PANCE Gastrointestinal 3 — Questions and Answers
Question 1: A 65-year-old male with a history of NSAID use presents with a duodenal ulcer. Which of the following locations is most common for duodenal ulcers?
- Posterior wall of the duodenal bulb
- Anterior wall of the first part of the duodenum (Correct answer)
- Second portion of the duodenum
- Junction of the pylorus and duodenum
Correct answer: Anterior wall of the first part of the duodenum
The majority of duodenal ulcers occur on the anterior wall of the first part (bulb) of the duodenum, where acid exposure is highest.
Question 2: A 50-year-old presents with jaundice, pale stools, dark urine, and a palpable, non-tender gallbladder. Which condition is most likely?
- Choledocholithiasis
- Acute cholecystitis
- Pancreatic head carcinoma (Correct answer)
- Primary sclerosing cholangitis
Correct answer: Pancreatic head carcinoma
Courvoisier's sign (painless palpable gallbladder with obstructive jaundice) suggests malignant biliary obstruction, most commonly pancreatic head cancer.
Question 3: Which of the following is the gold standard for diagnosing esophageal motility disorders such as achalasia?
- Barium swallow esophagram
- Upper endoscopy
- Esophageal manometry (Correct answer)
- CT scan of the chest
Correct answer: Esophageal manometry
Esophageal manometry is the definitive test for diagnosing achalasia, showing absence of peristalsis and failure of the LES to relax.
Question 4: A 35-year-old with Crohn disease develops a new fistula between the bowel and the bladder. What is the most specific symptom of this complication?
- Persistent hematuria
- Pneumaturia (air in the urine) (Correct answer)
- Recurrent UTIs only
- Feculent vaginal discharge
Correct answer: Pneumaturia (air in the urine)
Pneumaturia (passage of gas in urine) is the pathognomonic symptom of an enterovesical fistula, caused by a bowel-bladder connection.
Question 5: A patient on long-term PPI therapy is most at risk for deficiency in which micronutrient?
- Iron
- Vitamin B12
- Magnesium
- All of the above (Correct answer)
Correct answer: All of the above
Long-term PPI use impairs absorption of magnesium, vitamin B12 (requires acid for release from food), and iron, making all three deficiencies relevant.
Question 6: A 60-year-old presents with iron deficiency anemia, weight loss, and a change in bowel habits. Colonoscopy reveals a mass in the ascending colon. Which is the most likely histologic type?
- Squamous cell carcinoma
- Adenocarcinoma (Correct answer)
- Carcinoid tumor
- Lymphoma
Correct answer: Adenocarcinoma
Over 95% of colorectal cancers are adenocarcinomas arising from colonic epithelium, with right-sided tumors often presenting with occult bleeding and anemia.
Question 7: Which of the following is NOT a feature of irritable bowel syndrome (IBS)?
- Abdominal pain relieved by defecation
- Alternating diarrhea and constipation
- Nocturnal diarrhea awakening the patient (Correct answer)
- Bloating and flatulence
Correct answer: Nocturnal diarrhea awakening the patient
Nocturnal diarrhea that awakens the patient is a red flag suggesting organic disease, not IBS, which is a functional disorder that does not cause nighttime symptoms.
PANCE Gastrointestinal 3
A 65-year-old male with a history of NSAID use presents with a duodenal ulcer.
Which of the following locations is most common for duodenal ulcers?