PANRE Gastroenterology 5

Question 1

A 55-year-old woman presents with fatigue, arthralgias, and elevated transaminases (AST/ALT 3× ULN). ANA titer is 1:320 and anti-smooth muscle antibody is positive. Liver biopsy shows interface hepatitis. What is the diagnosis?

Accepted Answer

Autoimmune hepatitis

Answer

Autoimmune hepatitis is characterized by elevated transaminases, positive ANA and anti-smooth muscle antibodies, and interface hepatitis on biopsy.

Question 2

A 38-year-old man presents with severe epigastric pain radiating to the back, nausea, and vomiting. He denies alcohol use. Lipase is 4× normal and triglycerides are 1,800 mg/dL. What is the cause of his pancreatitis?

Accepted Answer

Hypertriglyceridemia-induced pancreatitis

Answer

Triglyceride levels above 1,000 mg/dL can cause acute pancreatitis, and this patient's markedly elevated triglycerides with no other identified cause confirms hypertriglyceridemia-induced pancreatitis.

Question 3

A 25-year-old woman presents with watery diarrhea (8-10 stools/day) and mild cramping. She recently completed a course of clindamycin. Stool testing is positive for C. difficile toxin. What is the first-line treatment?

Accepted Answer

Vancomycin (oral)

Answer

Current IDSA/ACG guidelines recommend oral vancomycin as the first-line treatment for initial C. difficile infection, having replaced metronidazole as first-line therapy.

Question 4

Which of the following features distinguishes Crohn's disease from ulcerative colitis?

Accepted Answer

Transmural inflammation with skip lesions

Answer

Crohn's disease is characterized by transmural inflammation that can affect any part of the GI tract in a discontinuous (skip lesion) pattern, unlike the continuous mucosal inflammation of UC.

Question 5

A 68-year-old man undergoes colonoscopy and is found to have a 25 mm pedunculated polyp in the transverse colon. Pathology shows invasive adenocarcinoma confined to the stalk with clear margins. What is the most appropriate next step?

Accepted Answer

No additional surgery if resection margins are clear and no high-risk features

Answer

Pedunculated polyps with invasive cancer at clear margins, no lymphovascular invasion, and well-differentiated histology can be managed endoscopically without surgery.

PANRE Test Practice Test

PANRE Test Practice Test

PANRE Gastroenterology 5