GI EXAM 1 PRACTICE QUESTIONS & ANSWERS
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 - Answer -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 - Answer -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 - Answer -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 - Answer -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 - Answer -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 - Answer -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?
A. Admit for IV fluids and cipro + metronidazole, schedule routine cholecystectomy to
prevent complications
B. Discharge with PPI and instruct patient to f/u with primary care if not feeling better in
1 week
C. Discharge with zofran and schedule cholecystectomy within 1 week
D. Admit for IV doxycycline, IV morphine, and schedule urgent cholecystectomy to
prevent complications - Answer -A. Admit for IV fluids and cipro + metronidazole,
schedule routine cholecystectomy to prevent complications
Dis gal has acute cholecystitis. Why? Bc she has epigastric pain, fever, N/V, blah blah
blah OH AND THE NICE LIL GALLSTONES ON US!! So ya know she's got gallstones,
and the presence of the fever and involuntary guarding should hint that this has
progressed to acute cholecystitis. And for that we tx by:
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 - Answer -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 - Answer -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 - Answer -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 - Answer -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 - Answer -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 - Answer -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?
A. Admit for IV fluids and cipro + metronidazole, schedule routine cholecystectomy to
prevent complications
B. Discharge with PPI and instruct patient to f/u with primary care if not feeling better in
1 week
C. Discharge with zofran and schedule cholecystectomy within 1 week
D. Admit for IV doxycycline, IV morphine, and schedule urgent cholecystectomy to
prevent complications - Answer -A. Admit for IV fluids and cipro + metronidazole,
schedule routine cholecystectomy to prevent complications
Dis gal has acute cholecystitis. Why? Bc she has epigastric pain, fever, N/V, blah blah
blah OH AND THE NICE LIL GALLSTONES ON US!! So ya know she's got gallstones,
and the presence of the fever and involuntary guarding should hint that this has
progressed to acute cholecystitis. And for that we tx by:
