Pance Gastroenterology Exam
Final Test Review
(Questions & Solutions)
2025
1
, 1. Diseases of the Esophagus (6 questions)
Q1
A 42-year-old man with chronic GERD undergoes surveillance EGD.
Biopsy from the distal esophagus shows intestinal metaplasia with low-
grade dysplasia. Which strategy is currently preferred?
A. Repeat EGD in 6 months with biopsies
B. Initiate high-dose PPI and repeat EGD in 1 year
C. Endoscopic radiofrequency ablation now
D. Esophagectomy
ANS: C
Rationale: Low-grade dysplastic Barrett’s carries ~1 %/yr cancer risk;
ablation eradicates dysplasia and lowers progression, whereas watchful
waiting is no longer standard.
---
Q2
A 70-year-old with progressive solid-food dysphagia has a barium
swallow showing birds-beak tapering. High-resolution manometry
demonstrates panesophageal pressurization and impaired LES relaxation.
First-line definitive therapy?
A. Laparoscopic Heller myotomy with partial fundoplication
B. Chronic nitrates and CCBs
C. Botox injection every 6 months
D. Esophageal stent placement
ANS: A
Rationale: Type II achalasia (best surgical outcome) is treated with
myotomy; pharmacologic or Botox options are temporizing.
---
2
, Q3
A patient with long-standing scleroderma reports nocturnal choking and
chronic cough. 24-hour pH-impedance monitoring shows >80 acid
episodes with near-absent peristalsis on manometry. Best empiric
intervention to reduce aspiration?
A. Doubling PPI dose and adding bedtime H2 blocker
B. Fundoplication
C. Total parenteral nutrition
D. Continuous nighttime nasojejunal tube feeding
ANS: A
Rationale: Severe reflux from hypotensive LES/peristalsis is managed
medically; fundoplication fails when motility is absent.
---
Q4
Which of the following endoscopic findings predicts poor response of
eosinophilic esophagitis to swallowed topical steroids?
A. Concentric rings (“trachealization”)
B. Linear furrows
C. White exudates/plaques
D. Fixed fibrostenotic stricture
ANS: D
Rationale: Established strictures represent end-stage fibrosis and often
need mechanical dilation; inflammatory changes respond to steroids.
---
Q5
A 58-year-old woman develops odynophagia after 10 days of doxycycline
for acne. Ulcerations are localized mid-esophagus on EGD. Most
important educational point to prevent recurrence?
3
, A. Take pills with ≥240 mL water and remain upright 30 min
B. Avoid acidic drinks with medication
C. Use enteric-coated doxycycline
D. Co-administer sucralfate
ANS: A
Rationale: Medication esophagitis is mechanical/caustic; sufficient
water and upright posture reduce mucosal contact.
---
Q6
A caustic ingestion patient has circumferential grade 2b esophageal
burns on EGD. Key step within the first 24 hours that decreases long-
term stricture formation?
A. Early nasoenteric feeding past the lesion
B. High-dose IV corticosteroids
C. Prophylactic broad-spectrum antibiotics
D. Immediate balloon dilation
ANS: A
Rationale: Early enteral nutrition preserves luminal caliber and
supports healing; steroids/antibiotics lack proven benefit, dilation is
delayed until maturation.
---
2. Disorders of the Stomach (5 questions)
Q7
A 59-year-old NSAID user presents with epigastric pain. EGD shows a 1-
cm clean-based duodenal ulcer. He is H. pylori positive. What triple
therapy is currently recommended given 20 % regional clarithromycin
resistance?
A. PPI + clarithromycin + amoxicillin 14 days
4
Final Test Review
(Questions & Solutions)
2025
1
, 1. Diseases of the Esophagus (6 questions)
Q1
A 42-year-old man with chronic GERD undergoes surveillance EGD.
Biopsy from the distal esophagus shows intestinal metaplasia with low-
grade dysplasia. Which strategy is currently preferred?
A. Repeat EGD in 6 months with biopsies
B. Initiate high-dose PPI and repeat EGD in 1 year
C. Endoscopic radiofrequency ablation now
D. Esophagectomy
ANS: C
Rationale: Low-grade dysplastic Barrett’s carries ~1 %/yr cancer risk;
ablation eradicates dysplasia and lowers progression, whereas watchful
waiting is no longer standard.
---
Q2
A 70-year-old with progressive solid-food dysphagia has a barium
swallow showing birds-beak tapering. High-resolution manometry
demonstrates panesophageal pressurization and impaired LES relaxation.
First-line definitive therapy?
A. Laparoscopic Heller myotomy with partial fundoplication
B. Chronic nitrates and CCBs
C. Botox injection every 6 months
D. Esophageal stent placement
ANS: A
Rationale: Type II achalasia (best surgical outcome) is treated with
myotomy; pharmacologic or Botox options are temporizing.
---
2
, Q3
A patient with long-standing scleroderma reports nocturnal choking and
chronic cough. 24-hour pH-impedance monitoring shows >80 acid
episodes with near-absent peristalsis on manometry. Best empiric
intervention to reduce aspiration?
A. Doubling PPI dose and adding bedtime H2 blocker
B. Fundoplication
C. Total parenteral nutrition
D. Continuous nighttime nasojejunal tube feeding
ANS: A
Rationale: Severe reflux from hypotensive LES/peristalsis is managed
medically; fundoplication fails when motility is absent.
---
Q4
Which of the following endoscopic findings predicts poor response of
eosinophilic esophagitis to swallowed topical steroids?
A. Concentric rings (“trachealization”)
B. Linear furrows
C. White exudates/plaques
D. Fixed fibrostenotic stricture
ANS: D
Rationale: Established strictures represent end-stage fibrosis and often
need mechanical dilation; inflammatory changes respond to steroids.
---
Q5
A 58-year-old woman develops odynophagia after 10 days of doxycycline
for acne. Ulcerations are localized mid-esophagus on EGD. Most
important educational point to prevent recurrence?
3
, A. Take pills with ≥240 mL water and remain upright 30 min
B. Avoid acidic drinks with medication
C. Use enteric-coated doxycycline
D. Co-administer sucralfate
ANS: A
Rationale: Medication esophagitis is mechanical/caustic; sufficient
water and upright posture reduce mucosal contact.
---
Q6
A caustic ingestion patient has circumferential grade 2b esophageal
burns on EGD. Key step within the first 24 hours that decreases long-
term stricture formation?
A. Early nasoenteric feeding past the lesion
B. High-dose IV corticosteroids
C. Prophylactic broad-spectrum antibiotics
D. Immediate balloon dilation
ANS: A
Rationale: Early enteral nutrition preserves luminal caliber and
supports healing; steroids/antibiotics lack proven benefit, dilation is
delayed until maturation.
---
2. Disorders of the Stomach (5 questions)
Q7
A 59-year-old NSAID user presents with epigastric pain. EGD shows a 1-
cm clean-based duodenal ulcer. He is H. pylori positive. What triple
therapy is currently recommended given 20 % regional clarithromycin
resistance?
A. PPI + clarithromycin + amoxicillin 14 days
4
