Gastrointestinal Board Review for PANCE

A patient presents with epigastric pain described as boring and radiating to the back. It is relieved with leaning forward. What organ is most likely involved?

• Gallbladder

• Pancreas

• Distal small bowel

• Duodenum

A 24-year-old patient has a 3-year history of GERD symptoms. He has failed multiple pharmacologic treatment regiments, including H2 blockers, PPIs and metoclopramide. What is the next best step?

• 24-hour pH probe

• barium esophagography

• esophagectomy

• upper endoscopy

A 51-year-old female presents with a 2-day history of colicky RUQ pain as well as nausea and bloating. Examination reveals temperature of 100.4 F and significant pain upon palpation of the RUQ. Laboratory findings include elevated WBC and mild bilirubinemia. What is the most likely diagnosis?

• acute cholecystitis

• acute pancreatitis

• duodenal ulcer

• viral gastroenteritis

A 14-year-old female presents to the ED with acute abdominal pain which began diffusely and has settled in the RLQ. Examination reveals tenderness, rigidity and rebound. Which of the following diagnostic tests would provide the highest accuracy rate for the most likely diagnosis?

• abdominal ultrasonography

• CBC with differential

• CT of abdomen

• Plain films of abdomen

A 16-year-old presents with abdominal pain that began periumbilical and has localized to the RLQ. She is nauseous and has no appetite. What is the most likely precipitant of this event?

• fecalith

• neoplastic hyperplasia

• growth of intestinal polyp

• viral infection

A previously healthy 37-year-old businessman complains of a 1 week history of fever and abdominal pain. Further questioning reveals a prodrome of decreased appetite, nausea and vomiting and general malaise. He denies diarrhea. He took a vacation to Mexico 5 weeks ago and a business trip to the US West Coast 2 weeks ago. He also ate at a new steak and seafood restaurant in town last week. Examination reveals a flat abdomen, normoactive bowel sounds, RUQ tenderness and negative Murphy sign. What is the most likely diagnosis?

• enterotoxigenic E. coli

• giardiasis

• hepatitis A

• salmonellosis

A 62-year-old female presents to he ED profoundly dehydrated after several bouts of watery diarrhea. She describes the diarrhea as “rice water” in color. She believes the shellfish she ate yesterday was improperly cooked. The diarrhea and dehydration associated with this disease are primarily the result of which of the following?

• An endotoxin component of the pathogen’s cell wall

• An enterotoxin actively secreted by the pathogen

• Direct destruction of the GI tissue by the pathogen

• The immune response of the body in eliminating the pathogen

In the newborn, failure to pass meconium is a common sign of Hirschsprung disease. Meconium should be passed within what time after birth?

• 12-18 hours

• 24-48 hours

• 72 hours

• 1 week

A 63-year-old male who smokes complains of insidious onset of vague epigastric pain over the past several months. He also complains of anorexia, diarrhea, malaise, and difficulty sleeping. Labs reveal hyperglycemia and elevated lipase. What is the most likely description of the pain?

• crampy quality after eating

• relief with sitting and leaning forward

• radiation to the left shoulder

• referral to the right lower quadrant

A patient is brought into the ED appearing quite ill. He has a fever of 103.2, dry skin and oral mucosal membranes, and abdominal distention and tenderness. His medical history is significant for ulcerative colitis. Given his history and physical exam findings, which of the following would be highest on the differential diagnosis?

• ileitis

• mesenteric ischemia

• small bowel obstruction

• toxic megacolon