CGRN Exam Questions with Correct
Answers
A 62-year-old woman presents with postprandial epigastric pain. Laboratory testing is positive for a
Helicobacter pylori infection. She is appropriately treated with 2 antibiotics and a proton pump
inhibitor, which is continued long-term. The patient's symptoms recur. Stool tests and a urea breath
test are negative for the recurrence of H. pylori, so a repeat endoscopy is performed and gastric
ulcers are identified. Fasting gastrin and basal acid secretion are elevated. What is the best next step?
A. Secretin-stimulated gastrin levels
B. Gastrin levels after a meal
C. Double the proton pump inhibitor dose
D. Re-treat for H. pylori - ANSWER✔✔-A. Secretin-stimulated gastrin levels
To make the diagnosis of Zollinger-Ellison Syndrome (ZES), a secretin stimulated gastrin level
should be obtained
if 2 pg/kg of intravenous secretin increases gastrin levels by more 200 pg within 15 mins, this is
more than 90% sensitive and specific for ZES
FOR STUDY PURPOSES ONLY COPYRIGHT © 2025 ALL RIGHTS RESERVED 1
,Endoscopic Ultrasound may identify the location of the gastrinoma
A somatostatin radioscan is very sensitive for detecting the primary location of metastatic lesions of
ZES. Other tests include upper endoscopy & CT scan.
A 14-year-old was suspected to have peptic ulcer disease caused by Helicobacter pylori infection. An
endoscopy is about to be performed. Which test would be the best screening technique to confirm
Helicobacter pylori infection?
A. Urease breath test
B. Rapid urease test
C. Serology
D. Culture - ANSWER✔✔-B. Rapid urease test
If endoscopy were indicated, the best test would be to perform urease test on antral biopsy as well as
Giemsa stain.
If there is no indication for endoscopy, urease breath test can be done.
Non-invasive methods of testing for a cure should be performed at least 4 weeks after completion
of treatment.
? A 64-year-old man with recently treated hepatitis C on sustained virological response who
developed cirrhosis (Childs-Pugh B) has an alpha-fetoprotein level of 300 mg/mL. An MRI
identified 4 ring-enhancing lesions, up to 4 cm, in the liver with a characteristic hypointense area
compared to the other parts of the liver. The patient has a n ECOG score of 0 and Okuda 1, and
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, staging did not reveal nodules or metastasis. Which of the following is most likely the initial
approach for this patient?
A. Consider hepatobiliary surgery referral for partial liver resection
B. Consider transplant surgery referral for orthotopic liver transplantation
C. Consider interventional radiology referral for transarterial chemoembolization
D. Consider oncology referral for sorafenib - ANSWER✔✔-? C. Consider interventional radiology
referral for transarterial chemoembolization
According to the Barcelona Clinic Liver Cancer (BCLC) staging classification & treatment algorithm,
the patient is an intermediate (stage B). Very early (stage 0) and early (stage A) may be considered for
resection or even liver transplant with curative intent. Resectable candidates are considered early
hepatocellular carcinoma (HCC) (stages less than IIIB) and liver disease Child-Pugh (Stage A only)
Transplant candidates are evaluated according to the Milan criteria. These are a single tumor less
than 5 cm or 2 to 3 tumors, none exceeding 3 cm, with no vascular invasion & extrahepatic spread.
Intermediate (Stage B) asymptomatic patients with multinodular HCC may benefit from transarterial
chemoembolization. This is often used in large (greater than 5 cm) or multifocal (greater than 3
tumors) disease and is unsuitable for local ablation with early liver disease.
BCLC advanced (stage C) symptomatic patients with vascular invasion and extrahepatic spread with
preserved liver function could be enrolled for chemotherapy. One agent used is sorafenib.
A 64-year-old woman with a history of multiple pulmonary embolisms and gastroesophageal reflux
disease (GERD) presents to the clinic for worsening heartburn. She currently takes warfarin due to
FOR STUDY PURPOSES ONLY COPYRIGHT © 2025 ALL RIGHTS RESERVED 3
Answers
A 62-year-old woman presents with postprandial epigastric pain. Laboratory testing is positive for a
Helicobacter pylori infection. She is appropriately treated with 2 antibiotics and a proton pump
inhibitor, which is continued long-term. The patient's symptoms recur. Stool tests and a urea breath
test are negative for the recurrence of H. pylori, so a repeat endoscopy is performed and gastric
ulcers are identified. Fasting gastrin and basal acid secretion are elevated. What is the best next step?
A. Secretin-stimulated gastrin levels
B. Gastrin levels after a meal
C. Double the proton pump inhibitor dose
D. Re-treat for H. pylori - ANSWER✔✔-A. Secretin-stimulated gastrin levels
To make the diagnosis of Zollinger-Ellison Syndrome (ZES), a secretin stimulated gastrin level
should be obtained
if 2 pg/kg of intravenous secretin increases gastrin levels by more 200 pg within 15 mins, this is
more than 90% sensitive and specific for ZES
FOR STUDY PURPOSES ONLY COPYRIGHT © 2025 ALL RIGHTS RESERVED 1
,Endoscopic Ultrasound may identify the location of the gastrinoma
A somatostatin radioscan is very sensitive for detecting the primary location of metastatic lesions of
ZES. Other tests include upper endoscopy & CT scan.
A 14-year-old was suspected to have peptic ulcer disease caused by Helicobacter pylori infection. An
endoscopy is about to be performed. Which test would be the best screening technique to confirm
Helicobacter pylori infection?
A. Urease breath test
B. Rapid urease test
C. Serology
D. Culture - ANSWER✔✔-B. Rapid urease test
If endoscopy were indicated, the best test would be to perform urease test on antral biopsy as well as
Giemsa stain.
If there is no indication for endoscopy, urease breath test can be done.
Non-invasive methods of testing for a cure should be performed at least 4 weeks after completion
of treatment.
? A 64-year-old man with recently treated hepatitis C on sustained virological response who
developed cirrhosis (Childs-Pugh B) has an alpha-fetoprotein level of 300 mg/mL. An MRI
identified 4 ring-enhancing lesions, up to 4 cm, in the liver with a characteristic hypointense area
compared to the other parts of the liver. The patient has a n ECOG score of 0 and Okuda 1, and
FOR STUDY PURPOSES ONLY COPYRIGHT © 2025 ALL RIGHTS RESERVED 2
, staging did not reveal nodules or metastasis. Which of the following is most likely the initial
approach for this patient?
A. Consider hepatobiliary surgery referral for partial liver resection
B. Consider transplant surgery referral for orthotopic liver transplantation
C. Consider interventional radiology referral for transarterial chemoembolization
D. Consider oncology referral for sorafenib - ANSWER✔✔-? C. Consider interventional radiology
referral for transarterial chemoembolization
According to the Barcelona Clinic Liver Cancer (BCLC) staging classification & treatment algorithm,
the patient is an intermediate (stage B). Very early (stage 0) and early (stage A) may be considered for
resection or even liver transplant with curative intent. Resectable candidates are considered early
hepatocellular carcinoma (HCC) (stages less than IIIB) and liver disease Child-Pugh (Stage A only)
Transplant candidates are evaluated according to the Milan criteria. These are a single tumor less
than 5 cm or 2 to 3 tumors, none exceeding 3 cm, with no vascular invasion & extrahepatic spread.
Intermediate (Stage B) asymptomatic patients with multinodular HCC may benefit from transarterial
chemoembolization. This is often used in large (greater than 5 cm) or multifocal (greater than 3
tumors) disease and is unsuitable for local ablation with early liver disease.
BCLC advanced (stage C) symptomatic patients with vascular invasion and extrahepatic spread with
preserved liver function could be enrolled for chemotherapy. One agent used is sorafenib.
A 64-year-old woman with a history of multiple pulmonary embolisms and gastroesophageal reflux
disease (GERD) presents to the clinic for worsening heartburn. She currently takes warfarin due to
FOR STUDY PURPOSES ONLY COPYRIGHT © 2025 ALL RIGHTS RESERVED 3
