Step 1 Question of the Week: Gastrointestinal

This week’s edition of the Step 1 Question of the Week is about gastrointestinal. See if you can answer the question and then watch the video to learn the correct answer as well as the rationales for each option.



A 10-year-old male is brought to the clinic because of chronic diarrhea and increased fatigue. The patient reports that his stools smell foul and float in the commode. He has no blood in his stool. Vital signs are normal. On physical examination, he appears pale and thin. His abdomen is mildly tender to palpation in all four quadrants. Laboratory studies are as follows:

Hemoglobin:  9.0 g/dL
Mean corpuscular volume:  73 ?m3
Platelet count:  212,000/mm3
Leukocyte count:  6,000/mm3
Ferritin:  27 ng/mL

A duodenal biopsy specimen reveals the following:

This condition is also associated with which of the following findings?

A. Ascending weakness
B. Frequent bloody stools
C. Hyperpigmented skin lesions
D. Painful, tender, erythematous nodules on the shins
E. Small clusters of fluid-filled papules and vesicles

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