Physician Assistant Gastrointestinal and Nutrition 4 — Questions and Answers
Question 1: A 55-year-old obese man with a history of Barrett's esophagus undergoes surveillance endoscopy showing high-grade dysplasia. What is the most appropriate management?
- Increased PPI dose and repeat biopsy in 1 year
- Endoscopic eradication therapy or esophagectomy (Correct answer)
- H. pylori eradication
- Nissen fundoplication alone
Correct answer: Endoscopic eradication therapy or esophagectomy
High-grade dysplasia in Barrett's esophagus carries significant risk of progression to adenocarcinoma and requires endoscopic eradication or surgical resection.
Question 2: Which finding is most consistent with acute mesenteric ischemia?
- Pain out of proportion to physical examination findings (Correct answer)
- Rebound tenderness with a rigid abdomen from onset
- Pain relieved by eating
- Gradual onset pain with nausea only
Correct answer: Pain out of proportion to physical examination findings
Acute mesenteric ischemia classically presents with severe abdominal pain that is disproportionately worse than the relatively benign physical exam findings early in the course.
Question 3: A 40-year-old woman presents with episodic right upper quadrant pain after fatty meals, lasting 30–60 minutes. Ultrasound shows gallstones but no bile duct dilation. What is this condition called?
- Acute cholecystitis
- Biliary colic (Correct answer)
- Choledocholithiasis
- Primary sclerosing cholangitis
Correct answer: Biliary colic
Biliary colic is transient RUQ pain caused by temporary gallstone obstruction of the cystic duct, without sustained inflammation or infection.
Question 4: Which test is the gold standard for diagnosing H. pylori infection in a patient who has not recently taken PPIs or antibiotics?
- Serology (IgG antibody)
- Urea breath test
- Stool antigen test
- Upper endoscopy with biopsy (Correct answer)
Correct answer: Upper endoscopy with biopsy
Upper endoscopy with biopsy allows direct visualization and multiple testing methods (urease test, culture, histology), making it the gold standard for H. pylori diagnosis.
Question 5: A patient with short bowel syndrome following extensive small intestine resection is at highest risk for which type of kidney stones?
- Calcium phosphate stones
- Uric acid stones
- Calcium oxalate stones (Correct answer)
- Struvite stones
Correct answer: Calcium oxalate stones
Fat malabsorption in short bowel syndrome increases free oxalate absorption (enteric hyperoxaluria), predisposing to calcium oxalate nephrolithiasis.
Question 6: A 28-year-old woman with known Crohn's disease presents with perianal fistulas and abscesses that have not responded to antibiotics. Which biologic agent is most appropriate?
- Certolizumab pegol
- Vedolizumab
- Infliximab (Correct answer)
- Ustekinumab
Correct answer: Infliximab
Infliximab (anti-TNF-α) is FDA-approved specifically for fistulizing Crohn's disease and has demonstrated efficacy in closing perianal fistulas.
Question 7: A malnourished patient who is started on aggressive refeeding develops hypophosphatemia, hypokalemia, and hypomagnesemia. What syndrome does this represent?
- Wernicke's encephalopathy
- Refeeding syndrome (Correct answer)
- Dumping syndrome
- Short bowel syndrome
Correct answer: Refeeding syndrome
Refeeding syndrome occurs when rapid introduction of carbohydrates drives intracellular shifts of electrolytes in malnourished patients, causing dangerous deficiencies.
Physician Assistant Gastrointestinal and Nutrition 4
A 55-year-old obese man with a history of Barrett's esophagus undergoes surveillance endoscopy showing high-grade dysplasia.
What is the most appropriate management?