Gastroenterology Practice Questions

Question 1

A 54-year-old man presents to the clinic for epigastric discomfort during the previous month. He states he has not vomited, but reports of having epigastric pain that worsens after most meals. The patient states that his stool “looks black sometimes.” The patient does not report of any weight loss. He has a past medical history of gastroesophageal reflux disease, diabetes mellitus, peptic ulcer disease, and Crohn’s disease. The patient takes over-the-counter ranitidine, and holds prescriptions for metformin and infliximab. The blood pressure is 132/84 mm Hg, the heart rate is 64/min, the respiratory rate is 14/min, and the temperature is 37.3°C (99.1°F). On physical examination, the abdomen is tender to palpation in the epigastric region. Which of the following is the most appropriate next step to accurately determine the diagnosis of this patient?

Accepted Answer

Endoscopy with biopsy

Answer

Treat with PPI, clarithromycin, and amoxicillin before doing lab and imaging tests

Answer

Urea breath testing

Answer

Serology for Helicobacter pylori

Answer

CT abdomen

Question 2

A 45-year-old male presents to his primary care doctor complaining of abdominal pain. He reports a three-month history of intermittent burning pain localized to the epigastrium that worsens 2-3 hours after a meal. He attributes this pain to increased stress at his job. He is otherwise healthy and takes no medications. He does not smoke or drink alcohol. His temperature is 98.8°F (37.1°C), blood pressure is 130/85 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination reveals mild epigastric tenderness to palpation. A urease breath test is positive. Which of the following treatments is most appropriate first-line therapy for this patient?

Accepted Answer

Amoxicillin, clarithromycin, and omeprazole

Answer

Octreotide

Answer

Sulfasalazine

Answer

Tetracycline, omeprazole, bismuth, and metronidazole

Answer

Pantoprazole

Question 3

A 45-year-old man comes to the emergency department because of a 1-day history of black, tarry stools. He has also had upper abdominal pain that occurs immediately after eating and a 4.4-kg (9.7-lb) weight loss in the past 6 months. He has no history of major medical illness but drinks 3 beers daily. His only medication is acetaminophen. He is a financial consultant and travels often for work. Physical examination shows pallor and mild epigastric pain. Esophagogastroduodenoscopy shows a bleeding 15-mm ulcer in the antrum of the stomach. Which of the following is the strongest predisposing factor for this patient's condition?

Accepted Answer

Helicobacter pylori infection

Answer

Alcohol consumption

Answer

Age above 40 years

Answer

Acetaminophen use

Answer

Work-related stress

Question 4

A family doctor in a rural area is treating a patient for dyspepsia. The patient had chronic heartburn and abdominal pain for the last 2 months and peptic ulcer disease due to a suspected H. pylori infection. For reasons relating to affordability and accessibility, the doctor decides to perform a diagnostic test in the office that is less invasive and more convenient. Which of the following is the most likely test used?

Accepted Answer

Stool antigen test

Answer

Steiner's stain

Answer

Culture of organisms from gastric specimen

Answer

Detection of the breakdown products of urea in biopsy

Answer

Serology (ELISA testing)

Question 5

A 52-year-old man comes to the physician because of a 3-month history of upper abdominal pain and nausea that occurs about 3 hours after eating and at night. These symptoms improve with eating. After eating, he often has a feeling of fullness and bloating. He has had several episodes of dark stools over the past month. He has smoked one pack of cigarettes daily for 40 years and drinks 2 alcoholic beverages daily. He takes no medications. His temperature is 36.4°C (97.5°F), pulse is 80/min, and blood pressure is 110/70 mm Hg. Abdominal examination shows epigastric tenderness with no guarding or rebound. Bowel sounds are normal. Which of the following treatments is most appropriate to prevent further complications of the disease in this patient?

Accepted Answer

Amoxicillin, clarithromycin, and omeprazole

Answer

Intravenous vitamin B12 supplementation

Answer

Truncal vagotomy

Answer

Fundoplication, hiatoplasty, and gastropexy

Answer

Distal gastrectomy with gastroduodenostomy

Question 6

A previously healthy 37-year-old man comes to the physician for the evaluation of an 8-week history of intermittent burning epigastric pain. During this period, he has also felt bloated and uncomfortable after meals. He has not had weight loss or a change in bowel habits. He has no personal or family history of serious illness. He takes no medications. He does not smoke. He drinks 1–3 beers per week. Vital signs are within normal limits. Abdominal examination shows mild epigastric tenderness on palpation without guarding or rebound tenderness. Bowel sounds are normal. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?

Accepted Answer

Urea breath test

Answer

Helicobacter pylori eradication therapy

Answer

Helicobacter pylori serum IgG

Answer

Upper gastrointestinal endoscopy

Answer

Proton pump inhibitors

Question 7

A 47-year-old man presents with recurrent epigastric pain and diarrhea. He has had these symptoms for the last year or so and has been to the clinic several times with similar complaints. His current dosage of omeprazole has been steadily increasing to combat his symptoms. The pain seems to be related to food intake. He describes his diarrhea as watery and unrelated to his meals. Blood pressure is 115/80 mm Hg, pulse is 76/min, and respiratory rate is 19/min. He denies tobacco or alcohol use. An upper endoscopy is performed due to his unexplained and recurrent dyspepsia and reveals thickened gastric folds with three ulcers in the first part of the duodenum, all of which are negative for H. pylori. Which of the following is the best next step in this patient's management?

Accepted Answer

Fasting serum gastrin levels

Answer

Secretin stimulation test

Answer

CT scan of the abdomen

Answer

Somatostatin receptor scintigraphy

Answer

Serum calcium levels

Question 8

A 52-year-old woman presents with mild epigastric pain and persistent heartburn for the past 2 months. An endoscopy is performed and reveals inflammation of the stomach mucosa without evidence of ulceration. A biopsy is performed and reveals intestinal metaplasia with destruction of a large number of parietal cells. She is diagnosed with chronic atrophic gastritis. Which of the following is characteristic of this patient’s diagnosis?

Accepted Answer

Destruction of the mucosa of the stomach is mediated by T cells.

Answer

Serum gastrin levels are decreased.

Answer

Caused by a gram-negative rod that is urease positive

Answer

It is the most common cause of folate deficiency in the US.

Answer

MALT lymphoma is a common complication.

Question 9

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

Accepted Answer

"Can you tell me more about the symptoms you have been experiencing?"

Answer

"Does the diarrhea typically precede the constipation, or vice-versa?"

Answer

"Is the diarrhea foul-smelling?"

Answer

"Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"

Answer

"Are the symptoms worse in the morning or at night?"

Question 10

A 55-year-old female presents to clinic with recurrent episodes of abdominal discomfort and pain for the past month. She reports that the pain occurs 2-3 hours after meals, usually at midnight, and rates it as moderate to severe in intensity when it occurs. She also complains of being fatigued all the time. Past medical history is insignificant. She is an office secretary and says that the job has been very stressful recently. Her temperature is 98.6°F (37.0°C), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Her BMI is 34. A physical examination reveals conjunctival pallor and mild tenderness over her epigastric region. Blood tests show:
Hb%: 10 gm/dL
Total count (WBC): 11,000 /mm3
Differential count:
Neutrophils: 70%
Lymphocytes: 25%
Monocytes: 5%
ESR: 10 mm/hr
Which of the following is the most likely diagnosis?

Accepted Answer

Duodenal peptic ulcer

Answer

Pancreatitis

Answer

Acute cholecystitis

Answer

Gallbladder cancer

Answer

Choledocholithiasis

Gastroenterology

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GERD and esophageal disorders

Peptic ulcer disease

Helicobacter pylori infection

Celiac disease

Irritable bowel syndrome

Diverticular disease

GI bleeding (upper and lower)

Small intestinal bacterial overgrowth

Malabsorption syndromes

Colorectal cancer screening

Functional GI disorders

Anorectal disorders

GI motility disorders

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About Gastroenterology for USMLE

Lessons in Gastroenterology

Master Gastroenterology