PANCE Gastrointestinal 3

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?

Accepted Answer

Anterior wall of the first part of the duodenum

Answer

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?

Accepted Answer

Pancreatic head carcinoma

Answer

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?

Accepted Answer

Esophageal manometry

Answer

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?

Accepted Answer

Pneumaturia (air in the urine)

Answer

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?

Accepted Answer

All of the above

Answer

Long-term PPI use impairs absorption of magnesium, vitamin B12 (requires acid for release from food), and iron, making all three deficiencies relevant.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Gastrointestinal 3