PANCE Gastrointestinal 2 — Questions and Answers
Question 1: A 55-year-old male presents with dysphagia to solids that has progressed to liquids over 3 months, with a 15-lb weight loss. Which diagnosis is most likely?
- Achalasia
- Esophageal adenocarcinoma (Correct answer)
- Zenker diverticulum
- Esophageal spasm
Correct answer: Esophageal adenocarcinoma
Progressive dysphagia from solids to liquids combined with significant weight loss in an older adult is the classic presentation of esophageal carcinoma.
Question 2: Which of the following is the most appropriate first-line treatment for Helicobacter pylori eradication in the US?
- Omeprazole + amoxicillin + clarithromycin for 14 days (Correct answer)
- Bismuth + metronidazole + tetracycline for 7 days
- Metronidazole + ciprofloxacin for 10 days
- Omeprazole alone for 8 weeks
Correct answer: Omeprazole + amoxicillin + clarithromycin for 14 days
Triple therapy with a PPI plus amoxicillin and clarithromycin for 14 days remains the standard first-line H. pylori regimen in regions with acceptable clarithromycin resistance rates.
Question 3: A patient with cirrhosis develops confusion, asterixis, and elevated ammonia. Which intervention is most appropriate?
- IV thiamine administration
- Lactulose to target 2-3 soft stools per day (Correct answer)
- Emergent liver biopsy
- High-protein diet supplementation
Correct answer: Lactulose to target 2-3 soft stools per day
Lactulose decreases ammonia production and absorption in the gut, making it the treatment of choice for hepatic encephalopathy.
Question 4: A 40-year-old woman presents with right upper quadrant pain after fatty meals, fever of 38.8°C, and jaundice. What is the most likely diagnosis?
- Acute cholecystitis
- Choledocholithiasis
- Ascending cholangitis (Correct answer)
- Hepatitis A
Correct answer: Ascending cholangitis
Charcot's triad of RUQ pain, fever, and jaundice is pathognomonic for ascending cholangitis caused by biliary obstruction and infection.
Question 5: A 28-year-old presents with bloody diarrhea, tenesmus, and proctitis. Colonoscopy shows continuous mucosal inflammation starting from the rectum. Which diagnosis is most consistent?
- Crohn disease
- Ulcerative colitis (Correct answer)
- Ischemic colitis
- Infectious colitis
Correct answer: Ulcerative colitis
Ulcerative colitis characteristically starts in the rectum with continuous mucosal involvement, causing bloody diarrhea and tenesmus.
Question 6: A patient presents with a painless, hard, left supraclavicular lymph node and significant weight loss. Upper endoscopy reveals a gastric mass. Which eponymous finding is described?
- Sister Mary Joseph node
- Virchow node (Correct answer)
- Irish node
- Blumer shelf
Correct answer: Virchow node
Virchow node (left supraclavicular lymphadenopathy) represents metastatic spread of intra-abdominal malignancy, most commonly gastric cancer, via the thoracic duct.
Question 7: Which laboratory finding is most characteristic of acute pancreatitis?
- Elevated ALT and AST
- Elevated lipase >3x upper limit of normal (Correct answer)
- Elevated direct bilirubin
- Elevated alkaline phosphatase
Correct answer: Elevated lipase >3x upper limit of normal
Serum lipase elevated more than three times the upper limit of normal is the most sensitive and specific marker for acute pancreatitis.
PANCE Gastrointestinal 2
A 55-year-old male presents with dysphagia to solids that has progressed to liquids over 3 months, with a 15-lb weight loss.
Which diagnosis is most likely?