PANCE Gastrointestinal 2

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?

Accepted Answer

Esophageal adenocarcinoma

Answer

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?

Accepted Answer

Omeprazole + amoxicillin + clarithromycin for 14 days

Answer

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?

Accepted Answer

Lactulose to target 2-3 soft stools per day

Answer

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?

Accepted Answer

Ascending cholangitis

Answer

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?

Accepted Answer

Ulcerative colitis

Answer

Ulcerative colitis characteristically starts in the rectum with continuous mucosal involvement, causing bloody diarrhea and tenesmus.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Gastrointestinal 2