Rosh GI UPDATED ACTUAL Questions and CORRECT Answers
1. A 19-year-old Asian man presents with compl1aints of IgA endomysial antibody
diarrhea, flatulence, and bloating that occur everyday test
after breakfast. His breakfast is usually fruit with cot-
tage cheese and a glass of milk. He denies weight loss,
constipation, steatorrhea, bloody stools, or tenesmus.
Which of the following tests will most likely diagnose
his condition?
A. Colonoscopy
B. Hydrogen breath test
C. IgA endomysial antibody test
D. Qualitative fecal fat assay
2. A 43-year-old man comes to the clinic complaining of Esophageal adenocarci-
a 3-week history of a "burning" sensation in his chest noma
and nocturnal cough. He says he wakes up several
times at night coughing and wheezing. He weighs
350-lbs and has a BMI of 48. If this patient's condition
is left untreated, which of the following complications
can most likely develop?
A. Esophageal adenocarcinoma
B. Hepatocellular carcinoma
C. Small cell carcinoma of the lung
D. Squamous cell carcinoma of the esophagus
3. A 55-year-old man with a past medical history of hy- Discharge home with oral
pertension presents to the emergency department antibiotics
with two days of left lower quadrant pain and a fever
of 38.2°C at home. He denies nausea or vomiting and
has been able to tolerate oral intake at home. He
endorses some intermittent painless hematochezia
over the last year but states that he has never had a
colonoscopy. His vitals are HR 89 beats per minute, RR
, 16, and BP 142/90. His abdominal exam is significant
for moderate tenderness to palpation of the left lower
quadrant without rebound or rigidity. His CBC shows a
white blood cell count of 12,000. A CT scan confirms di-
verticulitis without perforation or abscess formation.
Which of the following is the most appropriate next
step in the management of this patient's diverticuli-
tis?
A. Admit for inpatient intravenous antibiotics
B. Discharge home with oral antibiotics
C. Surgery consult for colon resection
D. Urgent colonoscopy to rule out colon cancer
4. Which of the following findings is classically associat- Metabolic alkalosis
ed with pyloric stenosis?
A. Bilious vomiting
B. Elevated lipase
C. Metabolic alkalosis
D. Poor feeding
5. Which of the following is the recommended treatment Esophageal dilation
of benign esophageal stricture disease?
A. Esophageal dilation
B. Esophogram
C. H2 blockers
D. Radiation treatment
6. Which one of the following tests can be used to con- Hydrogen breath test
firm lactose intolerance?
A. Anti-gliadin antibodies
B. Hydrogen breath test
, C. Sweat test
D. Urea breath test
7. A 43-year-old woman presents with episodic epigas- Order a right upper
tric pain that frequently follows a fatty meal and can quadrant abdominal ul-
last anywhere from 15 minutes to approximately two trasound
hours. At times the pain radiates toward her right
shoulder. She has associated nausea without vomit-
ing. Which of the following is the most appropriate
next step in managing this patient?
A. Obtain serum amylase and lipase levels
B. Order a contrast-enhanced computed tomography
scan
C. Order a right upper quadrant abdominal ultra-
sound
D. Prescribe oral omeprazole
8. A young woman complains of daily diarrhea without Endoscopic band ligation
abdominal pain. She brings in a sample that appears
to contain much more fat than water. She has a family
history of diarrhea. She denies any recent antibiotic
therapy. Her vital signs are within normal limits and
her physical exam is unremarkable. Laboratory test-
ing reveals iron deficiency anemia, an elevated stool
osmotic gap, and positive anti-endomysial antibodies.
Which of the following is the most likely diagnosis?
A. Bile acid deficiency
B. Celiac disease
C. Clostridium difficile infection
D. Irritable bowel syndrome
A patient with alcohol abuse and cirrhosis presents
, with acute upper gastrointestinal bleeding, hypoten-
sion, and tachycardia. His past medical history also
includes portal hypertension. In addition to cardiopul-
monary stabilization and blood transfusion, which of
the following is the most appropriate emergent inter-
ventional treatment?
A. Distal splenorenal shunt
B. Endoscopic band ligation
C. Large volume paracentesis
D. Transjugular intrahepatic portosystemic shunt
9. A 46-year-old obese man presents to the clinic com- Scleroderma
plaining of recurrent heartburn. He reports compli-
ance with optimal medical management and dietary
modifications and has been unsuccessful at losing
weight. Which of the following is a contraindication to
surgical intervention and should be ruled out before
proceeding?
A. Benign esophageal strictures
B. Gastroparesis
C. Hiatal hernia
D. Scleroderma
10. A 43-year-old woman presents to the ED with abdom- Clarithromycin 500 mg
inal pain. She reports that the pain is epigastric and bid, amoxicillin 1 g bid,
worse with food. She denies any fevers, chills, vomit- lansoprazole 30 mg bid
ing, or diarrhea. She recently visited a gastroenterol- for 10-14 days
ogist who told her she had a bacterial infection in her
stomach. However, she did not follow up or receive
treatment. On exam, her abdomen is soft and non-
tender. Which of the following is the most appropriate
treatment regimen for this patient's condition?
1. A 19-year-old Asian man presents with compl1aints of IgA endomysial antibody
diarrhea, flatulence, and bloating that occur everyday test
after breakfast. His breakfast is usually fruit with cot-
tage cheese and a glass of milk. He denies weight loss,
constipation, steatorrhea, bloody stools, or tenesmus.
Which of the following tests will most likely diagnose
his condition?
A. Colonoscopy
B. Hydrogen breath test
C. IgA endomysial antibody test
D. Qualitative fecal fat assay
2. A 43-year-old man comes to the clinic complaining of Esophageal adenocarci-
a 3-week history of a "burning" sensation in his chest noma
and nocturnal cough. He says he wakes up several
times at night coughing and wheezing. He weighs
350-lbs and has a BMI of 48. If this patient's condition
is left untreated, which of the following complications
can most likely develop?
A. Esophageal adenocarcinoma
B. Hepatocellular carcinoma
C. Small cell carcinoma of the lung
D. Squamous cell carcinoma of the esophagus
3. A 55-year-old man with a past medical history of hy- Discharge home with oral
pertension presents to the emergency department antibiotics
with two days of left lower quadrant pain and a fever
of 38.2°C at home. He denies nausea or vomiting and
has been able to tolerate oral intake at home. He
endorses some intermittent painless hematochezia
over the last year but states that he has never had a
colonoscopy. His vitals are HR 89 beats per minute, RR
, 16, and BP 142/90. His abdominal exam is significant
for moderate tenderness to palpation of the left lower
quadrant without rebound or rigidity. His CBC shows a
white blood cell count of 12,000. A CT scan confirms di-
verticulitis without perforation or abscess formation.
Which of the following is the most appropriate next
step in the management of this patient's diverticuli-
tis?
A. Admit for inpatient intravenous antibiotics
B. Discharge home with oral antibiotics
C. Surgery consult for colon resection
D. Urgent colonoscopy to rule out colon cancer
4. Which of the following findings is classically associat- Metabolic alkalosis
ed with pyloric stenosis?
A. Bilious vomiting
B. Elevated lipase
C. Metabolic alkalosis
D. Poor feeding
5. Which of the following is the recommended treatment Esophageal dilation
of benign esophageal stricture disease?
A. Esophageal dilation
B. Esophogram
C. H2 blockers
D. Radiation treatment
6. Which one of the following tests can be used to con- Hydrogen breath test
firm lactose intolerance?
A. Anti-gliadin antibodies
B. Hydrogen breath test
, C. Sweat test
D. Urea breath test
7. A 43-year-old woman presents with episodic epigas- Order a right upper
tric pain that frequently follows a fatty meal and can quadrant abdominal ul-
last anywhere from 15 minutes to approximately two trasound
hours. At times the pain radiates toward her right
shoulder. She has associated nausea without vomit-
ing. Which of the following is the most appropriate
next step in managing this patient?
A. Obtain serum amylase and lipase levels
B. Order a contrast-enhanced computed tomography
scan
C. Order a right upper quadrant abdominal ultra-
sound
D. Prescribe oral omeprazole
8. A young woman complains of daily diarrhea without Endoscopic band ligation
abdominal pain. She brings in a sample that appears
to contain much more fat than water. She has a family
history of diarrhea. She denies any recent antibiotic
therapy. Her vital signs are within normal limits and
her physical exam is unremarkable. Laboratory test-
ing reveals iron deficiency anemia, an elevated stool
osmotic gap, and positive anti-endomysial antibodies.
Which of the following is the most likely diagnosis?
A. Bile acid deficiency
B. Celiac disease
C. Clostridium difficile infection
D. Irritable bowel syndrome
A patient with alcohol abuse and cirrhosis presents
, with acute upper gastrointestinal bleeding, hypoten-
sion, and tachycardia. His past medical history also
includes portal hypertension. In addition to cardiopul-
monary stabilization and blood transfusion, which of
the following is the most appropriate emergent inter-
ventional treatment?
A. Distal splenorenal shunt
B. Endoscopic band ligation
C. Large volume paracentesis
D. Transjugular intrahepatic portosystemic shunt
9. A 46-year-old obese man presents to the clinic com- Scleroderma
plaining of recurrent heartburn. He reports compli-
ance with optimal medical management and dietary
modifications and has been unsuccessful at losing
weight. Which of the following is a contraindication to
surgical intervention and should be ruled out before
proceeding?
A. Benign esophageal strictures
B. Gastroparesis
C. Hiatal hernia
D. Scleroderma
10. A 43-year-old woman presents to the ED with abdom- Clarithromycin 500 mg
inal pain. She reports that the pain is epigastric and bid, amoxicillin 1 g bid,
worse with food. She denies any fevers, chills, vomit- lansoprazole 30 mg bid
ing, or diarrhea. She recently visited a gastroenterol- for 10-14 days
ogist who told her she had a bacterial infection in her
stomach. However, she did not follow up or receive
treatment. On exam, her abdomen is soft and non-
tender. Which of the following is the most appropriate
treatment regimen for this patient's condition?
