GI EXAMMASTER PRACTICE QUESTIONS &
ANSWERS
A 65-year-old male patient presents to the ER with 3 days of left lower quadrant (LLQ)
abdominal pain, nausea, vomiting, non-bloody diarrhea, and a low-grade fever. On
examination, he has a temperature of 100.9°F, hyperactive bowel sounds, and localized
tenderness in the left lower quadrant. What is the most likely diagnosis? - Answer -
Diverticulitis
A 55-year-old male patient presents to the clinic for a follow-up exam. He was
diagnosed as having alcohol-related liver disease 9 months ago. Vital signs are
unremarkable. Physical exam shows scleral icterus and bilateral pedal edema. The
spleen is palpable 2 cm below the left costal margin. An upper endoscopy shows dilated
submucosal veins measuring 7 mm in diameter in the distal esophagus. What is the
mechanism of action of the most appropriate pharmacotherapy for this patient? -
Answer -beta-2 antagonist
A 42-year-old woman presents for a postoperative visit 6 weeks after a total abdominal
hysterectomy for fibroids. Medications taken during the postoperative period include
acetaminophen/hydrocodone alternating with ibuprofen as needed for pain
management, and clindamycin prescribed 10 days ago for bacterial vaginosis. Today,
she notes several new symptoms, including nausea, bloating, watery diarrhea up to 8-
10 times daily, fatigue, intermittent fever, and mild abdominal pain. These symptoms
have gradually worsened over the last few days. What is the most likely diagnosis? -
Answer -Clostridioides difficile infection
A 27-year-old woman presents with intermittent epigastric pain of 6 months duration.
She explains that her pain worsens 2 hours after eating breakfast, particularly cereal
and other milk products. She also endorses symptoms of diarrhea, flatulence, and
postprandial bloating. Upon physical exam, temperature is 98.1°F, blood pressure is
120/80 mm Hg, and there are no signs of epigastric pain on light or deep palpation.
What is the most likely diagnosis? - Answer -Lactose Intolerance
A 23-year-old woman underwent a gastric bypass 3 months ago and presents with
fatigue, numbness, and tingling of both hands. What is the best intervention to correct
these symptoms? - Answer -Oral Vit B complex capsule daily
A 56-year-old male patient presents with crampy abdominal pain, nausea, and bloating
within an hour after taking food. Crohn's disease was diagnosed 6 months ago. He has
been passing feces and flatus with difficulty for 4 days. On examination, the abdomen is
distended and he appears dehydrated. What is the most appropriate step to prevent
further worsening of this condition? - Answer -Placement of a nasogastric tube
,A 27-year-old man who was prescribed malaria prophylaxis a week ago presents with
dark urine and jaundice. Laboratory studies show:
Total bilirubin3.4 mg/dL
Direct bilirubin1.1 mg/dL
Hemoglobin8.2 g/dL
Reticulocytes7.20%
Lactate dehydrogenase (LDH)340 U/L
Haptoglobin39 mg/dL
What is the most likely finding on peripheral blood smear examination? - Answer -Heinz
bodies
A 58-year-old man who is a heavy smoker with alcoholism presents with intermittent
epigastric pain for 3 months. The epigastric pain does not refer to the back. He
experiences sudden-onset episodes of nausea, vomiting, and bloating. The patient
states that he frequently takes pain killers for arthritis. Physical examination is
unremarkable for icterus, abdominal tenderness, and periumbilical ecchymosis.
Inflammation of what organ is most likely in this patient? - Answer -gastric mucosa
A 15-month-old male patient is reluctant to stand and walk. Birth weight was 3.4 kg (7.5
lb). Developmental history reveals that at age 8 months, he could sit without support; at
9 months, he could hold objects with pincer grasp, say "mama" and "baba," and
understand "no"; at 12 months, he could stand with support, bang things together, and
understand simple commands. Examination shows flaring at both knee joints and
presence of only four central incisor teeth in the oral cavity. There is no hypercalciuria.
Genetic studies detect an activating mutation of fibroblast growth factor 23. In addition
to treatment for the condition, what deficiency should the parents take dietary measures
to prevent in the patient? - Answer -iron
A 54-year-old man with hypertension and a sedentary lifestyle presents with fatigue and
body ache for 3 days. He states that he suffered a head injury 1 year ago while
intoxicated. The patient has a history of extensive alcohol abuse. He has taken
acetaminophen 500 mg daily for 3 days to help relieve body ache. Physical examination
reveals palmar erythema, gynecomastia, splenomegaly, and 4 spider nevi on his trunk.
What is the most likely cause of abnormal physical examination findings in this patient?
- Answer -Alcohol abuse
A 56-year-old man with known cirrhosis due to prior hepatitis C infection is brought to
the clinic by his wife due to 1 month of worsening malaise, abdominal swelling, and
nausea with 1 week of right upper quadrant pain. Physical examination is notable for
new hepatomegaly. On computed tomography (CT) of the liver, he is found to have a
contrast-enhancing 4 cm single hepatocellular mass. Histology revealed carcinoma. His
performance status is excellent despite his recent decline. He still works as a
webmaster and walks over 4 city blocks daily. What is the most appropriate intervention
for the management of this case? - Answer -liver transplantation
, A 4-year-old girl presents with abdominal pain and chronic diarrhea. Her mother says
she has developed similar symptoms multiple times in the past. Detailed history reveals
that the patient's symptoms begun from 6 months of age when supplementary nutrition
was initiated. Temperature is 37°C (98.6°F) and blood pressure is 110/70 mm Hg. What
physical exam finding, if present, would be the most specific indicator of the disease in
this patient? - Answer -Short stature
A 50-year-old male patient presents for a follow-up exam. He has type 2 diabetes
mellitus well-controlled with metformin. He does not smoke. He drinks 5-6 beers daily.
Vital signs are within reference ranges. Physical examination shows bilateral pedal
edema, decreased testicular volume, and increased breast tissue. The liver is palpable
2 cm below the right costal margin. Abdominal ultrasound shows a nodular liver. An
upper endoscopy shows dilated submucosal veins 2 mm in diameter with red surface
spots in the distal esophagus. What is the most appropriate next step in the
management of this patient's esophageal findings? - Answer -Nadolol therapy
A 73-year-old Caucasian man in generally good health presents for evaluation of a
bulge in the left lower quadrant of the abdomen. It tends to be more prominent after
meals and resolves after lying down. There is some dull associated discomfort of the left
lower quadrant. Symptoms were initially noted 2 months ago and have recurred
intermittently.
Past Medical History: Coronary artery disease with LAD stent age 59. Congenital cleft
lip, surgically repaired at age 6 months.Allergies: No known drug allergies.Usual
Medications: ASA 81 mg daily. Toprol XL 25 mg daily. Zocor 40 mg daily.Social History:
Quit smoking 50 years ago. Drinks 1 glass of wine or beer daily. No use of illegal
drugs.Family History: Father died of end-stage COPD age 72. Mother died at 74 of
malignant thymoma.
Physical Examination:
Vital signs - Stable.General - Alert white male in no acute distress.Heart - Normal S1
and S2 without rub, murmur, or ga - Answer -weakness in posterior floor of inguinal
canal in Hesselbach's triangle
A 55-year-old male patient presents to the ED due to an episode of acute retrosternal
chest pain that radiates to the back. The pain started after he drank a glass of cold
water at lunch. He has experienced two similar episodes this year. On the way to the
hospital, he took a sublingual nitrate tablet he had at home, which helped relieve the
pain. Pulse 88/min, respirations 16/min, blood pressure 145/85 mm Hg. Examination
shows no other abnormalities. ECG shows a normal sinus rhythm with no ST-segment
abnormalities. What is the most likely diagnosis? - Answer -Diffuse esophageal spasm
A 32-year-old Caucasian man presents due to multiple itchy papules and vesicles
(Refer to the image.) on his elbows and knees for several days. He denies any pain,
fevers, chills, sweats, or dysuria, though he states he has had some mild and non-
bloody but greasy diarrhea. He appears unconcerned, as he has had those symptoms a
few times a year for most of his life. The diarrhea usually lasts a few days and goes
away on its own.
ANSWERS
A 65-year-old male patient presents to the ER with 3 days of left lower quadrant (LLQ)
abdominal pain, nausea, vomiting, non-bloody diarrhea, and a low-grade fever. On
examination, he has a temperature of 100.9°F, hyperactive bowel sounds, and localized
tenderness in the left lower quadrant. What is the most likely diagnosis? - Answer -
Diverticulitis
A 55-year-old male patient presents to the clinic for a follow-up exam. He was
diagnosed as having alcohol-related liver disease 9 months ago. Vital signs are
unremarkable. Physical exam shows scleral icterus and bilateral pedal edema. The
spleen is palpable 2 cm below the left costal margin. An upper endoscopy shows dilated
submucosal veins measuring 7 mm in diameter in the distal esophagus. What is the
mechanism of action of the most appropriate pharmacotherapy for this patient? -
Answer -beta-2 antagonist
A 42-year-old woman presents for a postoperative visit 6 weeks after a total abdominal
hysterectomy for fibroids. Medications taken during the postoperative period include
acetaminophen/hydrocodone alternating with ibuprofen as needed for pain
management, and clindamycin prescribed 10 days ago for bacterial vaginosis. Today,
she notes several new symptoms, including nausea, bloating, watery diarrhea up to 8-
10 times daily, fatigue, intermittent fever, and mild abdominal pain. These symptoms
have gradually worsened over the last few days. What is the most likely diagnosis? -
Answer -Clostridioides difficile infection
A 27-year-old woman presents with intermittent epigastric pain of 6 months duration.
She explains that her pain worsens 2 hours after eating breakfast, particularly cereal
and other milk products. She also endorses symptoms of diarrhea, flatulence, and
postprandial bloating. Upon physical exam, temperature is 98.1°F, blood pressure is
120/80 mm Hg, and there are no signs of epigastric pain on light or deep palpation.
What is the most likely diagnosis? - Answer -Lactose Intolerance
A 23-year-old woman underwent a gastric bypass 3 months ago and presents with
fatigue, numbness, and tingling of both hands. What is the best intervention to correct
these symptoms? - Answer -Oral Vit B complex capsule daily
A 56-year-old male patient presents with crampy abdominal pain, nausea, and bloating
within an hour after taking food. Crohn's disease was diagnosed 6 months ago. He has
been passing feces and flatus with difficulty for 4 days. On examination, the abdomen is
distended and he appears dehydrated. What is the most appropriate step to prevent
further worsening of this condition? - Answer -Placement of a nasogastric tube
,A 27-year-old man who was prescribed malaria prophylaxis a week ago presents with
dark urine and jaundice. Laboratory studies show:
Total bilirubin3.4 mg/dL
Direct bilirubin1.1 mg/dL
Hemoglobin8.2 g/dL
Reticulocytes7.20%
Lactate dehydrogenase (LDH)340 U/L
Haptoglobin39 mg/dL
What is the most likely finding on peripheral blood smear examination? - Answer -Heinz
bodies
A 58-year-old man who is a heavy smoker with alcoholism presents with intermittent
epigastric pain for 3 months. The epigastric pain does not refer to the back. He
experiences sudden-onset episodes of nausea, vomiting, and bloating. The patient
states that he frequently takes pain killers for arthritis. Physical examination is
unremarkable for icterus, abdominal tenderness, and periumbilical ecchymosis.
Inflammation of what organ is most likely in this patient? - Answer -gastric mucosa
A 15-month-old male patient is reluctant to stand and walk. Birth weight was 3.4 kg (7.5
lb). Developmental history reveals that at age 8 months, he could sit without support; at
9 months, he could hold objects with pincer grasp, say "mama" and "baba," and
understand "no"; at 12 months, he could stand with support, bang things together, and
understand simple commands. Examination shows flaring at both knee joints and
presence of only four central incisor teeth in the oral cavity. There is no hypercalciuria.
Genetic studies detect an activating mutation of fibroblast growth factor 23. In addition
to treatment for the condition, what deficiency should the parents take dietary measures
to prevent in the patient? - Answer -iron
A 54-year-old man with hypertension and a sedentary lifestyle presents with fatigue and
body ache for 3 days. He states that he suffered a head injury 1 year ago while
intoxicated. The patient has a history of extensive alcohol abuse. He has taken
acetaminophen 500 mg daily for 3 days to help relieve body ache. Physical examination
reveals palmar erythema, gynecomastia, splenomegaly, and 4 spider nevi on his trunk.
What is the most likely cause of abnormal physical examination findings in this patient?
- Answer -Alcohol abuse
A 56-year-old man with known cirrhosis due to prior hepatitis C infection is brought to
the clinic by his wife due to 1 month of worsening malaise, abdominal swelling, and
nausea with 1 week of right upper quadrant pain. Physical examination is notable for
new hepatomegaly. On computed tomography (CT) of the liver, he is found to have a
contrast-enhancing 4 cm single hepatocellular mass. Histology revealed carcinoma. His
performance status is excellent despite his recent decline. He still works as a
webmaster and walks over 4 city blocks daily. What is the most appropriate intervention
for the management of this case? - Answer -liver transplantation
, A 4-year-old girl presents with abdominal pain and chronic diarrhea. Her mother says
she has developed similar symptoms multiple times in the past. Detailed history reveals
that the patient's symptoms begun from 6 months of age when supplementary nutrition
was initiated. Temperature is 37°C (98.6°F) and blood pressure is 110/70 mm Hg. What
physical exam finding, if present, would be the most specific indicator of the disease in
this patient? - Answer -Short stature
A 50-year-old male patient presents for a follow-up exam. He has type 2 diabetes
mellitus well-controlled with metformin. He does not smoke. He drinks 5-6 beers daily.
Vital signs are within reference ranges. Physical examination shows bilateral pedal
edema, decreased testicular volume, and increased breast tissue. The liver is palpable
2 cm below the right costal margin. Abdominal ultrasound shows a nodular liver. An
upper endoscopy shows dilated submucosal veins 2 mm in diameter with red surface
spots in the distal esophagus. What is the most appropriate next step in the
management of this patient's esophageal findings? - Answer -Nadolol therapy
A 73-year-old Caucasian man in generally good health presents for evaluation of a
bulge in the left lower quadrant of the abdomen. It tends to be more prominent after
meals and resolves after lying down. There is some dull associated discomfort of the left
lower quadrant. Symptoms were initially noted 2 months ago and have recurred
intermittently.
Past Medical History: Coronary artery disease with LAD stent age 59. Congenital cleft
lip, surgically repaired at age 6 months.Allergies: No known drug allergies.Usual
Medications: ASA 81 mg daily. Toprol XL 25 mg daily. Zocor 40 mg daily.Social History:
Quit smoking 50 years ago. Drinks 1 glass of wine or beer daily. No use of illegal
drugs.Family History: Father died of end-stage COPD age 72. Mother died at 74 of
malignant thymoma.
Physical Examination:
Vital signs - Stable.General - Alert white male in no acute distress.Heart - Normal S1
and S2 without rub, murmur, or ga - Answer -weakness in posterior floor of inguinal
canal in Hesselbach's triangle
A 55-year-old male patient presents to the ED due to an episode of acute retrosternal
chest pain that radiates to the back. The pain started after he drank a glass of cold
water at lunch. He has experienced two similar episodes this year. On the way to the
hospital, he took a sublingual nitrate tablet he had at home, which helped relieve the
pain. Pulse 88/min, respirations 16/min, blood pressure 145/85 mm Hg. Examination
shows no other abnormalities. ECG shows a normal sinus rhythm with no ST-segment
abnormalities. What is the most likely diagnosis? - Answer -Diffuse esophageal spasm
A 32-year-old Caucasian man presents due to multiple itchy papules and vesicles
(Refer to the image.) on his elbows and knees for several days. He denies any pain,
fevers, chills, sweats, or dysuria, though he states he has had some mild and non-
bloody but greasy diarrhea. He appears unconcerned, as he has had those symptoms a
few times a year for most of his life. The diarrhea usually lasts a few days and goes
away on its own.
