Physician Assistant Gastrointestinal and Nutrition 2 — Questions and Answers
Question 1: A 45-year-old man presents with dysphagia to solids that has progressed to liquids over 3 months, along with a 20-lb weight loss. Which diagnosis is most likely?
- Achalasia
- Esophageal adenocarcinoma (Correct answer)
- Zenker's diverticulum
- Esophageal spasm
Correct answer: Esophageal adenocarcinoma
Progressive dysphagia from solids to liquids with significant weight loss is classic for esophageal carcinoma.
Question 2: Which electrolyte abnormality is most commonly associated with prolonged nasogastric suctioning?
- Hyperkalemia
- Hypernatremia
- Hypokalemic hypochloremic metabolic alkalosis (Correct answer)
- Hyperchloremic metabolic acidosis
Correct answer: Hypokalemic hypochloremic metabolic alkalosis
Prolonged NG suctioning removes HCl and K+, leading to hypokalemic hypochloremic metabolic alkalosis.
Question 3: A patient with Crohn's disease involving the terminal ileum is at greatest risk for deficiency of which nutrient?
- Folate
- Vitamin B12 (Correct answer)
- Iron
- Calcium
Correct answer: Vitamin B12
Vitamin B12 (cobalamin) is exclusively absorbed in the terminal ileum; Crohn's disease in this location impairs its absorption.
Question 4: A 60-year-old woman presents with nausea, early satiety, and bloating after meals. Her blood glucose is poorly controlled. Which condition best explains her symptoms?
- Peptic ulcer disease
- Gastroparesis (Correct answer)
- Celiac disease
- Irritable bowel syndrome
Correct answer: Gastroparesis
Gastroparesis is a common complication of long-standing diabetes mellitus and causes delayed gastric emptying with these symptoms.
Question 5: Which finding on colonoscopy is most characteristic of ulcerative colitis compared to Crohn's disease?
- Skip lesions
- Transmural inflammation
- Continuous involvement starting at the rectum (Correct answer)
- Cobblestoning mucosa
Correct answer: Continuous involvement starting at the rectum
Ulcerative colitis causes continuous, contiguous mucosal inflammation that always involves the rectum and extends proximally.
Question 6: A patient taking high-dose NSAIDs develops a peptic ulcer. Which H. pylori-negative, NSAID-associated mechanism is responsible?
- Increased gastrin secretion
- Inhibition of prostaglandin synthesis (Correct answer)
- Direct mucosal acid burn
- Increased parietal cell mass
Correct answer: Inhibition of prostaglandin synthesis
NSAIDs inhibit COX-1, reducing prostaglandin synthesis, which normally maintains the gastric mucosal protective barrier.
Question 7: Which nutritional deficiency most commonly causes night blindness?
- Vitamin D
- Vitamin A (Correct answer)
- Vitamin C
- Zinc
Correct answer: Vitamin A
Vitamin A (retinol) is required for rhodopsin synthesis in rod photoreceptors; deficiency impairs dark adaptation and causes night blindness.
Physician Assistant Gastrointestinal and Nutrition 2
A 45-year-old man presents with dysphagia to solids that has progressed to liquids over 3 months, along with a 20-lb weight loss.
Which diagnosis is most likely?