ABIM Gastroenterology 2

Question 1

A 45-year-old woman with primary biliary cholangitis has an alkaline phosphatase of 4x normal and pruritus. Which medication is first-line?

Accepted Answer

Ursodeoxycholic acid (UDCA)

Answer

UDCA is the first-line treatment for PBC, improving liver biochemistry, slowing histological progression, and improving transplant-free survival.

Question 2

A 30-year-old man presents with recurrent abdominal pain, weight loss, and terminal ileal involvement on imaging showing 'cobblestone' mucosa and skip lesions. What is the diagnosis?

Accepted Answer

Crohn disease

Answer

Crohn disease characteristically involves any part of the GI tract with transmural inflammation, skip lesions, and cobblestoning, most commonly affecting the terminal ileum.

Question 3

A 68-year-old man with jaundice, weight loss, and painless jaundice has a CT showing a mass in the head of the pancreas with dilated biliary and pancreatic ducts (double duct sign). What is the next step?

Accepted Answer

EUS-guided FNA for tissue diagnosis

Answer

EUS-guided FNA provides tissue diagnosis for pancreatic masses with high sensitivity and specificity while simultaneously staging local extension before definitive surgery.

Question 4

A patient with alcohol-related cirrhosis has hepatic encephalopathy. Ammonia is elevated. Which treatment reduces recurrence of hepatic encephalopathy?

Accepted Answer

Rifaximin plus lactulose

Answer

Rifaximin (a non-absorbable antibiotic) combined with lactulose is more effective than lactulose alone in preventing recurrence of overt hepatic encephalopathy.

Question 5

A 55-year-old woman presents with epigastric pain, early satiety, and unintentional weight loss for 4 months. Upper endoscopy shows a gastric ulcer. What is the most critical next step?

Accepted Answer

Biopsy the ulcer edges to exclude malignancy

Answer

All gastric ulcers require biopsy to exclude gastric cancer, as malignant ulcers can appear benign endoscopically.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Gastroenterology 2