchymoses (especially at injection sites), which condition should be suspected?
A 25-year-old female farmer presents with pallor and fatigue for 1 year. CBC shows: RBC 2.0×10<sup>12</sup>/L, Hb 50g/L, WBC 7.6×10<sup>9</sup>/L (neutrophils 50%, lymphocytes 26%, eosinophils 14%), SF 10μg/L. Blood smear reveals increased central pallor of red blood cells. Diagnosed with iron deficiency anemia. If this patient requires surgical treatment for gastrointestinal tumor and needs parenteral iron therapy (weight 50kg), the total iron dose required is approximately:
A 28-year-old male with a 5-year history of duodenal bulb ulcers presents with recurrent melena and intermittent proton pump inhibitor (PPI) use. Four hours ago, he experienced three episodes of hematemesis (total ~600ml) and three episodes of melena (total ~200g), accompanied by significant dizziness, sweating, and palpitations. He had multiple syncopal episodes when changing from lying to sitting position. Despite aggressive resuscitation, his blood pressure (BP) dropped again to 90/60mmHg after initial improvement, requiring daily transfusion of 4U red blood cells (RBCs) to maintain BP at 90/60mmHg. Blood urea nitrogen (BUN) rose to 14.3mmol/L. Gastroscopy under transfusion revealed jet bleeding from an ulcer on the anterior wall of the duodenal bulb. The most effective next step is:
A 40-year-old male presents with intermittent epigastric pain for 3 years, often occurring when hungry or at night, and relieved by food. Within how many hours after perforation is surgical intervention most effective?
A 40-year-old female presents with low-grade fever, abdominal distension, oliguria, and lower extremity edema for 2 months. She has a history of hepatitis B. Physical exam: no scleral icterus, abdominal distension, liver and spleen not clearly palpable, shifting dullness present, mild lower extremity edema. Laboratory tests: TBil 21 μmol/L, CB 7.2 μmol/L, ALT 50 U/L, albumin 2.6 g/L, globulin 3.5 g/L, AFP 100 ng/mL. [Hypothetical scenario] If laparoscopy reveals gray-white nodules on the peritoneum and ascitic fluid ADA >45 U/L, the most appropriate treatment would be:
A 28-year-old male with a 5-year history of duodenal bulb ulcers has recurrent melena and intermittent proton pump inhibitor (PPI) therapy. Four hours ago, he experienced hematemesis three times (total ~600ml) and passed black tarry stool (melena) three times (total ~200g), accompanied by marked dizziness, sweating, and palpitations. He had multiple episodes of syncope when changing from lying to sitting position. Which of the following statements about blood urea nitrogen (BUN) changes after gastrointestinal bleeding is INCORRECT?
A 50-year-old male presents with sudden hematemesis 4 times (approximately 1200ml) and melena twice (approximately 600g), accompanied by dizziness and palpitations. On examination: blood pressure 75/45 mmHg, heart rate 118 bpm, mild icterus of the sclera, abdominal distension, liver not palpable, spleen palpable 3 cm below the costal margin, shifting dullness (+). What is the first-line management for this patient?
A 26-year-old male presents with a 2-year history of rhythmic epigastric pain that worsens with hunger, improves after meals, and often wakes him at night. Yesterday, he noticed black stools. On examination: normal BP and pulse rate, mild tenderness in the upper abdomen, no masses. Occult blood (+++). The most likely diagnosis is:
A 25-year-old female farmer presents with pallor and fatigue for 1 year. CBC shows: RBC 2.0×10<sup>12</sup>/L, Hb 50g/L, WBC 7.6×10<sup>9</sup>/L (neutrophils 50%, lymphocytes 26%, eosinophils 14%), serum ferritin 10μg/L. Blood smear reveals increased central pallor of RBCs. A diagnosis of iron deficiency anemia is made. After 1 month of oral ferrous sulfate 0.3g TID with poor response, the most likely cause is:
A 28-year-old male with a 5-year history of duodenal bulb ulcers, recurrent melena, and intermittent proton pump inhibitor (PPI) treatment; 4 hours ago, he experienced hematemesis 3 times (total ~600ml) and black tarry stool (melena) 3 times (total ~200g), accompanied by marked dizziness, sweating, palpitations, and multiple episodes of syncope upon changing from lying to sitting position. The most likely diagnosis is:
A 55-year-old male presents to the emergency department with epigastric pain 12 hours after alcohol consumption, followed by vomiting fresh red blood (hematemesis) of 200ml. Physical examination reveals a soft abdomen, tenderness in the upper abdomen, non-palpable liver, spleen palpable 1.5 cm below the costal margin, and normal blood pressure (BP). Which test should be performed first to confirm the diagnosis?
A 48-year-old male patient with a 2-year history of poor appetite and fatigue, accompanied by intermittent epistaxis and gingival bleeding, developed abdominal distension over the past month. Four hours after eating pancakes, he suddenly experienced palpitations, sweating, and vomited 200ml of dark red blood. On emergency examination: BP 80/55 mmHg, heart rate 120 bpm, splenomegaly with spleen palpable 3.0 cm below the costal margin. The most immediate intervention for this patient is: