Family Practice Exam Gastrointestinal Medicine 2 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
Family Practice Exam Gastrointestinal Medicine 2
Which hepatitis B serologic pattern indicates immunity due to vaccination (not prior infection)?