What is the most accurate diagnostic test

Question 1

Asthma

Answer 1

• Pulmonary function testing (PFTs)

- In stable patient do it with methacholine which will lead to decrease in FEV1 by > 20% in asthmatic patient

Question 2

RTA Type I

Answer 2

Infusion of acid into the blood with ammonium chloride (urine pH will remain above 5.5)

Question 3

RTA Type II

Answer 3

Evaluation of bicarbonate malabsorption by giving bicarbonate and test for urine pH (it will rise after giving the bicarbonate)

Question 4

RTA IV

Answer 4

Persistently high urine sodium despite sodium-depleted diet; in addition to hyperkalemia

Question 5

Atheroemboli

Answer 5

Biopsy of the purplish skin lesions

Question 6

Acute (allergic) Interstitial nephritis (AIN)

Answer 6

Hansel or Wright stain of urine to determine the presence of eosinophils

Question 7

Renal Papillary Necrosis

Answer 7

CT scan

Question 8

Urinary Tract Infection (UTI)

Answer 8

Urine culture

Question 9

Achalasia

Answer 9

Manometry

Question 10

Esophageal cancer

Answer 10

Endoscopy with biopsy

Question 11

Diffuse esophageal spasm

Answer 11

Manometry

Question 12

Nutcracker esophagus

Answer 12

Manometry

Question 13

Zenker diverticulum

Answer 13

Barium swallow

Question 14

H. pylori infection

Answer 14

Biopsy

Question 15

Gastrinoma (Zollinger-Ellison syndrome)

Answer 15

After biopsy (that confirms the presence of ulcers), persistent high gastrin levels despite injecting secretin

Question 16

Diabetic gastroparesis

Answer 16

Nuclear gastric emptying study

Question 17

Celiac disease

Answer 17

Small bowel biopsy

Question 18

Whipple disease

Answer 18

Small bowel biopsy

Question 19

Tropical sprue

Answer 19

Small bowel biopsy

Question 20

Chronic pancreatitis

Answer 20

Secretin stimulation testing (placing NG tube; unaffected pancreas will release a large volume of bicarbonate rich fluids after IV injection of secretin)

Question 21

Diverticulosis

Answer 21

Colonoscopy

Question 22

Acute pancreatitis

Answer 22

CT scan with IV and oral contrast to better define and outline abdominal structures

Question 23

Spontaneous bacterial peritonitis

Answer 23

Fluid culture

Question 24

Primary biliary cirrhosis

Blood test

Answer 24

Anti-mitochondrial antibody

Question 25

Primary biliary cirrhosis

Answer 25

Liver biopsy

Question 26

Primary sclerosing cholangitis

Answer 26

ERCP

Question 27

Hemochromatosis

Answer 27

Liver biopsy (we can spare the patient this test by doing a combination of abdominal MRI and HFE (C282y) gene testing)

Question 28

Hepatitis B viral replication activity

Answer 28

PCR of hepatitis B DNA level

Question 29

Hepatitis C disease activity

Answer 29

PCR (hepatitis C RNA viral load)

Question 30

Wilson disease

Answer 30

Abnormally increased amount of copper excretion into urine after giving penicillamine

Question 31

Autoimmune Hepatitis

Answer 31

Liver biopsy

Question 32

Non-alcoholic Steatohepatitis (NASH)

Answer 32

Liver biopsy

Question 33

Hyperaldosteronism due to unilateral adrenal adenoma

Answer 33

Adrenal venous sampling for aldosterone level