Physician Assistant Gastrointestinal and Nutrition 3 — Questions and Answers
Question 1: A 35-year-old woman with chronic diarrhea, bloating, and a positive anti-tissue transglutaminase (anti-tTG) IgA antibody most likely has which condition?
- Lactose intolerance
- Celiac disease (Correct answer)
- Whipple's disease
- Microscopic colitis
Correct answer: Celiac disease
Elevated anti-tTG IgA is the most sensitive and specific serologic test for celiac disease.
Question 2: A 70-year-old man presents with painless jaundice, clay-colored stools, and dark urine. CT shows a mass in the head of the pancreas. Which additional finding would most support malignancy?
- Elevated amylase
- Palpable, non-tender gallbladder (Courvoisier's sign) (Correct answer)
- Murphy's sign
- McBurney's point tenderness
Correct answer: Palpable, non-tender gallbladder (Courvoisier's sign)
Courvoisier's sign — a palpable, non-tender gallbladder in the setting of painless jaundice — suggests malignant biliary obstruction.
Question 3: Which organism is most commonly responsible for traveler's diarrhea?
- Campylobacter jejuni
- Salmonella typhi
- Enterotoxigenic Escherichia coli (ETEC) (Correct answer)
- Giardia lamblia
Correct answer: Enterotoxigenic Escherichia coli (ETEC)
ETEC is the leading cause of traveler's diarrhea, producing heat-labile and heat-stable enterotoxins that increase intestinal fluid secretion.
Question 4: A patient with liver cirrhosis and portal hypertension develops confusion, asterixis, and elevated serum ammonia. Which treatment is most appropriate?
- Neomycin IV
- Lactulose (Correct answer)
- Rifaximin IV
- Metronidazole PO
Correct answer: Lactulose
Lactulose acidifies the colon, trapping ammonia as ammonium (NH4+) and promoting its excretion, reducing serum ammonia in hepatic encephalopathy.
Question 5: Which type of hepatitis is most commonly transmitted via the fecal-oral route and does NOT cause chronic disease?
- Hepatitis B
- Hepatitis C
- Hepatitis A (Correct answer)
- Hepatitis D
Correct answer: Hepatitis A
Hepatitis A is transmitted fecal-orally (contaminated food/water) and never leads to chronic hepatitis or cirrhosis.
Question 6: A child presents with failure to thrive, foul-smelling greasy stools, and recurrent respiratory infections. Sweat chloride testing confirms the diagnosis. Which nutritional supplement is most critical for this patient?
- Water-soluble vitamins
- Fat-soluble vitamins (A, D, E, K) (Correct answer)
- Iron supplementation
- Calcium only
Correct answer: Fat-soluble vitamins (A, D, E, K)
Cystic fibrosis causes pancreatic exocrine insufficiency with fat malabsorption, making fat-soluble vitamin supplementation essential.
Question 7: A patient presents with right lower quadrant pain, fever, and elevated WBC. CT shows a 9 cm appendix with periappendiceal fat stranding. Which is the most appropriate next step?
- IV antibiotics and discharge
- Urgent appendectomy (Correct answer)
- Colonoscopy
- Barium enema
Correct answer: Urgent appendectomy
CT findings of an enlarged appendix with periappendiceal fat stranding indicate acute appendicitis requiring urgent surgical intervention.
Physician Assistant Gastrointestinal and Nutrition 3
A 35-year-old woman with chronic diarrhea, bloating, and a positive anti-tissue transglutaminase (anti-tTG) IgA antibody most likely has which condition?