GASTROENTEROLOGY EXAM

1. Which of the following is NOT a common symptom of gastrointestinal disorder?

a. Heart burn
b. Jaundice
c. Odynophagia
d. Suprapubic pain

2. True about abdominal pain EXCEPT

a. Parietal pain is less severe than visceral pain and to localized
b. Visceral pain occurs when hollow organs (intestine, biliary tree) contract forcefully
or stretched
c. Visceral periumbilical pain signifies early appendicitis and gradually changes to
parietal pain in the right lower quadrant
d. Pain from acute myocardial infarction may be referred epigastric area

3. Which of the following signifies upper gastrointestinal bleed?

I. Melena II. Hematemesis III. Hematochezia
a. I, II
b. I, III
c. I, II, III
d. II

4.Which of the following is true regarding diarrhea?

a. Acute diarrhea lasts for 1and chronic diarrhea last for 3weeks
b. Acute diarrhea is typically infectious in origin and chronic caused by infection
c. High volume frequent watery stool usually from intestine
d. Diarrhea is increased water content of the stool or stool volume greater than 100

5. What is the most common cause of indigestion that results from many physiologic defects
such as reduced lower esophageal sphincter tone and transient LES relaxations?
a. Functional dyspepsia
b. Esophageal diverticula
c. Gastroesophegeal reflux
d. Gastritis

6.A 26 years old female patient came to you at the ER due to epigastric pain and has been
previously diagnosed with GERD, you would advise the following EXCEPT:

a. Limit intake of ethanol, caffeine and chocolate

b. Low-fat diet
c. Eating snacks before bedtime
d. Elevating the head of the bed during lying
7. The advantages of endoscopy over barium radiography in the evaluation of dysphagia include
all of the following EXCEPT:
a. Ability to intervene as well as diagnose
b. Ability to obtain biopsy specimens
c. Increased sensitivity or the detection of mucosal lesions
d. Ability to assess function and morphology

8. A 40-year-old man came in to the ER due to chest pain that developed after swallowing a
piece of steak. He had intermittent episodes of meat getting stuck in his lower chest over the
past 3 years, but none as severe as this event. He denies food regurgitation outside of these
episodes or heartburn symptoms. He is able to swallow liquids without difficulty and has not
had any weight loss. Which of the following is the most likely diagnosis?
a. Schatzki ring
b. Achalasia
c. Adenocarcinoma of the esophagus
d. Esophageal diverticula

9. What is the Initial treatment in Acute diarrhea? *

a. Antibiotic
b. Fecalysis
c. Hydaration
d. Loperamide

10. In chronic diarrhea, what is the example of secretory cause?

a. Addison disease
b. Lactase and other dissacharide deficiency
c. Osmotic laxatives
d. Radiation injury

11. There are several laboratory examinations requested to diagnose acute pancreatitis.
Which of the following laboratory results suggest pancreatitis? *
a. Serum amylase which is three fold higher than the upper normal
limit
b. CBC shows leukocytopenia and hemoconcentration
c. Hypercalcemia
d. BUN < 22 mg/dl

12. Which of the following is NOT an indicator of severity of pancreatitis?

a. Obesity
b. Presence of azotemia
c. Systemic inflammatory response syndrome
d. Age 60 years old
13. The management of acute pancreatitis begins in the emergency room. After a diagnosis
has been confirmed, what is the best and important step to do?
a. Give IV narcotic analgesics
b. Place patient on NPO and start enteral nutrition
c. Aggressive intravenous fluid resuscitation
d. Oxygen supplementation

14. Patients exhibiting signs of clinical deterioration despite aggressive fluid resuscitation
and hemodynamic monitoring should be assessed for local complications. Which of the
following statement is TRUE?
a. There is no rule of prophylactic antibiotics in necrotizing pancreatitis
b. Most of the pseudocyst does not resolve and requires drainage thru surgery or
endoscopic procedure
c. Hospital acquired infections occur in up to 10% of cases
d. All of the above

15. A 52 year old male came in the ER due to epigastric pain and hematemesis. On physical
examination, epigastric tenderness was noted. Upper GI bleeding secondary to peptic ulcer
disease was considered. Which of the following drugs is the most potent in inhibiting
gastric acid secretion?
a. Ranitidine
b. Bismuth salicylate
c. Sucralfate
d. Pantoprazole

16. A 40 year old male diagnosed of colon cancer underwent his 1st cycle of
chemotherapy. After which, patient experienced nausea and vomiting. Given this case,
which medication will you give?
a. Scopolamine
b. Ondansetron
c. Phenothiazines
d. Metoclopramide

17. What is a repeated effortless passage of gastric contents into the

mouth?

a. Emesis
b. Indigestion
c. belching
d. Rumination
18 . Which of the following is TRUE regarding gastroesophageal
reflux?
a. Increased lower esophageal spincter (LES)
b. Increased in esopahgeal body motility
c. Most cases heart burn result from excess non acidic reflux
d. Transient LES relaxation

19. A 75 year old male, alcoholic admitted at medical ICU due to CAP-HR on his 15 hospital day
with the following antibiotic received Clarithromycin, Piperacillin Tazobactam shifted to
Meropenemdue toprogression of pneumonia and culture based antibiotic. He developed
diarrhea on the 16th hospital day. What is the most likely causative agent?
a. E. Histolytica
b. Campylobacter
c. Clostridium difficile
d. Yersenia

20. Which of the following is INCORRECTLY match?

a. Bacillus cereus- fried rice/ reheated food
b. Staphylococcus aureus- mayonnaise/ creams
c. Listeria- in cooked foods/ soft cheese
d. None of the above

21. A 38 year old male patient with an lower GI bleeding no hemodynamic instability. What is
next step?
A. Angiography
B. Colonoscopy
C. Flexible sigmoidoscopy
D. Upper endoscopy

22. A 60 year old male with hematochezia a week with BP of 60/40 mmHg. What diagnostic test is
appropriate request?
a. Angiography
b. Colonoscopy
c. flexible sigmoidoscopy
d. upper endoscopy

23. Neurogenic abnormalities are one of the causes of motor/propulsive

dysphagia. Patientsusually present with difficulty in swallowing associated
with a neurologic deficit or abnormality. Which of the following scenarios are
myogenic causes of motor dysphagia?
a. A patient with dysphagia, hoarseness of voice, ptosis, weakness aggravated
by exertion and relieved by rest by the end of the day
b. A patient with violaceous tint over the eyelids, raised erythematous rash over extensor
surfaces, difficulty in changing clothes, combing hair, climbing stairs, standing up from a
sitting position
c. A patient with discoid rashes, oral ulcers, photosensitivity
d. All of the above

24. A patient with severe ascites underwent paracentesis. Ascitic fluid was sent for
examination. Ascitic Albumin s– 2.2 g/dl, Ascitic Protein 2g/dl, Serum Albumin – 3.4 g/dl, .
What is the SAAG of the patient? *
a. 5.5
b. 1.54
c. 1.2
d. 7.48

25. Aling bebang has been using pain medication to relieve her joint pain for 10 years
now, what enzyme is usually being depleted in chronic use of NSAIDS and a risk factor in
developing gastric ulcer?
a. COX 2
b. COX 1
c. Arachidonic acid
d. Prostaglandin

26. Aling Mando came in to ER w/ a complaint of black tarry stools for 3 days, what will beyour
next step?
a. Consider an upper GI bleed and do an endoscopy
b. Check the cbc of the patient
c. Do an andomianl x-ray to rule out obstruction
d. Complete history and PE

27. In relation to above question, after doing an upper GI endoscopy you noticed ulcer w/ signs
of recent hemorrhage with visible vessels at the antral area, what will be your forrest
classification?
a. IA
b. 1B
c. IIA
d. III

28. Mang Jose 69yr old farmer, and for 2 months he had episodes of fresh blood in his stools.
Barium study was done and revealed stricture and cobble stone like mass in endoscopy.
Whatwill be your consideration?
a. Ulcerative colitis
b. Chrons disease
c. Multiple polyposis
d. Diverticulitis

29. Patient experience hematemesis, approximately 2 glasses of fresh blood after

havingforceful retching. What will be your diagnosis? *
a. Bleeding gastric ulcer
b. Mallory Weiss tear
c. Bleeding Esophageal varices
d. Achalasia

30. What is your management in the above patients? *

a. Endoscopic therapy
b. IV PPI
c. Ligation
d. Octreotide

31. Manong Coco experience late night and early morning abdominal pain, he took antacidsw/c
offers relief and noticed after 2-3hrs of eating severe abdominal pain recurs. Most likelywhat
will be your diagnosis?
a. Gastric ulcer
b. GERD
c. Duodenal ulcer
d. Acute gastritis

32. In approach of GI symptoms, what is the most common indication of upper GI endoscopy?
a. Upper GI bleeding
b. Dysphagia
c. Dyspepsia despite treatment
d. Obstruction

33. Colonoscopy has been widely used as one of the modalities helping in our diagnosis as well
as therapeutic management in our patient. What is the most common indication in using
colonoscopy?
a. Obstruction
b. Cancer screening
c. Lower GI bleeding
d. Diarrhea
34. In cases of GI bleeding, the most common cause is?

a. Hemorrhoids
b. Neoplasm
c. Ulcer disease
d. Esophagitis

35. Diarrhea has been one of the common symptoms in patient having GI
symptoms. The most common cause of diarrhea? *
a. Medications
b. Infection
c. Microscopic colitis
d. Poorly absorbed sugars

36. What is the treatment in a patient with acute upper GI bleeding with a clean base ulcer?
A. Omeprazole IV + endoscopic therapy
B. Omprazole IV
C. Endoscopic therapy
D. NO IV PPI or endoscopic therapy

37. What is the best approach for a patient requiring elective surgery for Crohn disease with
obstructive symptoms?
A. Resection of the bowel to microscopically clear margins with primary anastomosis
B. Diverting ileostomy and future anastomosis
C. Resection of grossly normal bowel and primary anastomosis
D. Dilatation and transverse closure

38. A 25-year-old man presents with low-grade fever, weight loss, fatigue, crampy abdominal
pain, episodic diarrhea, and recurrent urinary tract infections. Physical examination reveals
pallor, and tender, erythematous lesions on the extensor surfaces of his legs. Right lower
quadrant tenderness is elicited on palpation of the abdomen. A capsule endoscopy reveals
thickening of the terminal ileum, edema, marked luminal narrowing, and a cobblestone
appearance of the mucosa. The patient undergoes successful surgery with an unremarkable
post-operative course. When should the patient undergo repeat ileocolonoscopy to monitor his
disease course?

A. 1 year
B. 2 years
C. 3 years
D. 5 years

39. Which feature most reliably differentiates Crohn disease from ulcerative colitis?
A. Age at presentation
B. Presence of extraintestinal symptoms
C. Blood in stools
D. Presence of granulomas

40. A 31-year-old female presents with progressive abdominal discomfort for the past few
weeks. Most days she has diarrhea, but on occasion, she has constipation. She also reports
bloating and flatulence. Stress and eating seem to increase symptoms, while defecation
improves her condition. She has not traveled out of the United States. Temperature is 36.7 C
(98 F), blood pressure is 118/74 mm Hg, the pulse is 74/min, and respirations are 14/min. A
physical exam is essentially normal. Labs show white blood cell count 7000 cells/microliter,
hemoglobin 10 grams/dL, hematocrit 30%, platelets 200,000, AST 91 U/L, ALT 112 U/L, and
erythrocyte sedimentation rate of 49 mm/hr. Stool shows no blood but is positive for
lactoferrin. Which of the following is the next best step in the management of this patient?

A. Fiber supplements
B. Colonoscopy
C. Biofeedback and antidepressants
D. Broad-spectrum antibiotics

41. Which of the following is the most common cause of ulcerative colitis-related mortality
A. Colonic adenocarcinoma
B. Toxic megacolon
C. Perforated colon
D. Colonic infarction

42. Which of the following is the most common extraintestinal manifestation associated with
ulcerative colitis?
A. Pulmonary manifestations
B. Hepatopancreatobiliary manifestations
C. Ocular manifestations
D. Musculoskeletal manifestations

43. Which of the following is a defining characteristic of severe ulcerative colitis?

A. More than four bowel movements per day
B. Bleeding from the rectum
C. A systemic illness with hypoalbuminemia (< 30 g/L)
D. Fistulae

44. Which of the following studies is used to help distinguish ulcerative colitis from infectious
colitis in a patient with acute onset of bloody diarrhea?
A. Radiography
B. Stool assays
C. Double-contrast barium enema
D. Mucosal biopsy
45. Which of the following is the preferred therapy in mild ulcerative colitis confined to the
rectum?
A. Topical mesalazine given by suppository
B. Oral prednisone
C. Intravenous azathioprine
D. Hydrocortisone given by enema

46. Inflammatory bowel disease (IBD) includes both Crohn disease and ulcerative colitis. IBD is a
relapsing and remitting condition characterized by chronic inflammation at various sites in the
GI tract resulting in diarrhea and abdominal pain. Which of the following is indicative of Crohn
disease but NOT ulcerative colitis?

A Gross rectal bleeding is always present

B. Inflammation is confined to mucosa except in severe cases
C. Inflammation is uniform and diffuse
D. Rectum is often spared

47. Which of the following disorders is clearly associated with IBD but appears regardless of
whether or not the patient is experiencing an IBD flare-up?
A. Aphthous stomatitis
B. Episcleritis
C. Erythema nodosum
D. Uveitis

48. MJP, a 25 year old female, diagnosed with Crohn’s Disease came in for complaints of pallor,
easy fatigability, and carpopedal spasm. Upon physical examination, (+) Chvostek’s sign and
Trousseau’s sign. Which of the following organs is most likely involved?
A. duodenum
B jejunum
C. ileum
D. cecum

49. True about inflammatory bowel disease except?

A. ulcerative colitis is a continuous process
B. Ulcerative colitis is associated with intestinal fistula, strictures, and perianal disease
C. elevated levels of alkaline phosphatase in a patient with UC suggest the presence of primary
schlerosing colangitis
D. the presence of strictures in patient with active UC suggest colonic adenocarcinoma

50. True of Crohn disease but not true of ulcerative colitis:

A. gross blood and mucus in stool
B. systemic symptoms
C. recurrence after surgery
D. ANCA (+)

51. A patient undergoing therapy for Crohn's Disease, had a reactivation of his Latent TB, what
Drug may have been responsible?
A. Rituximab
B. Sulfasalazine
C. 5-ASA
D. Infliximab

52. This condition presents with crypt abscesses and friable mucosal pseudopolyps. There is
also leadpipe appearance on imaging. What disease is this?
A. Crohn's disease
B. Ulcerative colitis
C. Irritable bowel syndrome
D. Peutz-Jeghers syndrome

53. Among elderly patients, which of the following is the most common cause of lower GI
bleeding?
A. Diverticulosis
B. Colorectal cancer
C. Anal fissure
D. Ulcerative colitis

54. The following parameters are components of the Child Pugh score, except:
A. Serum bilirubin
B. Serum albumin
C. Serum creatinine
D. Prothrombin time

55. The stigmata of liver cirrhosis include all of the following except:
A. Testicular atrophy
B. Spider angiomata
C. Gynecomastia
D. Esophageal varices

56. Which of the following hepatitis virus causes the most cases of chronic liver disease in
humans?
A. hepatitis A
B. hepatitis B
C. hepatitis C
D. hepatitis D
57. A middle-aged man presents with tiredness, itchiness, weakness, loss of appetite, and
weight loss. Physical examination reveals the presence of spider telangiectasias, palmar
erythema, Dupuytren's contractures, gynecomastia, and testicular atrophy. Laboratory results
are AST 100 U/L and ALT 150 U/L. Levels of which of the following is likely to be decreased?
A. Ammonia
B. Iron
C. Bilirubin
D. Albumin

58. A 56-year-old male patient presented with symptoms of intermittent episodes of constant,
sharp, right upper quadrant (RUQ) abdominal pain associated with nausea and vomiting,
normal physical examination findings, and normal laboratory test results. Which of the
following is pertinent to the underlying pathophysiological?
A. Disproportionately higher branched amino-acid intake
B. Microangiopathy in the common bile duct microvasculature
C. Hyperuricemia
D. Cholesterol supersaturation mechanism

59. Which of the following would present with an elevated AFP?

A. prostate cancer
B. cirrhosis
C. ovarian germ cell tumor
D both B and C

60. A 28-year-old pregnant woman at 16 weeks gestation comes to the office due to fatigue,
intermittent joint pains, and loss of appetite for several months. Her past medical history is
unremarkable. She does not use tobacco, alcohol, or any other illicit drugs. She has multiple
sexual partners and does not use condoms regularly. Her laboratory values show elevated
serum aspartate aminotransferase and alanine aminotransferase. Her serologic markers are
positive for hepatitis B infection. Which of the following markers has the strongest associated
with viral replication and increased infectivity in this patient?
A. HBcAg
B. Anti-HBsAg
C. HBeAg
D. HBcAg
ANSWER KEYS
1. D 23. D
2. A 24. C
3. A 25. D
4. C 26. D
5. C 27. C
6. C 28. B
7. D 29. B
8. A 30. A
9. C 31. C
10. A 32. C
11. A 33. B
12. D 34. C
13. C 35. B
14. A 36. D
15. D 37. A
16. B 38. A
17. D 39. D
18. D 40. B
19. C 41. B
20. D 42. D
21. C 43. C
22. D

44. D
45. A
46. D
47. D
48. A
49. B
50. D
51. D
52. B
53. B
54. C
55. D
56. C
57. D
58. D
59. D
60. C