Gastrointestinal (GI) Exam 1 Practice Questions, Health Sciences Program, Academic Year 2026
– Study Guide and Review Material
A 50 year old female presents to the clinic complaining of heartburn, regurgitation, and
frequent belching for the past three months. You prescribe an empirical trial of esomeprazole
for 4 weeks, which alleviates her symptoms. Which of the following is not a likely
pathophysiologic cause of this patient's conditions?
A. Defective esophageal clearance of food
B. Hiatal hernia
C. Transient relaxation of the lower esophageal sphincter
D. Increased acid production
E. Increased abdominal pressure - ANS✔✔ D. Increased acid production
Increased acid production is a very unlikely cause of GERD (Zollinger-Ellison syndrome is very
rare)
A 70 year old male presents to the clinic complaining of 2 days of severe, steady mid abdominal
pain that radiates to his left back. He mentions that the pain is slightly alleviated when leaning
forward, and confirms a history of chronic alcohol use. Past medical history is significant for
hypertension, and the patient is currently prescribed lisinopril. Which of the following is not a
likely cause of this patient's most likely condition?
A. Hypocalcemia
B. Alcohol use
C. Lisinopril medication
D. Idiopathic
E. Gallstones - ANS✔✔ A. Hypocalcemia
,HYPERcalcemia is a possible etiology of acute pancreatitis, not HYPOcalcemia
A 75 year old male presents to the clinic complaining of yellowing of his eyes and face. Past
medical history is significant for T2DM and alcoholism. On a physical exam, there is obvious
scleral icterus and jaundice of the skin, but no pain to palpation of the abdomen. These findings
are indicative of what condition until proven otherwise?
A. Stomach cancer
B. Zollinger-Ellison syndrome
C. Pancreatic cancer
D. Acute pancreatitis
E. Cholelithiasis - ANS✔✔ C. Pancreatic cancer
Painless jaundice in an adult is pathognomonic for pancreatic cancer
57M presents with a history of alcoholism and gallstones presents with steady upper abd pain
radiating to their back, present for the past 2 days that is relieved by leaning forward and worse
with movement. You are suspicious of a certain diagnosis and draw labs to confirm. Which of
the following lab findings would be most consistent with your diagnosis?
A. Elevated amylase 2x ULN, decreased HCT and BUN:Cr, hyponatremia, hyperglycemia
B. Elevated lipase 3x ULN, elevated HCT and BUN:Cr, hyperglycemia, hypocalcemia
C. Elevated Alk phos, CA19-9, amylase/lipase, T/D Bili and decreased Hgb/Hct
D. Gastric pH <2.0(normal is ~3.0), serum gastrin >1000pg/mL - ANS✔✔ B. Elevated lipase 3x
ULN, elevated HCT and BUN:Cr, hyperglycemia, hypocalcemia
Answer choice B is the only correct lab findings for acute pancreatitis, which is suspected in the
question stem due to the history of alcoholism and gallstones(80% of the etiology for acute
,panc), as well as the clinical presentation(steady upper abd pain radiating to their back, present
for the past 2 days, relieved by leaning forward, worse with movement).
Elevated amylase 2x ULN, decreased HCT and BUN:Cr, hyponatremia, hyperglycemia
Incorrect because these labs are just off from the correct findings seen in B
Elevated Alk phos, CA19-9, amylase/lipase, T/D Bili and decreased Hgb/Hct
These findings represent pancreatic malignancy, which is not indicated here
Gastric pH <2.0(normal is ~3.0), serum gastrin >1000pg/mL
These findings represent Zollinger Ellison syndrome, which is not indicated here
47 overweight male with presents complaining of right sided abdominal pain for the past week,
which he states is worse after meals. He likes to eat out at restaurants often because his wife
"doesn't know how to cook a damn steak." He has a history of HTN and hyperlipidemia which
he takes rosuvastatin and lisinopril for. Vital signs are 138/86, RR 16, HR 84 BPM, and temp:
101.2. Upon physical exam, he is noted to have a positive Murphy's sign. What is the best test
you can order to confirm your suspected diagnosis, and what will it show? (pt 1 of 2)
A. Abdominal XR: gallstones blocking the common bile duct
B. Abdominal CT: thick walled, inflamed gallbladder
C. Abdominal US: shadowing extending from the gallbladder, indicating the presence of
gallstones
D. Abdominal CT: shadowing extending from the gallbladder, indicating the presence of
gallstones - ANS✔✔ C. Abdominal US: shadowing extending from the gallbladder, indicating the
presence of gallstones.
, The patient has a positive murphys sign, indicating acute cholecystitis. Acute cholecystitis is
commonly due to gallstones, therefore your 1st line imaging should be an abdominal US, in
which you'd see shadowing coming from the stones! The rest of the answer choices I honestly
made up but: gallstones can block the cystic duct, NOT the common bile duct. The thick
walled/inflamed thing I just pulled out of my ass hehe. CT wont show shadowing (or stones,
unless they're calcified), so that one is wrong. Takeaway is that murphys sign + fever + RUQ pain
after meals should make you think cholecystitis due to cholelithiasis and the imaging of choice
for this is abd US to show the stones.
Your imaging was negative for the suspected diagnosis, but you are still suspicious... What is
your next best step? (pt 2 of 2)
A. Treat empirically with IV cipro + metronidazole
B. Order a HIDA scan to assess for gallbladder filling
C. Admit and administer IV fluids
D. Order an EGD to assess for cystic duct obstruction - ANS✔✔ B. Order a HIDA scan to assess
for gallbladder filling
Aw shit, what do you do now? Well, good thing you got your trusty HIDA scan which is
DIAGNOSTIC bc it will show no gallbladder filling, aka a blockage of the cystic duct (gallstones
commonly cause this). You would not just treat empirically with abx bc you dont know whats
going on yet. Admit for IV fluids is cool and all but vague af, come on guys we can do better than
that. The EGD thing I made up but I don't think an EGD can just casually go into the gallbladder?
(pls shun me if I am wrong tho)
41F presents to the ED with epigastric pain and fever x 4 days. She rates it as a 6/10 and states
she has been very nauseated as well and has vomited twice. Only current medication is her
progesterone-estradiol OCP. On physical exam she has RUQ/epigastric tenderness to light and
deep palpation, as well as involuntary guarding. Abdominal US shows shadowing extending
from round white spots within the gallbladder. How do you treat?
– Study Guide and Review Material
A 50 year old female presents to the clinic complaining of heartburn, regurgitation, and
frequent belching for the past three months. You prescribe an empirical trial of esomeprazole
for 4 weeks, which alleviates her symptoms. Which of the following is not a likely
pathophysiologic cause of this patient's conditions?
A. Defective esophageal clearance of food
B. Hiatal hernia
C. Transient relaxation of the lower esophageal sphincter
D. Increased acid production
E. Increased abdominal pressure - ANS✔✔ D. Increased acid production
Increased acid production is a very unlikely cause of GERD (Zollinger-Ellison syndrome is very
rare)
A 70 year old male presents to the clinic complaining of 2 days of severe, steady mid abdominal
pain that radiates to his left back. He mentions that the pain is slightly alleviated when leaning
forward, and confirms a history of chronic alcohol use. Past medical history is significant for
hypertension, and the patient is currently prescribed lisinopril. Which of the following is not a
likely cause of this patient's most likely condition?
A. Hypocalcemia
B. Alcohol use
C. Lisinopril medication
D. Idiopathic
E. Gallstones - ANS✔✔ A. Hypocalcemia
,HYPERcalcemia is a possible etiology of acute pancreatitis, not HYPOcalcemia
A 75 year old male presents to the clinic complaining of yellowing of his eyes and face. Past
medical history is significant for T2DM and alcoholism. On a physical exam, there is obvious
scleral icterus and jaundice of the skin, but no pain to palpation of the abdomen. These findings
are indicative of what condition until proven otherwise?
A. Stomach cancer
B. Zollinger-Ellison syndrome
C. Pancreatic cancer
D. Acute pancreatitis
E. Cholelithiasis - ANS✔✔ C. Pancreatic cancer
Painless jaundice in an adult is pathognomonic for pancreatic cancer
57M presents with a history of alcoholism and gallstones presents with steady upper abd pain
radiating to their back, present for the past 2 days that is relieved by leaning forward and worse
with movement. You are suspicious of a certain diagnosis and draw labs to confirm. Which of
the following lab findings would be most consistent with your diagnosis?
A. Elevated amylase 2x ULN, decreased HCT and BUN:Cr, hyponatremia, hyperglycemia
B. Elevated lipase 3x ULN, elevated HCT and BUN:Cr, hyperglycemia, hypocalcemia
C. Elevated Alk phos, CA19-9, amylase/lipase, T/D Bili and decreased Hgb/Hct
D. Gastric pH <2.0(normal is ~3.0), serum gastrin >1000pg/mL - ANS✔✔ B. Elevated lipase 3x
ULN, elevated HCT and BUN:Cr, hyperglycemia, hypocalcemia
Answer choice B is the only correct lab findings for acute pancreatitis, which is suspected in the
question stem due to the history of alcoholism and gallstones(80% of the etiology for acute
,panc), as well as the clinical presentation(steady upper abd pain radiating to their back, present
for the past 2 days, relieved by leaning forward, worse with movement).
Elevated amylase 2x ULN, decreased HCT and BUN:Cr, hyponatremia, hyperglycemia
Incorrect because these labs are just off from the correct findings seen in B
Elevated Alk phos, CA19-9, amylase/lipase, T/D Bili and decreased Hgb/Hct
These findings represent pancreatic malignancy, which is not indicated here
Gastric pH <2.0(normal is ~3.0), serum gastrin >1000pg/mL
These findings represent Zollinger Ellison syndrome, which is not indicated here
47 overweight male with presents complaining of right sided abdominal pain for the past week,
which he states is worse after meals. He likes to eat out at restaurants often because his wife
"doesn't know how to cook a damn steak." He has a history of HTN and hyperlipidemia which
he takes rosuvastatin and lisinopril for. Vital signs are 138/86, RR 16, HR 84 BPM, and temp:
101.2. Upon physical exam, he is noted to have a positive Murphy's sign. What is the best test
you can order to confirm your suspected diagnosis, and what will it show? (pt 1 of 2)
A. Abdominal XR: gallstones blocking the common bile duct
B. Abdominal CT: thick walled, inflamed gallbladder
C. Abdominal US: shadowing extending from the gallbladder, indicating the presence of
gallstones
D. Abdominal CT: shadowing extending from the gallbladder, indicating the presence of
gallstones - ANS✔✔ C. Abdominal US: shadowing extending from the gallbladder, indicating the
presence of gallstones.
, The patient has a positive murphys sign, indicating acute cholecystitis. Acute cholecystitis is
commonly due to gallstones, therefore your 1st line imaging should be an abdominal US, in
which you'd see shadowing coming from the stones! The rest of the answer choices I honestly
made up but: gallstones can block the cystic duct, NOT the common bile duct. The thick
walled/inflamed thing I just pulled out of my ass hehe. CT wont show shadowing (or stones,
unless they're calcified), so that one is wrong. Takeaway is that murphys sign + fever + RUQ pain
after meals should make you think cholecystitis due to cholelithiasis and the imaging of choice
for this is abd US to show the stones.
Your imaging was negative for the suspected diagnosis, but you are still suspicious... What is
your next best step? (pt 2 of 2)
A. Treat empirically with IV cipro + metronidazole
B. Order a HIDA scan to assess for gallbladder filling
C. Admit and administer IV fluids
D. Order an EGD to assess for cystic duct obstruction - ANS✔✔ B. Order a HIDA scan to assess
for gallbladder filling
Aw shit, what do you do now? Well, good thing you got your trusty HIDA scan which is
DIAGNOSTIC bc it will show no gallbladder filling, aka a blockage of the cystic duct (gallstones
commonly cause this). You would not just treat empirically with abx bc you dont know whats
going on yet. Admit for IV fluids is cool and all but vague af, come on guys we can do better than
that. The EGD thing I made up but I don't think an EGD can just casually go into the gallbladder?
(pls shun me if I am wrong tho)
41F presents to the ED with epigastric pain and fever x 4 days. She rates it as a 6/10 and states
she has been very nauseated as well and has vomited twice. Only current medication is her
progesterone-estradiol OCP. On physical exam she has RUQ/epigastric tenderness to light and
deep palpation, as well as involuntary guarding. Abdominal US shows shadowing extending
from round white spots within the gallbladder. How do you treat?
