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

Combination therapy (epinephrine plus thermal therapy or clips) is superior to epinephrine injection alone for high-risk ulcers with visible vessels or active bleeding.

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

Carcinoid syndrome (flushing, diarrhea, wheezing) occurs when neuroendocrine tumors with liver metastases secrete serotonin directly into systemic circulation, elevated urinary 5-HIAA confirms the diagnosis.

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

Moderate-to-severe UC flares unresponsive to mesalamine are managed with oral corticosteroids to induce remission, followed by consideration of immunomodulators or biologics.

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

SBP is diagnosed by ascitic fluid PMN count ≥250 cells/mm³ and treated empirically with IV third-generation cephalosporin (cefotaxime) without waiting for culture results.

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

Non-dysplastic Barrett esophagus has a low malignant potential (~0.3% per year), and current guidelines recommend surveillance endoscopy every 3–5 years.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Gastroenterology