Free Physician Assistant Gastrointestinal and Nutrition Questions and Answers — Questions and Answers
Question 1: A 48-year-old male with a long history of heavy alcohol consumption presents with jaundice, ascites, and fever. His laboratory results show an AST of 300 U/L, an ALT of 120 U/L, and an elevated GGT. Which of the following features is most characteristic of alcoholic liver disease?
- Markedly elevated ALT (>1000 U/L)
- AST:ALT ratio > 2:1 (Correct answer)
- ALT > AST
- A normal GGT level
Correct answer: AST:ALT ratio > 2:1
An AST to ALT ratio greater than 2:1 is a classic laboratory finding highly suggestive of alcoholic liver disease. [6, 8, 11] In most other forms of liver injury, the ALT is typically higher than or equal to the AST. The absolute levels of aminotransferases in alcoholic hepatitis are usually only moderately elevated (<500 U/L). [2, 14, 26]
Question 2: A 68-year-old female with a history of autoimmune gastritis presents with progressive fatigue, paresthesias in her lower extremities, and glossitis. A complete blood count reveals a macrocytic anemia. Which of the following is the most likely underlying deficiency?
- Iron
- Folate (Vitamin B9)
- Cobalamin (Vitamin B12) (Correct answer)
- Pyridoxine (Vitamin B6)
Correct answer: Cobalamin (Vitamin B12)
The patient's presentation of macrocytic anemia combined with neurological symptoms (paresthesias) is a classic manifestation of cobalamin (Vitamin B12) deficiency. [32, 34, 36] Her history of autoimmune gastritis is a major risk factor for pernicious anemia, which is the leading cause of B12 deficiency due to a lack of intrinsic factor needed for absorption. [3, 5, 7]
Question 3: According to the most recent United States Preventive Services Task Force (USPSTF) recommendations, at what age should average-risk adults begin screening for colorectal cancer?
- 50
- 55
- 40
- 45 (Correct answer)
Correct answer: 45
In May 2021, the United States Preventive Services Task Force (USPSTF) updated its guidelines, lowering the recommended age for average-risk adults to begin screening for colorectal cancer from 50 to 45. [9, 12, 16] This change was based on data showing an increasing incidence of colorectal cancer in younger adults. [12]
Question 4: A 4-week-old male infant presents with a 1-week history of non-bilious, projectile vomiting immediately after feeding. The mother reports he seems hungry all the time. On physical examination, an olive-sized mass is palpated in the epigastric region. What is the most appropriate next step to confirm the diagnosis?
- Abdominal ultrasound (Correct answer)
- Barium upper GI series
- Abdominal X-ray
- Empiric trial of thickened feeds
Correct answer: Abdominal ultrasound
The history and physical exam findings are classic for hypertrophic pyloric stenosis. Abdominal ultrasound is the preferred, most sensitive, and specific imaging modality to confirm the diagnosis. [13, 23, 24] It is non-invasive, avoids radiation exposure, and allows for direct measurement of the pyloric muscle thickness and channel length. [25, 28]
Question 5: A 25-year-old male is diagnosed with moderate-to-severe ileocolonic Crohn's disease. Which of the following biologic agents is often considered a first-line therapy for inducing and maintaining remission in this patient?
- Mesalamine (5-ASA)
- Prednisone
- Infliximab (an anti-TNF agent) (Correct answer)
- Metronidazole
Correct answer: Infliximab (an anti-TNF agent)
For moderate-to-severe Crohn's disease, biologic therapies such as anti-TNF agents (e.g., infliximab, adalimumab) are recommended as a first-line treatment to both induce and maintain clinical remission. [15, 29, 45] Corticosteroids like prednisone are used for short-term induction but not maintenance, while mesalamine has limited efficacy in moderate-to-severe disease. [4, 10]
Question 6: A 55-year-old male complains of a chronic, gnawing epigastric pain that improves with meals but worsens 2-3 hours later. He has no alarm symptoms. Which of the following is considered the most accurate diagnostic test for an active *Helicobacter pylori* infection in this patient?
- Serology testing
- Stool antigen assay
- Urea breath test
- Upper endoscopy with biopsy (Correct answer)
Correct answer: Upper endoscopy with biopsy
While the urea breath test and stool antigen assay are excellent non-invasive tests, upper endoscopy with biopsy is considered the most accurate or 'gold standard' for the diagnosis of an active H. pylori infection. [30, 39] It allows for direct histological examination, rapid urease testing, and culture. In a patient over 50 with new-onset dyspepsia, endoscopy is also indicated to rule out other pathology like malignancy.
Free Physician Assistant Gastrointestinal and Nutrition Questions and Answers
A 48-year-old male with a long history of heavy alcohol consumption presents with jaundice, ascites, and fever.
His laboratory results show an AST of 300 U/L, an ALT of 120 U/L, and an elevated GGT.
Which of the following features is most characteristic of alcoholic liver disease?