Family Practice Exam Gastrointestinal Medicine — Questions and Answers

Question 1: Which of the following is the first-line treatment regimen for H. pylori eradication?

Triple therapy (PPI + amoxicillin + clarithromycin) (Correct answer)
PPI monotherapy for 8 weeks
Bismuth quadruple therapy alone
Metronidazole monotherapy for 14 days

Correct answer: Triple therapy (PPI + amoxicillin + clarithromycin)

Triple therapy with a PPI, amoxicillin, and clarithromycin for 14 days is the standard first-line regimen for H. pylori eradication in areas with low clarithromycin resistance.

Question 2: A 45-year-old patient reports heartburn and regurgitation occurring at least twice weekly for 6 months. What is the most appropriate first-line pharmacological treatment?

Proton pump inhibitor (e.g., omeprazole) (Correct answer)
H2 receptor antagonist (e.g., famotidine)
Calcium-based antacid
Surgical fundoplication referral

Correct answer: Proton pump inhibitor (e.g., omeprazole)

PPIs provide superior acid suppression compared to H2 blockers and are the first-line pharmacological therapy for chronic GERD.

Question 3: According to Rome IV criteria, which of the following is NOT a diagnostic criterion for irritable bowel syndrome (IBS)?

Unintentional weight loss >10 lbs (Correct answer)
Recurrent abdominal pain at least 1 day per week for 3 months
Pain related to defecation
Pain associated with a change in stool frequency or form

Correct answer: Unintentional weight loss >10 lbs

Unintentional weight loss is a red-flag symptom suggesting organic disease and is not part of the Rome IV IBS criteria; its presence warrants further workup.

Question 4: Which antibody test is the preferred initial screening test for celiac disease in patients with adequate IgA levels?

Anti-tissue transglutaminase IgA (anti-tTG IgA) (Correct answer)
Anti-gliadin IgG
Anti-endomysial IgM
Anti-deamidated gliadin peptide IgM

Correct answer: Anti-tissue transglutaminase IgA (anti-tTG IgA)

Anti-tTG IgA is the single best screening test for celiac disease due to its high sensitivity (>95%) and specificity (~95%) and is recommended by all major guidelines.

Question 5: A 62-year-old otherwise healthy patient is diagnosed with uncomplicated acute diverticulitis (no abscess, no perforation, mild symptoms). What is the most appropriate management?

Outpatient treatment with oral antibiotics and liquid diet (Correct answer)
Emergent surgical consultation for resection
Intravenous antibiotics with hospital admission
Urgent colonoscopy within 24 hours

Correct answer: Outpatient treatment with oral antibiotics and liquid diet

Uncomplicated diverticulitis in immunocompetent patients with mild symptoms can be safely managed outpatient with oral antibiotics and dietary modification.

Question 6: According to current USPSTF guidelines, at what age should average-risk asymptomatic adults begin colorectal cancer screening?

45 years (Correct answer)
50 years
40 years
55 years

Correct answer: 45 years

In 2021, the USPSTF updated its recommendation to begin colorectal cancer screening at age 45 for average-risk adults due to rising incidence in younger populations.

Question 7: Which of the following is the most common etiology of peptic ulcer disease in the United States?

Helicobacter pylori infection (Correct answer)
Chronic NSAID use
Zollinger-Ellison syndrome
Stress-related mucosal disease

Correct answer: Helicobacter pylori infection

H. pylori infection is responsible for approximately 70–90% of duodenal ulcers and 60–70% of gastric ulcers, making it the leading cause of peptic ulcer disease.

Question 8: Which hepatitis B serologic pattern indicates immunity due to vaccination (not prior infection)?

Anti-HBs positive only (HBsAg negative, anti-HBc negative) (Correct answer)
HBsAg positive with anti-HBc IgM positive
Anti-HBc positive with anti-HBs positive
Anti-HBe positive with HBsAg positive

Correct answer: Anti-HBs positive only (HBsAg negative, anti-HBc negative)

Vaccination generates anti-HBs without anti-HBc, because vaccines contain only surface antigen; natural infection also produces anti-HBc.

Question 9: Which of the following is the most common cause of acute pancreatitis in the United States?

Gallstones (Correct answer)
Alcohol use
Hypertriglyceridemia
Medication-induced

Correct answer: Gallstones

Gallstones account for approximately 40–70% of acute pancreatitis cases, as a stone obstructing the common bile duct can impair pancreatic enzyme drainage.

Question 10: Which endoscopic finding is more characteristic of Crohn's disease than ulcerative colitis?

Skip lesions with areas of normal intervening mucosa (Correct answer)
Continuous mucosal involvement from the rectum proximally
Isolated rectal disease without proximal extension
Pseudopolyp formation limited to the sigmoid colon

Correct answer: Skip lesions with areas of normal intervening mucosa

Crohn's disease characteristically produces patchy, discontinuous 'skip lesions,' whereas ulcerative colitis shows continuous mucosal inflammation extending proximally from the rectum.

Question 11: A 52-year-old patient with chronic constipation has failed dietary fiber supplementation and increased fluid intake. Which pharmacological agent is the most appropriate next step?

Polyethylene glycol (osmotic laxative) (Correct answer)
Senna (stimulant laxative)
Docusate sodium (stool softener)
Bisacodyl suppository

Correct answer: Polyethylene glycol (osmotic laxative)

Polyethylene glycol is the preferred first-line pharmacological agent for chronic constipation, with strong evidence for efficacy and long-term safety.

Question 12: A 28-year-old traveler returns from Central America with 4 days of watery, non-bloody diarrhea and mild cramping but no fever. What is the most appropriate initial management?

Oral rehydration therapy and supportive care (Correct answer)
Empiric ciprofloxacin for 3 days
Empiric metronidazole for Giardia
Stool culture and ova and parasite exam before any treatment

Correct answer: Oral rehydration therapy and supportive care

Mild traveler's diarrhea without fever, bloody stools, or systemic symptoms is self-limiting; oral rehydration and supportive care are sufficient management.

Question 13: Which intervention has the strongest evidence for improving liver histology in non-alcoholic fatty liver disease (NAFLD)?

Weight loss of 7–10% of body weight through diet and exercise (Correct answer)
Metformin therapy in non-diabetic patients
High-dose vitamin E supplementation in all patients
Ursodeoxycholic acid (UDCA) long-term therapy

Correct answer: Weight loss of 7–10% of body weight through diet and exercise

Lifestyle modification achieving 7–10% weight loss is the most effective intervention for NAFLD, consistently improving steatosis, inflammation, and fibrosis on histology.

Question 14: A 38-year-old woman with episodic right upper quadrant pain after fatty meals has an ultrasound confirming cholelithiasis. She has no fever, jaundice, or signs of acute cholecystitis. What is the definitive treatment?

Elective laparoscopic cholecystectomy (Correct answer)
Urgent cholecystectomy within 24 hours
Long-term ursodeoxycholic acid to dissolve stones
Dietary fat restriction as sole management

Correct answer: Elective laparoscopic cholecystectomy

Symptomatic cholelithiasis is definitively treated with elective laparoscopic cholecystectomy, which eliminates the risk of future complications including acute cholecystitis and gallstone pancreatitis.

Question 15: A 72-year-old man presents with painless, large-volume bright red blood per rectum. Vital signs are stable. What is the most likely cause?

Diverticular bleeding (Correct answer)
Internal hemorrhoids
Colorectal carcinoma
Ischemic colitis

Correct answer: Diverticular bleeding

Diverticular disease is the leading cause of significant lower GI bleeding in adults over 60, accounting for 30–40% of cases, and typically presents as painless, high-volume hematochezia.

Question 16: Which diagnostic procedure is the preferred initial evaluation for a patient presenting with hematemesis and hemodynamic stability?

Esophagogastroduodenoscopy (EGD) (Correct answer)
CT angiography of the abdomen
Tagged red blood cell nuclear scan
Upper GI barium series

Correct answer: Esophagogastroduodenoscopy (EGD)

EGD is the gold-standard first-line test for upper GI bleeding because it simultaneously identifies the bleeding source and allows therapeutic intervention (e.g., banding, injection, cautery).

Question 17: Barrett's esophagus is best defined as which of the following histological changes?

Replacement of normal squamous epithelium with intestinal-type columnar epithelium (Correct answer)
Dysplastic change within existing squamous epithelium
Replacement of columnar epithelium with squamous epithelium
Adenocarcinoma arising in the distal esophagus

Correct answer: Replacement of normal squamous epithelium with intestinal-type columnar epithelium

Barrett's esophagus is a metaplastic change where normal esophageal squamous epithelium is replaced by specialized intestinal columnar epithelium, typically from chronic gastric acid reflux.

Question 18: A patient presents with jaundice, generalized pruritus, dark urine, and clay-colored stools. Lab results show markedly elevated direct bilirubin and alkaline phosphatase. What type of jaundice does this pattern represent?

Cholestatic (obstructive) jaundice (Correct answer)
Hemolytic jaundice
Hepatocellular jaundice
Gilbert syndrome

Correct answer: Cholestatic (obstructive) jaundice

Elevated direct (conjugated) bilirubin, alkaline phosphatase, and the clinical features of pruritus, dark urine, and pale stools indicate obstruction of bile flow (cholestatic jaundice).

Question 19: Which of the following is the most common cause of small bowel obstruction in adults in developed countries?

Intra-abdominal adhesions from prior surgery (Correct answer)
External hernias
Crohn's disease strictures
Small bowel neoplasm

Correct answer: Intra-abdominal adhesions from prior surgery

Post-surgical intra-abdominal adhesions account for approximately 60–75% of small bowel obstructions, making them by far the most common etiology in patients with prior abdominal surgery.

Question 20: A 24-year-old male presents with periumbilical pain that migrated to the right lower quadrant over 12 hours, accompanied by nausea, low-grade fever, and leukocytosis. Which physical exam finding is most classic for acute appendicitis?

Rebound tenderness at McBurney's point (Correct answer)
Murphy's sign (inspiratory arrest with RUQ palpation)
Rovsing's sign (RLQ pain with LLQ palpation)
Psoas sign (RLQ pain with right hip extension)

Correct answer: Rebound tenderness at McBurney's point

Rebound tenderness at McBurney's point—located one-third the distance from the right anterior superior iliac spine to the umbilicus—is the classic physical finding of peritoneal irritation in acute appendicitis.

Question 21: Which complication of hepatic cirrhosis is defined by spontaneous infection of ascitic fluid with >250 neutrophils/mm³ in the absence of a surgical intra-abdominal source?

Spontaneous bacterial peritonitis (SBP) (Correct answer)
Secondary bacterial peritonitis
Hepatic encephalopathy
Hepatorenal syndrome

Correct answer: Spontaneous bacterial peritonitis (SBP)

SBP is diagnosed when ascitic fluid PMN count exceeds 250 cells/mm³ without evidence of a surgically treatable intra-abdominal infection; it most commonly occurs in cirrhotic patients with low ascitic protein.

Family Practice Exam Gastrointestinal Medicine

Which of the following is the first-line treatment regimen for H. pylori eradication?

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