case

A 34-year-old female with celiac disease is brought to her nurse practitioner for evaluation of non-resolving sores at the corners of the mouth bilaterally.  On examination, her NP notices a smooth reddened appearance to the tongue with several sores on the oral mucosa and lips. Dietary deficiency of which of the following would most likely produce these symptoms?

A. Vitamin B1 B. Vitamin B2 C. Vitamin B3 D. Vitamin C E. Vitamin E

A  27-year-old male presents to an acute care clinic.  He reports that for the last five months he has had intermittent episodes of abdominal pain and diarrhea. He says that recently the diarrhea has appeared very fatty, and been difficult to flush.  He is referred by his nurse practitioner to a gastroenterologist who performs an EGD with biopsies.  The biopsy shows absence of villi and a lymphoid infiltrate in the submucosa. Of the following, what is the most likely diagnosis?

A. Whipple’s disease B. Giardiasis C. Pseudomembranous colitis D. Celiac disease E. Ménétrier’s disease

A 25-year-old white male presents to his family nurse practitioner.  Over the past six months, he has had multiple episodes of watery diarrhea.  The diarrhea has been associated with bloating, excessive flatulence, and some abdominal cramps.  The symptoms occur frequently in the late morning, after he eats breakfast.  Most frequently for breakfast he has cereal and a piece of fruit. His physician orders a 24-hour stool collection specimen for electrolytes and osmolality.  The test results from the collection are that his sodium is 8.1 mmol/24 hr, his potassium is 19.3 mmol/24 hr, and his measured osmolality is 123.3 mmol/24.  Of the following, what is the most likely cause of the patient’s symptoms?

A. Celiac disease B. VIPoma C. Disaccharidase deficiency D. Inflammatory bowel disease E. Rotavirus

Please discuss the rationales for your selected answer choices.