PANRE Gastroenterology 3 — Questions and Answers
Question 1: A 45-year-old woman presents with right upper quadrant pain after fatty meals, nausea, and a positive Murphy's sign. Ultrasound shows gallstones. What is the definitive treatment?
- Ursodeoxycholic acid therapy
- Laparoscopic cholecystectomy (Correct answer)
- Extracorporeal shock wave lithotripsy
- Low-fat diet and watchful waiting
Correct answer: Laparoscopic cholecystectomy
Symptomatic cholelithiasis is best treated with laparoscopic cholecystectomy, which is the definitive and most commonly recommended intervention.
Question 2: Which of the following is the most sensitive and specific test for diagnosing H. pylori infection in a patient who cannot undergo endoscopy?
- Serology (IgG antibody)
- Stool antigen test
- Urea breath test (Correct answer)
- String test
Correct answer: Urea breath test
The urea breath test has the highest sensitivity and specificity among non-invasive tests for active H. pylori infection.
Question 3: A 58-year-old man presents with new-onset ascites. Paracentesis shows SAAG of 1.5 g/dL. Which condition is most consistent with this result?
- Peritoneal carcinomatosis
- Nephrotic syndrome
- Portal hypertension (Correct answer)
- Tuberculous peritonitis
Correct answer: Portal hypertension
A SAAG ≥1.1 g/dL indicates portal hypertension as the cause of ascites, including cirrhosis, heart failure, or Budd-Chiari syndrome.
Question 4: A 32-year-old woman presents with alternating constipation and diarrhea, bloating, and abdominal cramping relieved by defecation. No alarm features are present. What is the most likely diagnosis?
- Ulcerative colitis
- Irritable bowel syndrome (Correct answer)
- Microscopic colitis
- Crohn's disease
Correct answer: Irritable bowel syndrome
The pattern of alternating bowel habits, bloating, and pain relieved by defecation without alarm features fits the Rome IV criteria for irritable bowel syndrome.
Question 5: A 66-year-old man is found to have a 1.2 cm sessile polyp removed during colonoscopy. Pathology shows a tubular adenoma with low-grade dysplasia. When should the next colonoscopy be performed?
- 1 year
- 3 years (Correct answer)
- 5 years
- 10 years
Correct answer: 3 years
Current guidelines recommend repeat colonoscopy in 3 years for patients with 1-2 tubular adenomas <10 mm with low-grade dysplasia.
Question 6: Which medication is contraindicated in patients with spontaneous bacterial peritonitis (SBP) who have acute kidney injury?
- Cefotaxime
- Albumin infusion
- NSAIDs (Correct answer)
- Albumin plus antibiotics
Correct answer: NSAIDs
NSAIDs are contraindicated in SBP with AKI as they further reduce renal perfusion in already hemodynamically compromised cirrhotic patients.
Question 7: A 50-year-old obese man with type 2 diabetes has elevated transaminases. Liver biopsy shows steatosis, lobular inflammation, and hepatocyte ballooning. What is the diagnosis?
- Alcoholic hepatitis
- Nonalcoholic steatohepatitis (NASH) (Correct answer)
- Primary sclerosing cholangitis
- Autoimmune hepatitis
Correct answer: Nonalcoholic steatohepatitis (NASH)
The triad of steatosis, lobular inflammation, and hepatocyte ballooning in the absence of significant alcohol use defines nonalcoholic steatohepatitis (NASH).
PANRE Gastroenterology 3
A 45-year-old woman presents with right upper quadrant pain after fatty meals, nausea, and a positive Murphy's sign.
Ultrasound shows gallstones.
What is the definitive treatment?