Physician Assistant Gastrointestinal and Nutrition 5 — Questions and Answers
Question 1: A 62-year-old man with alcoholic cirrhosis develops sudden onset, large-volume hematemesis. Endoscopy reveals actively bleeding esophageal varices. Which pharmacologic agent should be initiated immediately?
- Propranolol
- Octreotide (Correct answer)
- Vasopressin IV bolus only
- Nitroglycerin
Correct answer: Octreotide
Octreotide (somatostatin analogue) reduces splanchnic blood flow and portal pressure and is the preferred pharmacologic agent for acute variceal bleeding.
Question 2: A 50-year-old woman presents with chronic watery diarrhea, episodic flushing, and wheezing. Urine 5-HIAA levels are elevated. Where is this tumor most likely located?
- Stomach
- Duodenum
- Appendix or terminal ileum (Correct answer)
- Rectum
Correct answer: Appendix or terminal ileum
Carcinoid syndrome (flushing, diarrhea, wheezing) with elevated 5-HIAA is most commonly caused by carcinoid tumors of the appendix or terminal ileum with hepatic metastases.
Question 3: A 45-year-old woman presents with iron deficiency anemia and a positive fecal occult blood test. Which is the most appropriate next diagnostic step?
- Upper endoscopy only
- Colonoscopy only
- Both upper endoscopy and colonoscopy (Correct answer)
- Capsule endoscopy first
Correct answer: Both upper endoscopy and colonoscopy
In a patient with FOBT-positive iron deficiency anemia, bidirectional endoscopy (both upper and lower) is recommended to identify the source of occult GI bleeding.
Question 4: Which dietary modification is the first-line treatment for non-alcoholic fatty liver disease (NAFLD)?
- Low-fat, low-calorie diet with weight loss of 7–10% (Correct answer)
- High-protein diet with resistance training only
- Elimination of red meat and dairy
- Mediterranean diet without caloric restriction
Correct answer: Low-fat, low-calorie diet with weight loss of 7–10%
A sustained weight loss of 7–10% through caloric restriction improves hepatic steatosis, inflammation, and fibrosis in NAFLD.
Question 5: A 30-year-old woman is diagnosed with irritable bowel syndrome (IBS) with predominant constipation. Which dietary intervention has the strongest evidence for improving her symptoms?
- Gluten-free diet
- Low FODMAP diet (Correct answer)
- High-fiber diet with insoluble fiber
- Lactose-free diet alone
Correct answer: Low FODMAP diet
The low FODMAP diet reduces fermentable carbohydrates that cause osmotic diarrhea and gas production, and has the strongest evidence for symptom relief in IBS.
Question 6: A newborn presents with bilious vomiting, abdominal distension, and failure to pass meconium within 48 hours. Rectal suction biopsy shows absence of ganglion cells. What is the diagnosis?
- Meconium ileus
- Hirschsprung's disease (Correct answer)
- Intussusception
- Pyloric stenosis
Correct answer: Hirschsprung's disease
Hirschsprung's disease results from failed neural crest cell migration, causing an aganglionic segment of colon that cannot relax, leading to functional obstruction.
Question 7: A 68-year-old man with a history of smoking and alcohol use presents with chronic epigastric pain radiating to the back, steatorrhea, and new-onset diabetes. CT shows pancreatic calcifications. What is the most likely diagnosis?
- Pancreatic adenocarcinoma
- Acute pancreatitis
- Chronic pancreatitis (Correct answer)
- Autoimmune pancreatitis
Correct answer: Chronic pancreatitis
Pancreatic calcifications on CT with steatorrhea (exocrine insufficiency) and diabetes (endocrine insufficiency) in a patient with chronic alcohol use is classic chronic pancreatitis.
Physician Assistant Gastrointestinal and Nutrition 5
A 62-year-old man with alcoholic cirrhosis develops sudden onset, large-volume hematemesis.
Endoscopy reveals actively bleeding esophageal varices.
Which pharmacologic agent should be initiated immediately?