PANCE Gastrointestinal 5

Question 1

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?

Accepted Answer

Increased risk of esophageal adenocarcinoma

Answer

Barrett esophagus (intestinal metaplasia of the distal esophagus) is a premalignant condition that increases risk of esophageal adenocarcinoma by 30-40 fold.

Question 2

A patient presents with watery diarrhea, hypokalemia, and achlorhydria. CT shows a pancreatic mass. Which hormone is most likely responsible?

Accepted Answer

Vasoactive intestinal peptide (VIP)

Answer

VIPoma secretes vasoactive intestinal peptide causing profuse watery diarrhea, hypokalemia, and achlorhydria — known as WDHA or Verner-Morrison syndrome.

Question 3

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?

Accepted Answer

Zollinger-Ellison syndrome

Answer

Zollinger-Ellison syndrome is caused by a gastrin-secreting tumor (gastrinoma), leading to massively elevated gastrin, multiple refractory peptic ulcers, and diarrhea.

Question 4

Which of the following is the most appropriate initial management for a patient presenting with acute upper GI bleeding and hemodynamic instability?

Accepted Answer

IV fluid resuscitation and blood transfusion, then endoscopy

Answer

Hemodynamically unstable patients require initial resuscitation with IV fluids and blood products before proceeding to urgent upper endoscopy within 24 hours.

Question 5

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?

Accepted Answer

Hirschsprung disease

Answer

Hirschsprung disease is caused by absence of enteric ganglion cells (neural crest migration failure) resulting in a functional obstruction and failure to pass meconium.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Gastrointestinal 5