PANRE Gastroenterology 4 — Questions and Answers
Question 1: A 28-year-old woman presents with bloody diarrhea, tenesmus, and urgency. Colonoscopy shows continuous mucosal inflammation starting from the rectum. Biopsy shows crypt abscesses. What is the diagnosis?
- Crohn's colitis
- Ulcerative colitis (Correct answer)
- Ischemic colitis
- Infectious colitis
Correct answer: Ulcerative colitis
Continuous inflammation starting from the rectum with crypt abscesses on biopsy is the hallmark presentation of ulcerative colitis.
Question 2: Which finding on endoscopy is most indicative of Barrett's esophagus?
- White plaques on the esophageal mucosa
- Salmon-colored tongues of mucosa extending above the GEJ (Correct answer)
- Linear ulcerations in the distal esophagus
- Esophageal rings at 20 cm from the incisors
Correct answer: Salmon-colored tongues of mucosa extending above the GEJ
Barrett's esophagus is characterized by salmon-colored columnar metaplasia extending proximal to the gastroesophageal junction, confirmed by intestinal metaplasia on biopsy.
Question 3: A 72-year-old woman on warfarin presents with painless bright red blood per rectum. Colonoscopy shows bleeding diverticula in the sigmoid colon. What is the most appropriate initial management?
- Emergency colectomy
- Endoscopic hemostasis (clips or coagulation) (Correct answer)
- Angiography with embolization
- Reversal of anticoagulation only
Correct answer: Endoscopic hemostasis (clips or coagulation)
Endoscopic hemostasis with clips or coagulation is the first-line treatment for actively bleeding diverticula identified at colonoscopy.
Question 4: A patient with chronic liver disease develops sudden onset abdominal pain, fever, and ascitic fluid PMN count >250 cells/mm³. What is the empiric antibiotic of choice?
- Ampicillin-sulbactam
- Cefotaxime or ceftriaxone (Correct answer)
- Metronidazole
- Vancomycin
Correct answer: Cefotaxime or ceftriaxone
Third-generation cephalosporins (cefotaxime or ceftriaxone) are the empiric treatment of choice for spontaneous bacterial peritonitis.
Question 5: A 44-year-old man presents with jaundice, pruritus, and an elevated alkaline phosphatase. MRCP shows multifocal strictures of both intrahepatic and extrahepatic bile ducts with a 'beaded' appearance. What is the most likely diagnosis?
- Primary biliary cholangitis
- Primary sclerosing cholangitis (Correct answer)
- Cholangiocarcinoma
- Autoimmune hepatitis
Correct answer: Primary sclerosing cholangitis
The beaded appearance of multifocal bile duct strictures on MRCP is pathognomonic of primary sclerosing cholangitis.
Question 6: Which of the following best describes the mechanism of action of lactulose in hepatic encephalopathy?
- Kills urease-producing bacteria in the colon
- Acidifies colonic content, converting NH3 to NH4+ and reducing absorption (Correct answer)
- Increases renal ammonia excretion
- Enhances hepatic ammonia metabolism
Correct answer: Acidifies colonic content, converting NH3 to NH4+ and reducing absorption
Lactulose is metabolized to lactic and acetic acid, acidifying the colon and trapping ammonia as ammonium ion (NH4+), which is then excreted in stool.
Question 7: A 60-year-old man with a history of alcohol use presents with acute pancreatitis. His lipase is 1,200 U/L and CT shows peripancreatic fat stranding but no necrosis. What is the Revised Atlanta Classification severity?
- Mild acute pancreatitis (Correct answer)
- Moderately severe acute pancreatitis
- Severe acute pancreatitis
- Critical acute pancreatitis
Correct answer: Mild acute pancreatitis
Mild acute pancreatitis has no organ failure and no local or systemic complications, resolving within the first week.
PANRE Gastroenterology 4
A 28-year-old woman presents with bloody diarrhea, tenesmus, and urgency.
Colonoscopy shows continuous mucosal inflammation starting from the rectum.
Biopsy shows crypt abscesses.
What is the diagnosis?