1.
A 36-year-old man presents with polyuria (9 L/day) and
hypernatremia (Na⁺ 154 mEq/L). Plasma osmolality 315
mOsm/kg; urine osmolality 120 mOsm/kg. After water
deprivation for 6 hrs, urine osmolality rises to 140 mOsm/kg;
after desmopressin, it increases to 580 mOsm/kg. Which
statement is most accurate regarding the underlying
mechanism?
A. Chronic lithium use has led to irreversible V2 receptor
insensitivity.
B. There is excessive free-water intake leading to dilutional
hyponatremia.
C. There is impaired ADH secretion from posterior pituitary due
to hypothalamic injury.
D. ADH secretion is intact, but collecting ducts fail to respond
due to AQP-2 mutation.
2. A 40-year-old man with bipolar disorder is on chronic
lithium therapy and develops polyuria (8 L/day). Labs: Plasma
osmolality 312 mOsm/kg; urine osmolality 150 mOsm/kg; no
response to desmopressin. Which combination is most
appropriate?
A. Furosemide + sodium restriction + spironolactone
B. Hydrochlorothiazide + amiloride + low-sodium, low-protein
diet
C. Vasopressin nasal spray + loop diuretic
D. Demeclocycline + normal diet + fluid restriction
3. A 65-year-old chronic smoker presents with headache,
confusion, and generalized weakness. Na⁺ 114 mEq/L, urine Na⁺
60 mEq/L, plasma osmolality 260 mOsm/kg, urine osmolality
480 mOsm/kg. Which of the following most likely explains his
laboratory findings?
A. Adrenal insufficiency causing secondary ADH excess and
hypovolemia.
B. Primary polydipsia with impaired urinary dilution capacity.
C. Cerebral salt wasting due to increased renal sodium loss and
hypovolemia.
D. Paraneoplastic ADH secretion due to small-cell carcinoma of
lung leading to euvolemic hyponatremia.
4. A 24-year-old woman with Type 1 diabetes presents with
abdominal pain and deep rapid breathing. ABG: pH 7.08, HCO₃⁻
8 mEq/L; serum K⁺ 5.6 mEq/L. After insulin and fluids, K⁺ drops
to 2.7 mEq/L. Which mechanism explains this paradoxical K⁺
fall?
A. Osmotic diuresis increases renal potassium reabsorption,
lowering plasma K⁺ levels.
B. Insulin drives potassium intracellularly, correcting extracellular
hyperkalemia despite total body K⁺ depletion.
C. Acidosis causes enhanced renal tubular potassium secretion.
D. Ketone bodies inhibit Na⁺/K⁺ ATPase, preventing K⁺ uptake.
5. A 58-year-old diabetic for 15 years presents with gradual
blurring of vision. Fundus: microaneurysms, hard exudates,
neovascularization. Which mechanism explains these
changes?
A. Accelerated atherosclerosis in retinal arteries causing
ischemic necrosis.
B. Capillary basement membrane thickening and pericyte loss
leading to microaneurysm formation.
C. Osmotic lens swelling due to sorbitol accumulation in lens
fibers.
D. Immune complex deposition and complement activation in
retinal capillaries.
6. A 35-year-old woman presents with galactorrhea and
amenorrhea for 8 months. MRI: pituitary microadenoma (7
mm). Serum prolactin 180 ng/mL. What is the best initial
therapy?
A. Bromocriptine, a dopamine antagonist that suppresses GnRH
secretion.
B. Cabergoline, a long-acting D2 receptor agonist that inhibits
prolactin secretion and reduces tumor size.
C. Octreotide, a somatostatin analog that inhibits pituitary
prolactin release.
D. Surgical transsphenoidal resection to prevent visual loss.
7. A 46-year-old man with coarse facial features, oily skin, and
enlarged hands presents with diabetes. Random GH 12 ng/mL
(↑); after oral glucose load (75 g), GH remains 9 ng/mL (fails to
suppress). MRI: pituitary macroadenoma. Which of the
following is the most specific diagnostic test?
A. Lack of GH suppression after 75 g oral glucose load
confirming autonomous GH secretion.
B. Low GH with low IGF-1 confirming functional adenoma.
C. Elevated IGF-1 with normal GH levels confirming GH
resistance.
D. Paradoxical fall in GH with TRH stimulation indicating
somatotroph hyperplasia.
8. A 52-year-old man post-pituitary surgery develops fatigue,
weight gain, and cold intolerance. Labs: TSH 0.6 μIU/mL, Free
T4 0.4 ng/dL. What should be done first?
A. Measure morning cortisol before initiating thyroxine, as
uncorrected ACTH deficiency can precipitate adrenal crisis.
B. Perform TRH stimulation test to confirm pituitary origin.
C. Measure prolactin to evaluate stalk compression.
D. Immediately start levothyroxine to correct low T4 regardless
of cortisol status.
9. A 35-year-old woman with central obesity, violaceous
striae, and hypertension has: Cortisol ↑, ACTH ↑.
Dexamethasone 1 mg test: no suppression; 8 mg test: cortisol
suppressed by 60%. What is the likely diagnosis?
A. Ectopic ACTH syndrome from small-cell lung carcinoma.
B. Cushing disease (pituitary ACTH adenoma).
C. Adrenal adenoma secreting cortisol.
D. Exogenous glucocorticoid use.
10. A 40-year-old hypertensive woman with hypokalemia has:
Aldosterone 28 ng/dL, Plasma renin activity 0.2 ng/mL/hr (ARR
= 140). Saline suppression fails to suppress aldosterone. What
is the next best step?
A. Adrenal vein sampling to localize unilateral adenoma before
surgery.
B. Adrenal CT and empirical eplerenone therapy.
C. High-dose dexamethasone suppression test.
D. 24-hr urinary aldosterone measurement for confirmation.
11. A 28-year-old woman presents with hypotension, weight
loss, and hyperpigmentation. Na⁺ 125 mEq/L, K⁺ 5.6 mEq/L,
glucose 68 mg/dL. Cortisol 2 μg/dL, ACTH 180 pg/mL. What is
the mechanism?
A. Primary adrenal failure → cortisol & aldosterone deficiency
with high ACTH.
B. Secondary adrenal failure → low ACTH, low renin.
C. Drug-induced adrenal suppression → low ACTH, low cortisol,
normal K⁺.
D. Pituitary tumor → isolated cortisol deficiency.
12. A 45-year-old man with paroxysmal headache,
palpitations, and sweating has plasma metanephrines ↑. CT
abdomen shows adrenal mass (4 cm). Which preoperative
protocol is most correct?
A. Beta blockade first to control tachycardia followed by alpha
blockade.
B. Calcium channel blockers alone are sufficient for
preoperative preparation.
C. No blockade required for laparoscopic removal.
D. Alpha blockade with phenoxybenzamine followed by beta-
blocker to prevent unopposed alpha stimulation.
13. A 70-year-old man presents with weight loss, atrial
fibrillation, and depression but no tremor or goiter. T3 ↑, T4 ↑,
TSH ↓. What is this atypical presentation called?
A. Apathetic thyrotoxicosis due to blunted adrenergic response
in elderly.
B. T3 toxicosis due to early Graves’ disease.
C. Subacute thyroiditis with transient thyrotoxicosis.
D. Silent thyroiditis due to autoimmune infiltration.
14. A 55-year-old man on amiodarone develops fatigue and
weight gain. TSH 12 μIU/mL, T4 low, T3 low. What is the
mechanism?
A. Inhibition of peripheral T4 → T3 conversion and iodine-
induced hypothyroidism (Wolff–Chaikoff effect).
B. Autoimmune thyroiditis secondary to drug hypersensitivity.
C. TPO stimulation causing hyperthyroidism.
D. TSH suppression by iodine load causing central
hypothyroidism.
15. A 50-year-old woman develops tingling and carpopedal
spasm 2 days after thyroidectomy. Serum Ca²⁺ 6.8 mg/dL,
phosphate ↑, PTH ↓. What is the most likely cause?
A. Inadvertent parathyroid gland removal during thyroid surgery
causing acute hypocalcemia.
B. Vitamin D deficiency causing secondary hypoparathyroidism.
C. Magnesium deficiency inhibiting PTH action.
D. Autoimmune destruction of parathyroid glands.
16. A 55-year-old woman with recurrent renal stones and bone
pain has Ca²⁺ 11.8 mg/dL, phosphate 2.3 mg/dL, PTH 180 pg/mL.
X-ray: subperiosteal resorption and brown tumors. What is the
mechanism?
A. Vitamin D intoxication causing increased intestinal Ca²⁺
absorption.
B. Parathyroid adenoma secreting excess PTH causing
osteoclastic bone resorption and hypercalcemia.
C. Secondary hyperparathyroidism from chronic renal failure.
D. PTH resistance due to Gsα mutation.
17. A 22-year-old female with short 4th metacarpal, round
face, and obesity presents with tetany. Serum Ca²⁺ 7.0 mg/dL,
phosphate ↑, PTH ↑. What explains these findings?
A. End-organ resistance to PTH due to Gsα subunit defect
(Albright’s hereditary osteodystrophy).
B. Parathyroid hyperplasia due to chronic renal failure.
C. PTH receptor activating mutation causing excess bone
formation.
D. Maternal imprinting defect leading to decreased PTH
synthesis.
18. A 60-year-old man on chronic steroids for COPD is
admitted with pneumonia. He becomes hypotensive,
hyponatremic, and hyperkalemic. Cortisol 1.8 μg/dL, ACTH low.
What is the most appropriate management?
A. Continue maintenance oral steroids until infection subsides.
B. Desmopressin to correct hyponatremia.
C. Fludrocortisone alone to restore mineralocorticoid balance.
D. IV hydrocortisone and rapid volume replacement with
isotonic saline.
19. A 68-year-old hypertensive man presents with progressive
dyspnea, pedal edema, and abdominal distension. On
examination, the JVP is elevated with giant a-waves and slow
y-descent. There is a right parasternal heave, a loud P2, and a
pansystolic murmur at the left lower sternal border.
Echocardiography shows severe pulmonary hypertension
with preserved LV function. Which of the following explains his
JVP waveform?
A. Impaired atrial relaxation due to constrictive pericarditis
B. Forceful right atrial contraction against a hypertrophied,
noncompliant right ventricle
C. Early diastolic ventricular filling in pericardial constriction
D. Free regurgitation of blood from RV to RA during systole
20. A 60-year-old man with prior tubercular pericarditis
presents with progressive abdominal distension and ankle
edema. He has elevated JVP with paradoxical rise during
inspiration, loud early diastolic knock, and clear lung fields.
Echocardiography shows normal LV function with septal
bounce. What is the cause of his abnormal JVP pattern?
A. Decreased intrathoracic pressure transmitted to right atrium
B. Obstruction of tricuspid inflow due to vegetation
C. Impaired right ventricular filling due to noncompliant
pericardium
D. Increased venous return during inspiration due to pulmonary
hypertension
21. A 44-year-old man presents with exertional dyspnea and
bounding carotid pulsations. On palpation, the carotid pulse is
bifid, with two palpable systolic peaks per cardiac cycle.
Auscultation reveals an ejection systolic murmur at the right
upper sternal border that radiates to the neck, and an early
diastolic decrescendo murmur at the left sternal border.
Echocardiogram confirms calcific aortic valve thickening with
regurgitation. Which pulse type is present and what does it
signify?
A. Collapsing pulse – isolated aortic regurgitation
B. Bisferiens pulse – combined aortic stenosis with regurgitation
C. Dicrotic pulse – severe LV failure
D. Anacrotic pulse – isolated aortic stenosis
22. A 28-year-old man is admitted with septic shock due to
pneumonia. Despite vasopressors, his pulse feels weak and
double-beating, with the second wave occurring in diastole.
BP is 80/40 mmHg, HR 124/min, echo shows small LV cavity
with hyperdynamic motion. Which of the following best
explains his pulse?
A. Pulsus alternans due to LV systolic dysfunction
B. Bisferiens pulse due to dynamic LV obstruction
C. Dicrotic pulse due to low stroke volume and increased aortic
compliance
D. Anacrotic pulse due to fixed LV outflow obstruction
23. A 62-year-old man with syncope on exertion and
crescendo-decrescendo murmur radiating to carotids shows
paradoxical splitting of S2. The splitting disappears with
inspiration and widens on expiration. What is the mechanism
behind this finding?
A. Delayed closure of aortic valve due to left ventricular outflow
obstruction
B. Simultaneous closure of both semilunar valves
C. Delayed closure of pulmonary valve due to right bundle
branch block
D. Early closure of aortic valve due to severe regurgitation
24. A 56-year-old diabetic man presents with orthopnea and
exertional dyspnea. On auscultation, there is an extra heart
sound just after S2, producing a “ventricular gallop.” Another
patient with hypertension and LVH has a sound just before S1, a
“presystolic gallop.” Which pairing is correct?
A. S3 – rapid ventricular filling (systolic dysfunction); S4 – atrial
contraction against stiff LV (diastolic dysfunction)
B. S3 – physiologic in elderly; S4 – always benign
C. S3 – ejection click; S4 – early diastolic murmur
D. Both sounds occur in mitral regurgitation
25. A 42-year-old woman from rural Bihar presents with
progressive dyspnea and hemoptysis. On auscultation, there
is a loud S1, a short A2–opening snap interval, and a rumbling
diastolic murmur at the apex. Echocardiogram shows
thickened mitral leaflets with area 0.9 cm². Which inference is
correct?
A. Presence of opening snap indicates mild stenosis.
B. Murmur intensity directly indicates valve area.
C. Shorter A2–OS interval indicates severe mitral stenosis with
high LA pressure.
D. Longer A2–OS interval correlates with more severe
obstruction
26. A 55-year-old woman with mitral valve prolapse presents
with fatigue and palpitations. A holosystolic murmur radiating
to axilla is heard, which increases with handgrip and
decreases with amyl nitrite inhalation. Echo shows posterior
leaflet prolapse with regurgitant jet. What explains the change
with handgrip?
A. Increased systemic afterload augments regurgitant volume
into LA.
B. Handgrip increases venous return to right heart.
C. It is due to dynamic LVOT obstruction.
D. Decreased preload intensifies the murmur.
27. A 70-year-old man presents with angina, exertional
dyspnea, and presyncope. Carotid upstroke is slow and
delayed. A harsh ejection systolic murmur radiates to the neck
and decreases with Valsalva. Echo: peak gradient 60 mmHg,
valve area 0.7 cm². What is the best management?
A. Long-term diuretic therapy
B. Surgical aortic valve replacement
C. Beta-blockers for rate control
D. Balloon valvuloplasty
28. A 25-year-old athlete collapses during sprinting.
Examination reveals a systolic murmur at left sternal border
that increases with standing and Valsalva but decreases with
squatting. Echo shows asymmetric septal hypertrophy with
SAM of mitral valve. Which drug is contraindicated?
A. Nitrate therapy that reduces preload and worsens obstruction
B. Verapamil used for diastolic relaxation
C. Beta-blockers that slow heart rate
D. Amiodarone for rhythm control
29. A 58-year-old man with amyloidosis presents with
dyspnea and ascites. Echo: normal EF, thickened myocardium,
biatrial enlargement. Cardiac catheterization shows elevated
LVEDP = RVEDP but no pericardial calcification. Which feature
differentiates this from constrictive pericarditis?
A. Thickened myocardium with preserved pericardium
B. Equalized diastolic pressures
C. Rapid y-descent in JVP
D. Pericardial knock
30. A 45-year-old woman with malignancy presents with
dyspnea, hypotension, and muffled heart sounds. JVP is
raised, and pulsus paradoxus is present. Echocardiogram
shows swinging heart and diastolic collapse of RV wall. Which
immediate step is lifesaving?
A. Emergency pericardiocentesis to relieve pressure.
B. ACE inhibitors to reduce afterload.
C. Beta-blockers to slow HR.
D. High-dose diuretics to reduce preload.
31. A 50-year-old man with remote TB presents with ascites
and raised JVP with prominent y-descent. There is Kussmaul’s
sign, but lungs are clear. Echo shows “septal bounce,” normal
EF. What investigation confirms diagnosis?
A. Transesophageal echo showing MR
B. PET-CT showing myocarditis
C. Coronary angiography
D. CT/MRI showing thickened calcified pericardium
32. A 30-year-old male presents with sharp pleuritic chest
pain relieved by leaning forward. ECG shows diffuse concave
ST elevation with PR depression. Troponin is normal; echo
shows no effusion. What is the next step?
A. NSAIDs + colchicine
B. Beta-blockers
C. Thrombolysis
D. Urgent pericardiocentesis
33. A 14-year-old girl presents with fever, migratory
polyarthritis, and new pansystolic murmur. She also has
raised ESR, elevated ASO titers, and prolonged PR interval.
What is the major manifestation confirming diagnosis?
A. Pancarditis due to autoimmune cross-reactivity following GAS
infection
B. Isolated arthritis of small joints due to immune complex
C. Autoimmune myocarditis due to viral infection
D. Reactive arthritis post enteric infection
34. A 48-year-old alcoholic presents with dyspnea,
orthopnea, and displaced apical impulse. Echo shows LV
dilation and EF 25%. There is functional mitral regurgitation
and S3. Which mechanism best explains this?
A. Diastolic dysfunction with preserved EF.
B. Systolic dysfunction with chamber dilation secondary to
myocyte injury.
C. Coronary vasospasm without dilation.
D. Pericardial constriction restricting filling.
35. A 62-year-old man with EF 32%, NYHA III is on loop diuretics
and ACE inhibitors. BP 110/70 mmHg, HR 88/min. Which drug
added next provides proven survival benefit?
A. Verapamil for afterload reduction
B. Digoxin for rate control
C. Nitrates and hydralazine combination only
D. Beta-blocker (carvedilol or bisoprolol)
36. A 30-year-old woman with prosthetic aortic valve requires
dental extraction. Which antibiotic regimen prevents infective
endocarditis?
A. Amoxicillin 250 mg TID for 5 days
B. Amoxicillin 2 g orally 30–60 min before procedure
C. Gentamicin IV alone
D. No prophylaxis required
37. A 46-year-old man with heavy alcohol intake for 20 years
presents with jaundice, fever, and tender hepatomegaly. Labs:
AST 160 IU/L, ALT 70 IU/L, bilirubin 7 mg/dL, PT prolonged by 6
sec, albumin 2.6 g/dL. Ultrasound: fatty liver, no biliary
obstruction. What is the next best step in management?
A. Use N-acetylcysteine as primary therapy.
B. Perform liver biopsy before starting treatment.
C. Start prednisolone as Maddrey’s Discriminant Function >32
indicates poor prognosis.
D. Begin pentoxifylline and refer for transplant immediately.
38. A 58-year-old man with known cirrhosis presents with
abdominal distension, confusion, and pedal edema. He denies
active alcohol use. Exam: spider angiomas, splenomegaly,
ascites, and asterixis. Labs: bilirubin 3.4, INR 1.9, albumin 2.8.
What is his Child–Pugh class and prognosis?
A. MELD score preferred for all prognostic assessment.
B. Class C – poor prognosis, median survival <1 year.
C. Class A – compensated, >5 years.
D. Class B – moderate severity, 2-year survival 70%.
39. A 45-year-old man with chronic hepatitis B presents with
hematemesis and melena. Endoscopy reveals large
esophageal varices. He has splenomegaly and
thrombocytopenia but normal renal function. What
mechanism best explains his findings?
A. Right-sided heart failure causing post-hepatic congestion.
B. Pre-hepatic obstruction due to portal vein thrombosis.
C. Increased resistance to portal flow due to cirrhosis leading to
formation of portosystemic collaterals.
D. Increased splanchnic inflow from hyperdynamic circulation.
40. A 50-year-old man with alcoholic cirrhosis develops
abdominal distension. Ascitic fluid: protein 1.8 g/dL, serum
albumin 3.2 g/dL. SAAG = 1.4. Which mechanism is correct?
A. Malignant ascites due to peritoneal carcinomatosis.
B. Portal hypertension due to cirrhosis with transudative ascites
(SAAG >1.1).
C. Tubercular peritonitis causing exudative ascites (SAAG <1.1).
D. Pancreatic ascites due to ductal rupture.
41. A 56-year-old man with decompensated cirrhosis and
ascites develops fever and abdominal tenderness.
Paracentesis shows WBC 500/mm³ (neutrophils 300/mm³),
culture grows E. coli. What is the next step?
A. Empirical metronidazole and drain ascites completely.
B. Continue diuretics and wait for culture.
C. IV 3rd-generation cephalosporin (cefotaxime) and albumin
infusion.
D. Switch to fluoroquinolone prophylaxis after 1 week only.
42. A 65-year-old man with cirrhosis and ascites presents
with confusion and flapping tremor. Labs: NH₃ 110 µmol/L, Na⁺
128, K⁺ 2.8. He recently increased his diuretic dosage. Which
factor most likely precipitated his encephalopathy?
A. Hypernatremia due to fluid loss.
B. Increased dietary protein intake.
C. Hypokalemic metabolic alkalosis promoting ammonia entry
into brain.
D. Hyperglycemia due to steroid use.
43. A 48-year-old man with cirrhosis and clubbing complains
of dyspnea that worsens on standing. ABG shows hypoxemia
improving when lying supine. Contrast echo shows delayed
microbubble appearance in left heart. What is the diagnosis?
A. Portopulmonary hypertension due to vasoconstriction.
B. Restrictive lung disease due to ascitic splinting.
C. Pulmonary embolism secondary to hypercoagulability.
D. Hepatopulmonary syndrome due to intrapulmonary vascular
dilatations.
44. A 54-year-old man with decompensated cirrhosis
develops rapidly rising creatinine without proteinuria or casts.
He is nonresponsive to fluids and has low urinary Na⁺ (<10
mEq/L). BP 90/60 mmHg. Which treatment improves outcome?
A. Immediate dialysis without medical therapy.
B. ACE inhibitor to reduce afterload.
C. High-dose loop diuretic therapy.
D. IV albumin + vasoconstrictor (terlipressin or norepinephrine).
45. A 35-year-old man presents for evaluation after needle-
stick injury. Serology: HBsAg +, HBeAg –, anti-HBe +, HBV DNA
10⁵ copies/mL. LFT: ALT 120 IU/L. What phase of HBV infection is
this?
A. Acute resolving infection.
B. Immunotolerant phase.
C. HBeAg-negative chronic hepatitis B (precore mutant strain).
D. Inactive carrier state.
46. A 45-year-old man with HCV genotype 1 infection presents
for therapy. Viral load is high; Fibroscan shows F3 fibrosis.
What regimen is preferred?
A. Lamivudine-based regimen.
B. Peg-interferon monotherapy.
C. Sofosbuvir + Ledipasvir for 12 weeks.
D. Interferon + Ribavirin for 48 weeks.
47. A 10-year-old boy presents with fever, malaise, jaundice,
and tender liver. LFT: ALT 1200, bilirubin 5.2 mg/dL. Serology:
HAV IgM positive. What is true?
A. Requires interferon therapy.
B. Transmitted parenterally.
C. High risk of chronic hepatitis.
D. Self-limited illness with lifelong immunity; no chronicity.
48. A 30-year-old HBV carrier develops rapidly progressive
jaundice and hepatic failure. Serology: HBsAg +, anti-HBc IgG
+, anti-HDV IgM +. What does this pattern indicate?
A. Recovery from HBV infection.
B. Isolated HDV infection.
C. HDV superinfection on chronic HBV infection causing
fulminant hepatitis.
D. HDV coinfection with acute HBV.
49. A 26-year-old woman in 3rd trimester presents with
jaundice, encephalopathy, and coagulopathy. Serology: anti-
HEV IgM positive. What is the likely course?
A. Chronic infection likely with relapse.
B. Protection due to pregnancy hormones.
C. Usually subclinical disease.
D. Fulminant hepatic failure with high maternal mortality
(especially in genotype 1).
50. A 19-year-old boy presents with tremors, dysarthria, and
psychiatric symptoms. Exam: Kayser–Fleischer rings in
cornea. Labs: ceruloplasmin 12 mg/dL (low), urinary copper ↑.
What is the best initial treatment?
A. Zinc supplementation only.
B. D-Penicillamine chelation and pyridoxine supplementation.
C. Phlebotomy.
D. Steroids to reduce inflammation.
51. A 52-year-old man presents with fatigue, arthropathy, and
hyperpigmented skin. He has diabetes and hepatomegaly.
Serum ferritin 1800 ng/mL, transferrin saturation 80%. What is
the first-line therapy?
A. Iron chelation with deferasirox.
B. Regular phlebotomy to maintain ferritin <50 ng/mL.
C. Steroids.
D. Vitamin C supplementation.
52. A 45-year-old man presents with chronic diarrhea, weight
loss, arthritis, and hyperpigmentation. Biopsy of small
intestine shows PAS-positive macrophages containing rod-
shaped bacilli. Which organism causes this?
A. Mycobacterium avium complex.
B. Giardia lamblia.
C. Tropheryma whipplei, an actinomycete infecting
macrophages.
D. Yersinia enterocolitica.
53. A 28-year-old woman reports recurrent abdominal pain,
alternating diarrhea and constipation, relieved by defecation.
She has normal colonoscopy and labs. Another 35-year-old
man has bloody diarrhea, weight loss, and colonoscopy
showing continuous ulcerations with pseudopolyps. What
distinguishes the two conditions?
A. IBS – functional disorder with normal mucosa; IBD –
inflammatory with mucosal damage.
B. IBS – inflammatory; IBD – motility disorder.
C. Both have elevated CRP.
D. IBS – presents with bleeding; IBD – never bleeds.