Rosh GI UPDATED ACTUAL Questions and CORRECT Answers
1. D. Ischemic coli- An 82-year-old man suffers a myocardial infarction. On day two of his ICU admis-
tis sion, he complains of severe left-sided abdominal pain. Nursing staff report his
last bowel movement was bloody. His past medical history is significant only for
Parkinson's disease, hypertension, hyperthyroidism, hypercholesterolemia and
the recent MI. His abdomen is tender, and the left lower quadrant bowel sounds
are diminished. Which of the following is the most like diagnosis?
A. Cholecystitis
B. Diverticulitis
C. Intestinal angina
D. Ischemic colitis
2. A. Calcium A patient presents with abdominal bloating and flatulence. She denies diarrhea.
Physical examination is significant only for borborygmi. You suspect lactose in-
tolerance and start the patient on lactase supplementation and diet modification.
Which of the following supplements should also be prescribed?
A. Calcium
B. Pancreatase
C. Sevelamer
D. Sodium
3. B. Dentate line What structure helps differentiate between internal and external hemorrhoids?
A. Anal verge
B. Dentate line
C. Linea alba
D. Perineum
4. D. Transmural in- Which of the following characteristics is associated with Crohn disease?
volvement with A. Continuous uninterrupted inflammation of the colonic mucosa
cobblestone ap- B. Rectal involvement occurs in all cases
pearance C. Smoking appears to confer a protective effect
D. Transmural involvement with cobblestone appearance
,5. D. Carcinoem- A patient complains of a change in bowel habits over the past 3 months. A fecal
bryonic antigen occult-blood test is positive. During a digital rectal examination, you palpate a
(CEA) solid 2cm by 2cm mass in the rectum. Which of the following serum tests would
you order in the initial laboratory evaluation of a patient with suspected rectal
neoplasia?
A. Alpha fetoprotein (AFP)
B. Cancer antigen 127- (CA-125)
C. Cancer antigen 15-3 (CA-15-3)
D. Carcinoembryonic antigen (CEA)
6. A. Acute mesen- A 72-year-old man presents to the emergency department with a 6-hour his-
teric ischemia tory of severe, diffuse abdominal pain. He has a past medical history diabetes
mellitus, hypertension, and colon cancer. Physical exam reveals an abdomen that
is extremely tender to light palpation and an irregularly, irregular heart rate.
Digital rectal exam is notable for grossly bloody mucous. Laboratory findings
are notable for leukocytosis, metabolic acidosis, elevated amylase, and elevated
lactate dehydrogenase. Which of the following is the most likely diagnosis?
A. Acute mesenteric ischemia
B. Appendicitis
C. Diverticulitis
D. Pancreatitis
7. B. Crohn disease A 34-year-old woman presents to the clinic with the skin lesions shown above.
She also complains of recent unintentional weight loss, low-grade fevers, and
nonbloody diarrhea. Which of the following is the most likely diagnosis?
A. Acute myelogenous leukemia
B. Crohn disease
C. Hodgkin lymphoma
D. Sarcoidosis
,8. B. Empiric trial of A 45-year-old woman presents to her primary care provider because of recurrent
omeprazole epigastric pain that usually occurs after heavy meals and with sitting in a reclined
position. She reports transient relief when she sits upright or drinks milk. She
denies weight loss, early satiety, dysphagia, and melena. Physical examination is
notable for obesity, but is otherwise unremarkable. Which of the following is most
appropriate next step?
A. Ambulatory 24-hour pH monitoring
B. Empiric trial of omeprazole
C. Fundoplication
D. Upper endoscopy
9. C. Fecal im- A 67-year-old woman presents to the emergency department complaining of
paction constipation, fecal seepage, and rectal pressure for the past two days. She fell
three weeks ago and broke two ribs. At that time, she was prescribed hydrocodone
for pain. Her pulse is 67 beats/min, respiratory rate is 18 breaths/min, blood
pressure is 138/90 mm Hg, and temperature is 98.5F. On exam, her abdomen
is mildly tender to palpation and distended, but is without guarding or rebound
tenderness. Digital rectal exam reveals a dilated rectal vault filled with hard stool.
Fecal occult blood test is negative. Which of the following is the most likely
diagnosis?
A. Colon cancer
B. Diverticulitis
C. Fecal impaction
D. Sigmoid volvulus
10.
, D. Nonalcoholic Which of the following is the most common form of liver disease in the United
fatty liver disease States?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Nonalcoholic fatty liver disease
11. D. Head of bed A 35-year-old woman presents for evaluation of chest pain. The patient describes
elevation while a burning pain that begins in the subxiphoid area and radiates up into her neck.
sleeping Occasionally she has a bitter taste in her mouth. Her electrocardiogram and
chest radiograph are normal. Which of the following is most likely to help her
symptoms?
A. Avoidance of fatty foods
B. Calcium channel blocker therapy
C. Eradication of H. pylori
D. Head of bed elevation while sleeping
12. C. Hypophos- You examine a 17-year-old girl due to anorexia nervosa. She has low self-esteem
phatemia with intense fear of gaining weight. She restricted her diet for the past three
months. On physical exam, her BMI is 18 with heart rate of 35 beats per minute
at rest. You decide to admit her for inpatient management. You plan to start nutri-
tional therapy but worry about the risk of refeeding syndrome. Which laboratory
finding is most consistent with refeeding syndrome?
A. Hyperkalemia
B. Hypermagnesemia
C. Hypophosphatemia
D. Thrombocytopenia
13. C. Ischemic colitis An 82-year-old nursing-home resident is sent to the emergency department
with lower abdominal pain and bloody diarrhea. He has a history of vascular
dementia, hypertension, and hyperlipidemia. On examination he is afebrile, and
a nasogastric aspirate is negative for evidence of bleeding. Which of the following
1. D. Ischemic coli- An 82-year-old man suffers a myocardial infarction. On day two of his ICU admis-
tis sion, he complains of severe left-sided abdominal pain. Nursing staff report his
last bowel movement was bloody. His past medical history is significant only for
Parkinson's disease, hypertension, hyperthyroidism, hypercholesterolemia and
the recent MI. His abdomen is tender, and the left lower quadrant bowel sounds
are diminished. Which of the following is the most like diagnosis?
A. Cholecystitis
B. Diverticulitis
C. Intestinal angina
D. Ischemic colitis
2. A. Calcium A patient presents with abdominal bloating and flatulence. She denies diarrhea.
Physical examination is significant only for borborygmi. You suspect lactose in-
tolerance and start the patient on lactase supplementation and diet modification.
Which of the following supplements should also be prescribed?
A. Calcium
B. Pancreatase
C. Sevelamer
D. Sodium
3. B. Dentate line What structure helps differentiate between internal and external hemorrhoids?
A. Anal verge
B. Dentate line
C. Linea alba
D. Perineum
4. D. Transmural in- Which of the following characteristics is associated with Crohn disease?
volvement with A. Continuous uninterrupted inflammation of the colonic mucosa
cobblestone ap- B. Rectal involvement occurs in all cases
pearance C. Smoking appears to confer a protective effect
D. Transmural involvement with cobblestone appearance
,5. D. Carcinoem- A patient complains of a change in bowel habits over the past 3 months. A fecal
bryonic antigen occult-blood test is positive. During a digital rectal examination, you palpate a
(CEA) solid 2cm by 2cm mass in the rectum. Which of the following serum tests would
you order in the initial laboratory evaluation of a patient with suspected rectal
neoplasia?
A. Alpha fetoprotein (AFP)
B. Cancer antigen 127- (CA-125)
C. Cancer antigen 15-3 (CA-15-3)
D. Carcinoembryonic antigen (CEA)
6. A. Acute mesen- A 72-year-old man presents to the emergency department with a 6-hour his-
teric ischemia tory of severe, diffuse abdominal pain. He has a past medical history diabetes
mellitus, hypertension, and colon cancer. Physical exam reveals an abdomen that
is extremely tender to light palpation and an irregularly, irregular heart rate.
Digital rectal exam is notable for grossly bloody mucous. Laboratory findings
are notable for leukocytosis, metabolic acidosis, elevated amylase, and elevated
lactate dehydrogenase. Which of the following is the most likely diagnosis?
A. Acute mesenteric ischemia
B. Appendicitis
C. Diverticulitis
D. Pancreatitis
7. B. Crohn disease A 34-year-old woman presents to the clinic with the skin lesions shown above.
She also complains of recent unintentional weight loss, low-grade fevers, and
nonbloody diarrhea. Which of the following is the most likely diagnosis?
A. Acute myelogenous leukemia
B. Crohn disease
C. Hodgkin lymphoma
D. Sarcoidosis
,8. B. Empiric trial of A 45-year-old woman presents to her primary care provider because of recurrent
omeprazole epigastric pain that usually occurs after heavy meals and with sitting in a reclined
position. She reports transient relief when she sits upright or drinks milk. She
denies weight loss, early satiety, dysphagia, and melena. Physical examination is
notable for obesity, but is otherwise unremarkable. Which of the following is most
appropriate next step?
A. Ambulatory 24-hour pH monitoring
B. Empiric trial of omeprazole
C. Fundoplication
D. Upper endoscopy
9. C. Fecal im- A 67-year-old woman presents to the emergency department complaining of
paction constipation, fecal seepage, and rectal pressure for the past two days. She fell
three weeks ago and broke two ribs. At that time, she was prescribed hydrocodone
for pain. Her pulse is 67 beats/min, respiratory rate is 18 breaths/min, blood
pressure is 138/90 mm Hg, and temperature is 98.5F. On exam, her abdomen
is mildly tender to palpation and distended, but is without guarding or rebound
tenderness. Digital rectal exam reveals a dilated rectal vault filled with hard stool.
Fecal occult blood test is negative. Which of the following is the most likely
diagnosis?
A. Colon cancer
B. Diverticulitis
C. Fecal impaction
D. Sigmoid volvulus
10.
, D. Nonalcoholic Which of the following is the most common form of liver disease in the United
fatty liver disease States?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Nonalcoholic fatty liver disease
11. D. Head of bed A 35-year-old woman presents for evaluation of chest pain. The patient describes
elevation while a burning pain that begins in the subxiphoid area and radiates up into her neck.
sleeping Occasionally she has a bitter taste in her mouth. Her electrocardiogram and
chest radiograph are normal. Which of the following is most likely to help her
symptoms?
A. Avoidance of fatty foods
B. Calcium channel blocker therapy
C. Eradication of H. pylori
D. Head of bed elevation while sleeping
12. C. Hypophos- You examine a 17-year-old girl due to anorexia nervosa. She has low self-esteem
phatemia with intense fear of gaining weight. She restricted her diet for the past three
months. On physical exam, her BMI is 18 with heart rate of 35 beats per minute
at rest. You decide to admit her for inpatient management. You plan to start nutri-
tional therapy but worry about the risk of refeeding syndrome. Which laboratory
finding is most consistent with refeeding syndrome?
A. Hyperkalemia
B. Hypermagnesemia
C. Hypophosphatemia
D. Thrombocytopenia
13. C. Ischemic colitis An 82-year-old nursing-home resident is sent to the emergency department
with lower abdominal pain and bloody diarrhea. He has a history of vascular
dementia, hypertension, and hyperlipidemia. On examination he is afebrile, and
a nasogastric aspirate is negative for evidence of bleeding. Which of the following
