Family Practice Exam Gastrointestinal Medicine 3

Question 1

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?

Accepted Answer

Diverticular bleeding

Answer

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 2

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

Accepted Answer

Esophagogastroduodenoscopy (EGD)

Answer

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 3

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

Accepted Answer

Replacement of normal squamous epithelium with intestinal-type columnar epithelium

Answer

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 4

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?

Accepted Answer

Cholestatic (obstructive) jaundice

Answer

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 5

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

Accepted Answer

Intra-abdominal adhesions from prior surgery

Answer

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.

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Family Practice Exam Gastrointestinal Medicine 3