Gastrointestinal Flashcards
7 cards from real PANCE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Gastrointestinal flashcards as text
A 55-year-old with long-standing GERD undergoes endoscopy showing replacement of squamous epithelium with columnar epithelium in the distal esophagus. What is the most serious concern with this finding?
Answer: Increased risk of esophageal adenocarcinoma
Barrett esophagus (intestinal metaplasia of the distal esophagus) is a premalignant condition that increases risk of esophageal adenocarcinoma by 30-40 fold.
A patient presents with watery diarrhea, hypokalemia, and achlorhydria. CT shows a pancreatic mass. Which hormone is most likely responsible?
Answer: Vasoactive intestinal peptide (VIP)
VIPoma secretes vasoactive intestinal peptide causing profuse watery diarrhea, hypokalemia, and achlorhydria — known as WDHA or Verner-Morrison syndrome.
A 35-year-old presents with episodic peptic ulcers refractory to PPI therapy and diarrhea. Fasting serum gastrin is 1,200 pg/mL. What is the most likely diagnosis?
Answer: Zollinger-Ellison syndrome
Zollinger-Ellison syndrome is caused by a gastrin-secreting tumor (gastrinoma), leading to massively elevated gastrin, multiple refractory peptic ulcers, and diarrhea.
Which of the following is the most appropriate initial management for a patient presenting with acute upper GI bleeding and hemodynamic instability?
Answer: IV fluid resuscitation and blood transfusion, then endoscopy
Hemodynamically unstable patients require initial resuscitation with IV fluids and blood products before proceeding to urgent upper endoscopy within 24 hours.
A newborn fails to pass meconium within 48 hours of birth. Abdominal X-ray shows a distended colon with a transition zone. Rectal biopsy confirms absence of ganglion cells. What is the diagnosis?
Answer: Hirschsprung disease
Hirschsprung disease is caused by absence of enteric ganglion cells (neural crest migration failure) resulting in a functional obstruction and failure to pass meconium.
A patient with alcoholic cirrhosis develops tense ascites and acute kidney injury with urine sodium <10 mEq/L and no response to diuretics or albumin. What is the most likely diagnosis?
Answer: Hepatorenal syndrome
Hepatorenal syndrome is a functional renal failure in cirrhosis with ascites, characterized by very low urine sodium, no response to volume expansion, and exclusion of other causes.
A 60-year-old presents with rectal bleeding, mucus discharge, and tenesmus. Digital rectal exam reveals a rectal mass 4 cm from the anal verge. Which is the most appropriate next step?
Answer: Flexible sigmoidoscopy with biopsy
Flexible sigmoidoscopy with biopsy is the most appropriate initial step to directly visualize and obtain tissue from a palpable rectal mass for histologic diagnosis.