Practical Gastroenterology and Hepatology Board Review Toolkit

Nicholas J. Talley , Kenneth R. Devault, Michael B. Wallace, Bashar A. Aqel, Keith D. Lindor

Multiple Choice Questions

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Question 1 A 42-year-old African American male presents to the emergency department with acute severe epigastric abdominal pain. The pain is 10 out of 10 in intensity, worsens with eating, is associated with nausea/vomiting, and is non-radiating. The patient has a history of HIV diagnosed 4 years ago and is currently not on treatment. His most recent CD4 count was 75. He was recently evaluated in the outpatient setting and was started on fluconazole for oral thrush and on pentamidine for PCP prophylaxis, as he has sulfa allergy. He has a history of alcohol use but has not had a drink for more than 4 weeks. His labs on arrival show hemoglobin 10.3 g/dL, WBC 2.2 cells/mm3, platelet 145,000, sodium 132 mg/dL, creatinine 0.6 mg/dL, total bilirubin 1.2 mg/dL, AST 40 IU/L, ALT 28 IU/L, alkaline phosphatase 128 IU/L, lipase 4000 IU/mL, lactate 4.6, and normal urine analysis. CT abdomen only shows evidence of acute interstitial pancreatitis.

What is the likely diagnosis?

A. Alcoholic pancreatitis

B. Drug-induced pancreatitis related to pentamidine

C. Gallstone pancreatitis

D. Perforated peptic ulcer

E. Pancreatic cancer