GI PRACTICE QUESTIONS

When choosing pharmacological interventions to prevent recurrence of duodenal ulcer in a middle aged man, you prescribe:

a H2 blocker

Lower GI hemorrhage associated with diverticular disease usually manifests as:

a painless event

Which best represents the peak ages for acute appendicitis?

10 to 30 yo

According to ACS, colorectal cancer is the number____cause of cancer death in men and women.

3

Approximately what percent of the population will develop diverticulosis by the time they reach 50 yo?

33%

A common complication of viral gastroenteritis in children is: A. Dehydration B. GI bleeding C. Peritonitis D Bacterial sepsis

A

Clinical findings most consistent with appendiceal rupture include all of the following except: A. abdominal discomfort less than 48 hours in duration. B. fever greater than 102°F (>38°C). C. palpable abdominal mass. D. marked leukocytosis with total WBC greater than 20,000/mm3

A

In a 2 month old infant with vomiting an diarrhea, the most effective way to determine a fluid deficit is to check for: A. decreased peripheral perfusion B. hyperventilation C. irritability D. hyperthermia

A

One of the alarm signs and symptoms of IBS that requires prompt investigation is: A. blood or pus in the stool B. weight gain C. hyperkalemia D. first onset in the teen years

A

Sam has UC and is on a low residue diet. Which foods do you recommend Sam avoid? A. Potato skins, potato chips, and brown rice B. Vegetable juices and cooked and canned vegetables C. Ground beef, veal, pork, and lamb D. White rice and pasta

A

Which maneuver for diagnosing appendicitis is done by deep palpation over the LLQ with resultant pain in the RLQ? A. Rovsing's sign B. Psoas sign C. Obturator sign D. McBurney's sign

A

Jonas, age 34, had a Billroth II (hemigastrectomy and gastrojejunostomy) performed 1 week ago and just started eating a bland diet. What do you suspect when he complains of epigastric fullness, distention, discomfort, abdominal cramping, nausea, and flatus after eating? A. Obstruction B. Dumping syndrome C. Metabolic acidosis D. Infectious colitis

B

Lipids are broken down where in the GI tract? A. Esophagus B. Stomach C. Small intestine D. Large intestine

B

Marvin, a known alcoholic with cirrhosis, is frequently admitted for coagulopathies and occasionally receives blood transfusions. His wife asks why he has a bleeding problem. You respond: A. Occasionally he accumulates blood in the gut. B. There is an interruption of normal clotting mechanisms. C. Long term alcohol abuse has made his vessels very friable. D. His bone marrow has been affected.

B

Melva presents with an exacerbation of acute pancreatitis and you are going to admit her to the hospital. Which is the most important factor in determining a negative long term outcome for her? A. age B. infection C. pain D. length of time between exacerbations

B

Risk factors for the development of hemorrhoidal symptoms include all fo the following except: A. prolonged sitting B. insertive partner in anal intercourse C. chronic diarrhea D. excessive alcohol use

B

Therapy for hemorrhoids includes all of the following except: A. weight control B. low fat diet C. topical corticosteroids D. stool softener

B

What is the most common cause of melena? A. Colon cancer B. Upper GI bleeding C. Drug abuse D. Smoking

B

Which of the following antibiotics causes more episodes of nausea and/or vomiting than the others? A. Azithromycin B. Erythromycin C. Penicillin D. Tetracycline

B

A 54 yo man with an anal fissure responds inadequately to dietary intervention and standard therapy during the past 2 weeks. Additional treatment options include all of the following except: A. intraanal nitro ointment B. botox to internal anal sphincter C. surgical sphincterotomy D. rubber band ligation of the lesion

D

All of the following are typically noted in a young adult with the diagnosis of acute appendicitis except: A. epigastric pain. B. positive obturator sign. C. rebound tenderness. D. marked febrile response.

D

In a patient who presents with a history consistent with anal fissure but with notation of an atypical anal lesion, alternative diagnoses to consider include all of the following except: A. condylomata acuminate B. Crohn's disease C. anal squamous cell carcinoma D. C. difficile colitis

D

The NP is advising a 58 yo woman about the benefits of a high fiber diet. Which of the following foods provides the highest fiber content? A. 1 small banana B. 1 cup of cooked oatmeal C. 1/2 cup of brown rice D. medium sized blueberry muffin

D

The most important diagnostic test for celiac disease is: A. Confirming malabsorption by lab tests B. Barium enema C. A peroral biopsy of the duodenum D. A gluten free diet trial with an accompanying improvement in mucosal histological response

D

You are doing routine teaching with a patient who has a family history of colorectal cancer. You know she misunderstands the teaching when she tells you: A. decrease her fat intake B. increase her fiber intake C. continue her daily ASA use D. increase her fluid intake

D

A 43 yo woman has a 12 hour history of sudden onset RUQ pain with radiation to the shoulder, fever, and chills. She has similar, milder episodes in the past. Exam reveals marked tenderness to palpation. Her most likely diagnosis is:

acute cholecystitis

Which is least likely to be found in a patient with gastric ulcer? A. history of long-term naproxen use B. age younger than 50 years C. previous use of H2RA or antacids D. cigarette smoking

age < 50 yo

Antiprostaglandin drugs cause stomach mucosal injury primarily by:

altering the thickness of the protective mucosal layer

A 58 yo man recently began taking an antihypertensive medication and reports that his heartburn has become much worse. He is most likely taking

amlodipine

A 35 yo woman complains of a 6 month history of periodic "heartburn" primarily after eating tomato based sauces. Her weight is unchanged and exam reveals a single altered finding of epigastric tenderness without rebound. As first line therapy you advise:

avoiding trigger foods

According to ACS recommendations, which of the following is the preferred method for annual colorectal cancer screening in a 51 yo man?

Fecal occult blood test

The gastric parietal cells produce:

Hydrochloric acid

Later colorectal cancer presentation often includes what condition?

IDA

The location of discomfort with acute diverticulitis is usually in which of the following areas of the abdomen?

LLQ

A 26 yo man presents with acute abdominal pain. You order a CBC and anticipate:

Left shift with bandemia

A 38 yo nonsmoking man presents with signs and symptoms consistent of GERD. he has self treated with OTC antacids and acid suppression therapy with effect. His weight is stable, and he denies nausea, vomiting, diarrhea, or melena. Which of the following represents the most appropriate diagnostic plan for this patient?

No specific diagnostic testing is needed

The most sensitive and specific test for H. Pylori is from the following list is: A. stool Gram stain, looking for the offending organism. B. serological testing for antigen related to the infection. C. organism-specific stool antigen testing. D. fecal DNA testing.

Organism specific stool antigen

Commonly encountered diagnoses other than appendicitis can include which of the following in a 28 yo with a 2 day history of lower abdominal pain with right sided pain slightly worse than the left?

PID ectopic pregnancy constipation

Which of the following best describes Grade III internal hemorrhoids?

Prolapse on defecation and must be reduced manually

A 58 yo man reports intermittent RUQ pain. He is obese and being actively treated for hyperlipidemia. Imaging in a patient with symptomatic cholelithiasis usually includes an abdominal:

RUQ US

Murphy's sign can be best described as abdominal pain elicited by:

RUQ palpation

Long term PPI use is associated with all of the following except: A. increased risk of pneumonia in hospitalized patients. B. increased risk of C. difficile colitis in hospitalized patients. C. reduced absorption of calcium and magnesium. D. reduced absorption of dietary carbohydrates.

Reduced absorption of carbohydrates

A 62 yo man presents with a 2 month history of noting a bit of dark blood mixed in with my stool most days", PE reveals external hemorrhoids, no rectal mass, and a small amount of dark brown sool on the examining digit. In office occult test is positive, and a hemogram reveals a microcytic hypochromic anemia. The next best step is:

Refer to GI for colonoscopy

You prescribe a fluoroquinolone antibiotic to a 54 yo woman who has occasional GERD symptoms that she treats with an antacid. When discussing appropriate medication use, you advise that she should take the antimicrobial:

Seperated from the antacid by 2-4 hours hours before or 4-6 hours after taking the fluoroquinolone

Which of the following is false about H. Pylori? A. H. pylori is a Gram-negative, spiral-shaped bacterium. B. Infection with H. pylori is the most potent risk factor for duodenal ulcer. C. The organism is often resistant due to the production of beta-lactamase. D. H. pylori is transmitted via the oral-fecal or oral-oral route.

The organism is often resistant due to beta lactamase.

Which imaging study potentially exposes the patient being evaluated for abdominal pain to the lowest radiation?

US

Which is likely to reported in a patient with persistent GERD?

chronic sore throat

The H2 blocker most likely to cause drug interactions with phenytoin and theophylline is:

cimetidine

A 56 yo woman is diagnosed with mild diverticulitis. In addition to counseling her about increased fluid intake and adequate rest, you recommend antimicrobial treatment with:

ciprofloxacin and metronidazole

Which is most consistent with acute colonic diverticulitis? A. cramping, diarrhea, and leukocytosis B. constipation and fever C. right-sided abdominal pain D. frank blood in the stool with reduced stool caliber

cramping, diarrhea, and leukocytosis

In caring for a patient with symptomatic GERD, you prescribe a PPI to:

increase the pH of the stomach

COX-2 contributes to:

inflammatory response

Which of the following medications is a PPI? A. loperamide B. metoclopramide C. nizatidine D. lansoprazole

lansoprazole

Peptic ulcer disease can occur in any of the following locations except: A. duodenum. B. stomach. C. esophagus. D. large intestine.

large intestine

Which does not increase a patient's risk of developing colorectal cancer? A. family history of colorectal cancer B. familial polyposis C. personal history of neoplasm D. long-term aspirin therapy

long term ASA therapy

Major risk factors for diverticulosis include all of these except: A. low-fiber diet. B. family history of the condition. C. older age. D. select connective tissue disorders (e. g. , Marfan syndrome).

low fiber diet

COX-1 contributes to:

maintenance of gastric protective mucosal layer

Risk factors for the development of cholethiasis include all of the following except: A. rapid weight loss. B. male gender. C. obesity. D. Native American ancestry.

male gender

Which WBC form is an ominous finding in the presence of severe bacterial infection?

metamyelocyte

NSAID induced peptic ulcer can be best limited by the use of:

misoprostol

Which medication is a prostaglandin analog?

misoprostol

Which is the most common serious complication of cholecystitis?

pancreatitis

The psoas sign can be best described as abdominal pain elicited by:

passive extension of the hip

The obturator sign can best be described as abdominal pain elicited by:

passive flexion and internal rotation of the hip

In evaluation of acute diverticulitis, the most appropriate diagnostic approach to rule out free air in the abdomen is

plain abdominal film

The most common anal fissure location is:

posterior midline of anus

A gallstone that is not visualized on XR is said to be:

radiolucent

Which is most likely to be found in a 50 yo woman with new onset reflux esophagitis?

recent initiation of estrogen-progestin hormonal therapy

Measures to prevent diverticulosis and diverticulitis include all of the following except: A. whole grain intake. B. regular aerobic exercise. C. adequate hydration. D. refraining from excessive alcohol intake.

refraining from excessive alcohol intake

Rebound tenderness is best described as abdominal pain that worsens with:

release of deep palpation at the site of the discomfort

Colonic diverticulosis most commonly occurs in the walls of the:

sigmoid

Rectal bleeding associated with hemorrhoids is usually described as:

streaks of bright red blood on stool

You see a 72 yo woman with vomiting and abdominal cramping occurring over the past 24 hours. You consider that:

the presentation can differ according to the anatomical location of the appendix

To avoid diverticulitis treatment of diverticulosis includes: A. avoiding foods with seeds. B. the use of fiber supplements. C. ceasing cigarette smoking. D. limiting alcohol intake.

the use of fiber supplements

A 56 yo man with a 60 pack year cigarette smoking history, recent 5 lb unintended weight loss, and a 3 month history of new onset symptoms of peptic ulcer disease presents for care. He is taking no medications on a regular basis and drinks 6 12 oz beers per week with no more than 3 per day. PE is unremarkable except for mild pharyngeal erythema and moderate epigastric tenderness without rebound. The most helpful diagnostic test at this point is a:

upper endoscopy

Long term, recurrent high dose oral use of mineral oil can lead to deficiency in:

vitamin A

Which is most likely to be found in a person with acute cholecystitis?

vomiting

Abdominal palpation that yields rebound tenderness is also known as:

Blumberg's sign

Which of the following describes diverticulosis?

Bulging pockets in the intestinal wall

A 62 yo woman who reports frequent constipation is diagnosed with an anal fissure. First line therapy includes all of the following except: A. stool bulking supplements B. high fiber diet C. intraanal corticosteroids D. periodic use of mineral oil

C

Olive has an acute exacerbation of Crohn's disease. Which lab test values would you expect to be decreased? A. ESR B. LFT C. Vitamin A, B complex, and C levels D. Bilirubin

C

The proper order of assessment of the abdomen is: A. palpation, percussion, auscultation, inspection B. inspection, palpation, auscultation, percussion C. inspection, auscultation, percussion, palpation D. percussion, auscultation, inspection, palpation

C

Which of the following is the most likely patient report with anal fissure? A. I have anal pain that is relieved with having a BM B. Even after a BM, I feel like I still need to go more C. I have anal pain for up to 1-2 hours after a BM D. I itch down there almost all the time

C

Which of the following patients should be evaluated for possible surgical intervention for hemorrhoids? A. a 28-year-old woman with symptomatic external hemorrhoids who gave birth 6 days ago B. a 48-year-old man with Grade II internal hemorrhoids and improvement with standard medical therapy C. a 44-year-old woman who has internal and external hemorrhoids with recurrent prolapse D. a 58-year-old man who has Grade I internal hemorrhoids and improvement with psyllium supplements

C

Which of the following treatments for UC is contraindicated? A. A high calorie, nonspicy, caffeine free diet that is low in high residue foods and milk products B. Corticosteroids in the acute phase C. Antidiarrheal agents D. Colectomy with permanent ileostomy in severe cases

C

You suspect Harry has a peptic ulcer and tell him that it has been found to be strongly associated with: A. anxiety and panic attacks B. long term NSAID use C. infection with H. pylori D. a family history of peptic ulcer

C

A 48 yo man with obesity and a 1 year history of classic GERD symptoms has been on the consistent use of a therapeutic dose of a PPI for the past 6 months. He states he is really no better with the medication and I have cut out most of the food that bother me. I even cut out all alcohol and soda. PE reveals stable weight, mildly erythematous pharynx, and epigastric tenderness without rebound. Next step options include:

Barium swallow

An 18 yo man presents with periumbilical pain, vomiting, and abdominal cramping over the past 48 hours. PE reveals rebound tenderness, and las show bandemia and leukocytosis. To support appendicitis with rupture diagnosis you consider which abdominal imaging study:

CT scan

You are seeing Mr. Lopez, a 68 yo man with suspected diverticulitis. In choosing an appropriate imaging study to support this diagnosis, which study is most appropriate?

CT scan with contrast

Rectal bleeding associated with anal fissure is usually described by the patient as:

drops of blood noticed when wiping

Which of the following findings would you expect to encounter in a 33 yo man with appendiceal abscess?

dullness to percussion in RLQ

A 24 yo man presents with a 3 month history of upper abdominal pain. He describes it as an intermittent, centrally located burning feeling in his upper abdomen, most often occurring 2-3 hours after meals. His presentation is most consistent with:

duodenal ulcer

Which of the following is usually not seen in the diagnosis of acute cholecystitis? A. elevated serum creatinine B. increased alkaline phosphatase level C. leukocytosis D. elevated aspartate aminotransferase (AST) level

elevated serum creatinine

To avoid rebound gastric hyperacidity following discontinuation of long term PPI use, all of the following methods can be used except: A. gradually tapering the PPI dose with supplemental antacid. B. switch to every-other-day dosing of PPI with supplemental antacid. C. switch to a low-dose H2RA therapy with supplemental antacid. D. empiric H. pylori therapy.

empiric H. pylori therapy

You see a 62 yo man diagnosed with esophageal columnar epithelial metaplasia. You realize he is at increased risk for:

esophageal adenocarcinoma

Which is most consistent with the presentation of colonic diverticulosis?

few or no symptoms

Which is most likely to be noted in a person with colorectal cancer?

few symptoms

A 64 yo woman presents with a 3 month history of upper abdominal pain. She describes the discomfort as an intermittent, centrally located "burning" feeling in the upper abdomen, most often with meals and often accompanied by mild nausea. Use of OTC H2 blockers affords partial symptom relief. She also uses diclofenac on a regular basis for the control of OA. Her presentation is most consistent with:

gastric ulcer

An ulcer that is noted to be located in the region below the lower esophageal sphincter and before the pylorus is usually referred to as:

gastric ulcer

You see a 48 yo woman who has been taking a COX-2 for the past 3 years. In counseling her, you mention that long term use of COX-2 inhibitors is associated with all of the following except: A. hepatic dysfunction. B. gastropathy. C. cardiovascular events. D. cerebrovascular events.

hepatic dysfunction