GI Diagnostic Procedures and Endoscopy 2 — Questions and Answers
Question 1: Which modality is the preferred first-line imaging for suspected acute appendicitis in adult patients in the US?
- Plain abdominal X-ray
- Ultrasound
- CT scan of the abdomen/pelvis with IV contrast (Correct answer)
- MRI
Correct answer: CT scan of the abdomen/pelvis with IV contrast
CT abdomen/pelvis with IV contrast has the highest sensitivity (>95%) and specificity for diagnosing acute appendicitis in adults.
Question 2: Endoscopic ultrasound (EUS) is the most accurate modality for staging which malignancy?
- Hepatocellular carcinoma
- Colon cancer
- Esophageal and gastric cancer (T and N staging) (Correct answer)
- Small bowel adenocarcinoma
Correct answer: Esophageal and gastric cancer (T and N staging)
EUS provides high-resolution imaging of the esophageal and gastric wall layers for T staging and adjacent lymph nodes for N staging.
Question 3: The Alvarado score is a clinical scoring tool used to assess the probability of which GI condition?
- Acute cholecystitis
- Acute pancreatitis
- Acute appendicitis (Correct answer)
- Bowel obstruction
Correct answer: Acute appendicitis
The Alvarado score uses symptoms, signs, and lab values (total 10 points) to stratify risk for acute appendicitis.
Question 4: Fecal calprotectin is most useful for distinguishing which two conditions?
- Celiac disease vs. lactose intolerance
- Inflammatory bowel disease vs. irritable bowel syndrome (Correct answer)
- Colorectal cancer vs. diverticulitis
- Hepatitis vs. cirrhosis
Correct answer: Inflammatory bowel disease vs. irritable bowel syndrome
Fecal calprotectin is a sensitive noninvasive marker of intestinal inflammation, helping differentiate organic IBD from functional IBS.
Question 5: Which test is the gold standard for diagnosing H. pylori infection in patients who have not taken PPIs or antibiotics recently?
- Serology (IgG antibody)
- Urea breath test (Correct answer)
- Stool antigen test
- Rapid urease test (CLO test)
Correct answer: Urea breath test
The urea breath test detects active H. pylori infection by measuring labeled CO2 after ingestion of urea, with high sensitivity and specificity.
Question 6: The APACHE II score is used to assess severity and predict mortality in which GI condition?
- Upper GI bleeding
- Acute pancreatitis (Correct answer)
- Acute liver failure
- Colorectal cancer staging
Correct answer: Acute pancreatitis
APACHE II (along with Ranson criteria and BISAP) is used to stratify severity and predict outcomes in acute pancreatitis.
GI Diagnostic Procedures and Endoscopy 2
Which modality is the preferred first-line imaging for suspected acute appendicitis in adult patients in the US?