GI PACKRAT QUESTIONS AND ANSWERS
Primary biliary cirrhosis will have which of the following laboratory results?
A. Decreased haptoglobin
B. Anticholinesterase antibodies
C. Antimitochondrial antibodies
D. Elevated ceruloplasmin - Answers - C
Which of the following diagnostic tests is considered to be the best initial test to order in
a patient with suspected gallbladder disease?
A. Ultrasound
B. Hepatic iminodiacetic acid (HIDA) scan
C. Flat plate of the abdomen
D. Endoscopic retrograde cholangiopancreatography (ERCP) - Answers - A.
*Ultrasound* of the abdomen is the best test for checking the extra-hepatic biliary tree
for ductal dilatation and choledocholithiasis.
(HIDA is if U/S is negative but still a high index of suspicion;
ERCP is to retrieve a stone, but not an initial study)
A 76 year-old female presents to the ED with the worst abdominal pain in her life. The
pain began following a large meal and is located periumbilically. Although she is
writhing in pain, she does not have an exacerbation of the pain on palpation of the
abdomen. She has a history of coronary artery disease, asthma, and atrial fibrillation.
Which of the following is the most likely diagnosis?
A. Toxic megacolon
B. Mesenteric thrombosis
C. Fulminant hepatitis
D. Acute diverticulitis with perforation - Answers - B. This patient is at risk for
*mesenteric ischemia* due to advanced age, atherosclerosis and atrial fibrillation. This
is the classic presentation for this condition with pain out of proportion to physical
examination findings.
A patient is hospitalized with a change in mental status. Examination reveals that he is
unable to maintain dorsiflexion of the wrists after pronating his arms in front of his body.
Which of the following is the most likely diagnosis?
A. Cocaine overdose
B. Hyperthyroidism
C. Hepatic encephalopathy
D. Parkinson's Disease - Answers - C. This is the description for asterixis that is seen
with *hepatic encephalopathy*, uremia, and carbon dioxide narcosis.
In order to prevent the hepatic complications associated with hemochromatosis, which
of the following is used early in the course of therapy?
A. Penicillamine
,B. Recurrent paracentesis
C. Albumin infusions
D. Recurrent phlebotomy - Answers - D
Which of the following is associated with an increased risk of developing esophageal
cancer?
A. Helicobacter pylori
B. Familial polyposis
C. Chronic gastric reflux
D. Hepatitis C - Answers - C
A 77 year-old male presents with a two-week history of cough. The patient also
complains of a bad taste in his mouth. He complains of mild midsternal chest pressure
but denies any dyspnea. He denies any dysphagia or history of recent URI. Evaluation
of the cardiac and pulmonary systems, including pulmonary function tests and exercise
stress testing, is normal. Upper endoscopy is normal. Which of the following is the next
step in the evaluation of this patient?
A. Upper GI study with barium
B. Esophageal pH monitoring
C. CT of the thorax
D. D-xylose test of the stool - Answers - B. pH monitoring to evaluate for GERD
Which of the following is considered to be the treatment of choice for the pruritus that
occurs with primary biliary cirrhosis?
A. Colchicine
B. Atorvastatin (Lipitor)
C. Cholestyramine (Questran)
D. Enalapril (Vasotec) - Answers - C. Cholestyramine, a bile salt sequestrant, is able to
decrease the pruritus that occurs from the bile stasis and granulomas.
Which of the following medications is most useful in maintaining remission in a patient
with ulcerative colitis?
A. Oral corticosteroids
B. Corticosteroid enemas
C. Sulfasalazine
D. Macrodantin - Answers - C. *Sulfasalazine*, olsalazine, and mesalamine are
effective in maintaining remission in patients with ulcerative colitis.
Which of the following is the treatment of choice for patients with Hepatitis C?
A. Prednisolone
B. Acyclovir and azathioprine
C. Cyclosporine
D. Pegylated interferon and ribavirin - Answers - D
, A 35 year-old male completed a 2-week course of ciprofloxacin and now complains of
abdominal cramping and diarrhea. Stool is positive for C. difficile toxins. Which of the
following is the drug of choice for treatment?
A. Amoxicillin
B. Metronidazole
C. Tetracycline
D. Trimethoprim-sulfamethoxazole - Answers - B
Hepatitis D infection (HDV) or delta agent hepatitis requires co-infection with which of
the following other types of hepatitis?
A. HAV
B. HBV
C. HCV
D. HEV - Answers - B
A 62 year-old male is brought to the emergency department with acute hematemesis.
The patient denies a previous history of vomiting. His wife states he has chronic liver
disease. Physical examination reveals a distended abdomen without rebound, guarding
or organomegaly. There is a fluid wave. Which of the following is the most likely
diagnosis?
A. Esophageal varices
B. Mallory-Weiss tear
C. Arteriovenous malformation
D. Perforated duodenal ulcer - Answers - A
A 50 year-old male with history of alcohol abuse presents with acute, severe epigastric
pain radiating to the back. The patient admits to an episode of coffee ground emesis.
On examination he is ill-appearing with a rigid, quiet abdomen and rebound tenderness.
Which of the following is the most likely diagnosis?
A. Abdominal aortic aneurysm
B. Perforated duodenal ulcer
C. Acute myocardial infarction
D. Cholecystitis - Answers - B
A patient presents with nausea, vomiting, and fever for one day. She describes
periumbilical abdominal pain which has settled in her right lower quadrant. On
examination she has right lower quadrant pain with deep left lower quadrant palpation.
This finding is known as which of the following?
A. Psoas sign
B. Rebound tenderness
C. Rovsing's sign
D. Obturator sign - Answers - C
Which of the following is the study of choice to diagnose upper gastrointestinal
malignancy?
A. Abdominal CT
Primary biliary cirrhosis will have which of the following laboratory results?
A. Decreased haptoglobin
B. Anticholinesterase antibodies
C. Antimitochondrial antibodies
D. Elevated ceruloplasmin - Answers - C
Which of the following diagnostic tests is considered to be the best initial test to order in
a patient with suspected gallbladder disease?
A. Ultrasound
B. Hepatic iminodiacetic acid (HIDA) scan
C. Flat plate of the abdomen
D. Endoscopic retrograde cholangiopancreatography (ERCP) - Answers - A.
*Ultrasound* of the abdomen is the best test for checking the extra-hepatic biliary tree
for ductal dilatation and choledocholithiasis.
(HIDA is if U/S is negative but still a high index of suspicion;
ERCP is to retrieve a stone, but not an initial study)
A 76 year-old female presents to the ED with the worst abdominal pain in her life. The
pain began following a large meal and is located periumbilically. Although she is
writhing in pain, she does not have an exacerbation of the pain on palpation of the
abdomen. She has a history of coronary artery disease, asthma, and atrial fibrillation.
Which of the following is the most likely diagnosis?
A. Toxic megacolon
B. Mesenteric thrombosis
C. Fulminant hepatitis
D. Acute diverticulitis with perforation - Answers - B. This patient is at risk for
*mesenteric ischemia* due to advanced age, atherosclerosis and atrial fibrillation. This
is the classic presentation for this condition with pain out of proportion to physical
examination findings.
A patient is hospitalized with a change in mental status. Examination reveals that he is
unable to maintain dorsiflexion of the wrists after pronating his arms in front of his body.
Which of the following is the most likely diagnosis?
A. Cocaine overdose
B. Hyperthyroidism
C. Hepatic encephalopathy
D. Parkinson's Disease - Answers - C. This is the description for asterixis that is seen
with *hepatic encephalopathy*, uremia, and carbon dioxide narcosis.
In order to prevent the hepatic complications associated with hemochromatosis, which
of the following is used early in the course of therapy?
A. Penicillamine
,B. Recurrent paracentesis
C. Albumin infusions
D. Recurrent phlebotomy - Answers - D
Which of the following is associated with an increased risk of developing esophageal
cancer?
A. Helicobacter pylori
B. Familial polyposis
C. Chronic gastric reflux
D. Hepatitis C - Answers - C
A 77 year-old male presents with a two-week history of cough. The patient also
complains of a bad taste in his mouth. He complains of mild midsternal chest pressure
but denies any dyspnea. He denies any dysphagia or history of recent URI. Evaluation
of the cardiac and pulmonary systems, including pulmonary function tests and exercise
stress testing, is normal. Upper endoscopy is normal. Which of the following is the next
step in the evaluation of this patient?
A. Upper GI study with barium
B. Esophageal pH monitoring
C. CT of the thorax
D. D-xylose test of the stool - Answers - B. pH monitoring to evaluate for GERD
Which of the following is considered to be the treatment of choice for the pruritus that
occurs with primary biliary cirrhosis?
A. Colchicine
B. Atorvastatin (Lipitor)
C. Cholestyramine (Questran)
D. Enalapril (Vasotec) - Answers - C. Cholestyramine, a bile salt sequestrant, is able to
decrease the pruritus that occurs from the bile stasis and granulomas.
Which of the following medications is most useful in maintaining remission in a patient
with ulcerative colitis?
A. Oral corticosteroids
B. Corticosteroid enemas
C. Sulfasalazine
D. Macrodantin - Answers - C. *Sulfasalazine*, olsalazine, and mesalamine are
effective in maintaining remission in patients with ulcerative colitis.
Which of the following is the treatment of choice for patients with Hepatitis C?
A. Prednisolone
B. Acyclovir and azathioprine
C. Cyclosporine
D. Pegylated interferon and ribavirin - Answers - D
, A 35 year-old male completed a 2-week course of ciprofloxacin and now complains of
abdominal cramping and diarrhea. Stool is positive for C. difficile toxins. Which of the
following is the drug of choice for treatment?
A. Amoxicillin
B. Metronidazole
C. Tetracycline
D. Trimethoprim-sulfamethoxazole - Answers - B
Hepatitis D infection (HDV) or delta agent hepatitis requires co-infection with which of
the following other types of hepatitis?
A. HAV
B. HBV
C. HCV
D. HEV - Answers - B
A 62 year-old male is brought to the emergency department with acute hematemesis.
The patient denies a previous history of vomiting. His wife states he has chronic liver
disease. Physical examination reveals a distended abdomen without rebound, guarding
or organomegaly. There is a fluid wave. Which of the following is the most likely
diagnosis?
A. Esophageal varices
B. Mallory-Weiss tear
C. Arteriovenous malformation
D. Perforated duodenal ulcer - Answers - A
A 50 year-old male with history of alcohol abuse presents with acute, severe epigastric
pain radiating to the back. The patient admits to an episode of coffee ground emesis.
On examination he is ill-appearing with a rigid, quiet abdomen and rebound tenderness.
Which of the following is the most likely diagnosis?
A. Abdominal aortic aneurysm
B. Perforated duodenal ulcer
C. Acute myocardial infarction
D. Cholecystitis - Answers - B
A patient presents with nausea, vomiting, and fever for one day. She describes
periumbilical abdominal pain which has settled in her right lower quadrant. On
examination she has right lower quadrant pain with deep left lower quadrant palpation.
This finding is known as which of the following?
A. Psoas sign
B. Rebound tenderness
C. Rovsing's sign
D. Obturator sign - Answers - C
Which of the following is the study of choice to diagnose upper gastrointestinal
malignancy?
A. Abdominal CT
