PANRE Gastroenterology 2 — Questions and Answers
Question 1: A 55-year-old male presents with dysphagia to solids only that has progressively worsened over 6 months along with a 15-pound weight loss. Which diagnosis is most concerning?
- Achalasia
- Esophageal carcinoma (Correct answer)
- Diffuse esophageal spasm
- Schatzki ring
Correct answer: Esophageal carcinoma
Progressive dysphagia to solids with significant weight loss in an older male raises high concern for esophageal carcinoma.
Question 2: Which of the following is the most common cause of acute pancreatitis in the United States?
- Hypertriglyceridemia
- Gallstones (Correct answer)
- Alcohol use
- Medications
Correct answer: Gallstones
Gallstones are the most common cause of acute pancreatitis in the US, followed by alcohol as the second most common cause.
Question 3: A 40-year-old woman with known Crohn's disease presents with right lower quadrant pain, fever, and a palpable mass. Which complication should be suspected?
- Toxic megacolon
- Intra-abdominal abscess (Correct answer)
- Colorectal cancer
- Ischemic colitis
Correct answer: Intra-abdominal abscess
A palpable mass with fever in Crohn's disease strongly suggests an intra-abdominal abscess, a known complication of transmural inflammation.
Question 4: A 62-year-old man with cirrhosis develops confusion, asterixis, and an elevated ammonia level. Which is the most appropriate initial treatment?
- Rifaximin
- Lactulose (Correct answer)
- Neomycin
- Metronidazole
Correct answer: Lactulose
Lactulose is first-line therapy for hepatic encephalopathy as it reduces ammonia absorption by acidifying colonic contents.
Question 5: A 70-year-old man with a history of NSAID use presents with epigastric pain and melena. Endoscopy reveals a duodenal ulcer with a visible vessel. What is the endoscopic treatment of choice?
- Sclerotherapy alone
- Hemoclip or thermal coagulation plus epinephrine injection (Correct answer)
- Band ligation
- Argon plasma coagulation alone
Correct answer: Hemoclip or thermal coagulation plus epinephrine injection
Combination therapy with a mechanical method (hemoclip) or thermal coagulation plus epinephrine injection is the standard of care for high-risk ulcers with visible vessels.
Question 6: Which lab finding is most characteristic of primary biliary cholangitis (PBC)?
- Elevated AST/ALT with low alkaline phosphatase
- Positive anti-smooth muscle antibody
- Elevated alkaline phosphatase with positive anti-mitochondrial antibody (Correct answer)
- Elevated GGT with positive ANA
Correct answer: Elevated alkaline phosphatase with positive anti-mitochondrial antibody
PBC is characterized by elevated alkaline phosphatase (cholestatic pattern) and the presence of anti-mitochondrial antibodies (AMA) in >90% of cases.
Question 7: A patient with celiac disease continues to have diarrhea and weight loss despite strict gluten avoidance. What should be the next step in management?
- Start azathioprine empirically
- Reassess dietary compliance and consider refractory celiac disease workup (Correct answer)
- Start systemic corticosteroids immediately
- Perform colonoscopy to rule out colitis
Correct answer: Reassess dietary compliance and consider refractory celiac disease workup
Persistent symptoms despite gluten-free diet require reassessment of dietary adherence and consideration of refractory celiac disease, which may require biopsy and further evaluation.
PANRE Gastroenterology 2
A 55-year-old male presents with dysphagia to solids only that has progressively worsened over 6 months along with a 15-pound weight loss.
Which diagnosis is most concerning?