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?

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?

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?

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?

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?

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?

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

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?

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?

A 52-year-old obese Caucasian male with h/o chronic GERD presents with increasing dysphagia. He describes pain on swallowing and occasional regurgitation. He continues to smoke one pack of cigarettes daily, as he has for the past 30 years. He also enjoys a 4 oz glass of whiskey 3x a week. On examination his weight is down 10lbs from a visit one month ago. What is the most likely diagnosis?

What is the most common cause of obstruction of the small intestine in adults?

A 58-year-old female is brought to the ED for recurrent episodes of severe RUQ pain that lasts for hours. Ultrasonography has failed to show any abnormality on previous evaluations. She has a fever of 103.5 and appears jaundiced. She is morbidly obese at 295lbs. Which of the following would be the most appropriate step?

A 44-year-old overweight female presents with acute sharp epigastric pain 2 hours after a large meal. She vomited once. Which of the following examination findings will most likely be found on this patient?

What is the most common site of pathology in Crohn’s disease?

A patient presents after several episodes of recurrent diarrhea over the past 2 weeks. He describes one to two bulky, foul smelling stools daily, followed by several days of more frequent watery episodes, then with several days of apparent resolution. Other than mild fatigue and some mucus passed with stools, there are no other symptoms. What organism is most likely responsible?

A 25-year-old female with a history of chronic alcohol abuse presents with mild hematemesis and melena. Examination reveals a slightly overweight female with erosion of the front teeth and enlarged salivary glands. Bowel sounds are normal; abdomen is soft and nontender. What is the most likely cause of the bleeding?

Which of the following indicates viral replication and infectivity for a patient with chronic hepatitis B?

A 26-year-old male presents with four episodes of diarrhea per day, rectal bleeding, tenesmus, passage of mucus and crampy abdominal pain for 1 week. He has experienced intermittent episodes of bloody diarrhea over the past 6 months. What is the most likely diagnosis?

An 8-year-old complains of nonspecific abdominal pain, cramps, flatulence, bloating and occasional diarrhea. The symptoms seem to be related to the ingestion of dairy products. What is the next step in management?

A 13-year-old female is brought in for evaluation by her father who claims to hear the child vomiting after eating large volumes of food. The patient repeatedly denies vomiting and “feels fine.” What physical sign or symptom is most likely present in this patient?

A patient with no known risk factors for colorectal cancer should begin screening at what age?

A patient presents to the ED with constant epigastric pain for 6 hours with nausea and vomiting for 3 hours. The pain is not relieved with the vomiting. Abdomen is tender and bowel sounds are minimal. There are ecchymoses on the flanks. Which of the following lab findings would indicate the poorest prognosis?

In early intestinal obstruction, what are the characteristic initial findings on abdominal auscultation?

A 23-year-old female presents with a history of recurrent lower abdominal pain associated with alternating diarrhea and constipation for the past 4 months. Pain is temporarily relieved with defecation. She has had increased levels of stress at work, which seem to correlate with the appearance of her symptoms. She describes her symptoms as mild but is concerned about their recurring nature. She denies fever or weight loss; she has maintained normal menses. The entire abdomen is mildly tender on examination. What is the initial step in the management of this disorder?

A 41-year-old female with long-standing GERD undergoes endoscopy, which reveals orange, gastric type epithelium present in tongue-shaped lesions extending upward form the distal end of the esophagus. How often and by what method should this patient undergo screening for cancer?

Which of the following is an indication to refer an asymptomatic adolescent for colonoscopy?

Which of the following is the gold standard for diagnosing cirrhosis?

Which of the following is NOT a complication of cirrhosis?

Child’s criteria classifies:

Which of the following is a complication of Gilbert’s syndrome?

All of the following are made in the liver except:

All of the following are symptoms of chronic pancreatitis except:

The number one cause of achalasia is:

All of the following are risks for peptic ulcer disease except:

Celiac disease is diagnosed by:

What is the best screening lab test for recurrent colorectal carcinoma?

A 37 year old female presents to the surgery clinic for evaluation of chronic RUQ pain. She had a RUQ ultrasound which revealed gallstones. She undergoes an elective cholecystectomy. On histopathology, the gallbladder shows chronic inflammatory cell infiltration of the gallbladder. Which is the most appropriate diagnosis?

Which of the following is the most frequent cause of biliary obstruction in patients with acute cholangitis without bile duct stents?

Which of the following is a common etiology for spontaneous enterocutaneous fistulas?

A 61 year old male with PMH significant for tobacco use and hyperlipidemia presents to the ED with complaints of abdominal pain and diarrhea for two hours. CT abdomen and pelvis revealed segmental colitis involving the splenic flexure and the descending colon. A colonoscopy is completed with biopsies taken. Pathology shows edema, submucosal hemorrhage and necrotic areas, and an inflammatory infiltration with intravascular thrombi. Which of the following is the most likely diagnosis?

A 52 year old male presents to his primary care office with complaints of left lower quadrant pain x 2 days. He has associated fever, chills, nausea and diarrhea. Abdominal and pelvic CT scan with oral and IV contrast shows sigmoid diverticulitis. He is treated with ciprofloxacin and metronidazole. The patient returns to your office three days later with continued abdominal pain and fever. On exam, his abdomen is soft with tenderness to the left lower quadrant without rebound or guarding. Which is of the following is the most likely cause?

A 23 year old female with history of irritable bowel syndrome presents to your primary care office with complaints of anal pain for two weeks. The patient states the pain is constant, but increases with bowel movements and is associated with small amounts of hematochezia. Which of the following would you most expect to see on physical exam?

A 54 year old female who doesn’t have a primary care physician presents to your urgent care with complaints of abdominal discomfort. Upon questioning, she reveals she hasn’t had a bowel movement in 5 days. Abdominal flat plate x-ray shows constipation. What is the next best step?

A 63-year-old man with a history of alcoholism presents with fever, headache and altered mental status. What antibiotics should be administered?

Which of the following is the most common location of an aortoenteric fistula formation?

Which of the following conditions warrant inpatient treatment for acute diverticulitis?

A 3 year old boy swallowed a dime yesterday. The parents have been screening his bowel movements and haven’t seen it come out yet. They were concerned so they brought him to the emergency room. On chest and abdominal x-ray, the coin appears to be beyond the duodenal bulb. The patient is currently asymptomatic. What is the next best step?

What is the most common benign cause of large bowel obstructions?

What is the most common etiology of childhood intussusception?

A 21 day old infant is brought to the pediatrician’s office by his mom with complaints of vomiting. She states that he vomits forcefully after every feeding for the past few days. She believes he may have caught the stomach bug from his older sister who was sick last week. On exam, he appears dehydrated with a palpable mass at the lateral edge of the rectus abdominis in the right upper quadrant. What is the best definitive treatment for this condition?

A 79 year old nursing home resident is complaining of abdominal pain. On evaluation of her stool chart, you see she has not had a bowel movement in several days. She was given docusate and miralax x 1 without relief. Abdominal exam reveals a soft and non-distended abdomen with mild tenderness in the left lower quadrant. She does not have a fever. Abdominal x-ray reveals constipation. What is the next best step?

A 53 year old male presents to your office with complaints of rectal pain for 3 days. On exam, he has a large external hemorrhoid with a palpable clot. Which of the following is the best treatment?

A 57 year old, post-menopausal woman with PMH significant for osteoporosis presents to your office with complaints of odynophagia. On UGI series, she has evidence of esophagitis in her mid esophagus. What is the most likely cause?

Which of the following is an appropriate approach to primary prophylaxis of esophageal variceal hemorrhage?

In patients with dysphagia and noncardiac chest pain, which of the following should be completed after a normal esophagogastroduodenoscopy (EGD) for further evaluation?

A 34 year old female presents to your GI office with complaints of epigastric pain and nausea x 1 month. She underwent an upper endoscopy which showed acute gastritis. Biopsy urease testing resulted in color change. What is the most likely diagnosis?