ABIM Gastroenterology

Question 1

A 55-year-old man presents with melena and hematemesis. Upper endoscopy shows a duodenal ulcer with a visible vessel. What is the most appropriate endoscopic treatment?

Accepted Answer

Epinephrine injection plus thermal coagulation or clip

Answer

Biopsy the ulcer and observe

Answer

Epinephrine injection alone

Answer

Observe and start PPI only

Question 2

A 40-year-old woman presents with watery diarrhea, flushing, and wheezing. Urinary 5-HIAA is markedly elevated. CT scan shows a liver mass and ileal mass. What is the diagnosis?

Accepted Answer

Carcinoid tumor (neuroendocrine tumor) with carcinoid syndrome

Answer

VIPoma

Answer

Glucagonoma

Answer

Gastrinoma

Question 3

A 35-year-old woman with ulcerative colitis has been on mesalamine for 2 years. She develops worsening diarrhea and rectal bleeding despite treatment. Colonoscopy shows pancolitis. What is the next step?

Accepted Answer

Add oral corticosteroids for acute flare management

Answer

Increase mesalamine dose only

Answer

Proceed immediately to colectomy

Answer

Start antibiotics alone

Question 4

A patient with cirrhosis and ascites presents with fever, abdominal pain, and confusion. Paracentesis shows PMN count of 350 cells/mm³. What is the diagnosis and treatment?

Accepted Answer

Spontaneous bacterial peritonitis — start IV cefotaxime

Answer

Hepatic encephalopathy — start lactulose

Answer

Secondary peritonitis — emergency surgery

Answer

Hepatorenal syndrome — start terlipressin

Question 5

A 50-year-old man with Barrett esophagus (non-dysplastic, confirmed on two endoscopies) asks about surveillance. What is the recommended surveillance interval?

Accepted Answer

Every 3–5 years

Answer

Every 6 months

Answer

Every 1 year

Answer

No further surveillance needed

Question 6

A 65-year-old man is found to have a 1.5 cm polyp removed during colonoscopy. Pathology shows a tubular adenoma with low-grade dysplasia. When should his next surveillance colonoscopy be performed?

Accepted Answer

3 years

Answer

1 year

Answer

5–10 years

Answer

No follow-up needed