FREE PANCE/PANRE GI and Nutrition Practice Exam

Gastroenterology Practice Exam

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Question 1
Which of the following is a common physical examination finding in early intestinal obstruction?
A
high fever
Hint:
Fever and rebound tenderness occur only if a perforation has occurred.
B
profuse flatulence
Hint:
Profuse flatulence is not noted in early intestinal obstruction.
C
rebound tenderness
Hint:
Fever and rebound tenderness occur only if a perforation has occurred.
D
hyperactive, high-pitched bowel sounds
Question 1 Explanation: 
Abdominal distention and high-pitched, hyperactive bowel sounds are common in early intestinal obstruction. Read more about this blueprint topic: Click Here
Question 2
A 14 month-old male who attends day care presents with a two-day history of frequent watery stools. His mother states that he had a fever and vomiting the day before but these have resolved. His mother denies pain in the child. The child is mildly dehydrated but otherwise appears well. Stool samples are free of blood and white blood cells. The lab reports no ova or parasites noted in the stool samples. Which of the following is the most likely diagnosis?
A
Intussusception
Hint:
Intussusception may cause diarrhea, however, after two days the stool would have blood present. The absence of pain or discomfort would also argue against this diagnosis.
B
Viral gastroenteritis
C
Shigella
Hint:
Patients with Shigella have dysentery with the passage of bloody stools in a toxic-appearing child
D
Lactase insufficiency
Hint:
Lactase insufficiency would not have caused fever and vomiting.
Question 2 Explanation: 
Rotavirus is the most common cause of gastroenteritis in children and this is frequently passed in the daycare setting.
Question 3
A patient develops abdominal cramps and watery diarrhea 10 to 12 hours after eating a plate of unrefrigerated meat and vegetables. The patient denies vomiting. The causative agent is most likely
A
Staphylococcus aureus
Hint:
Staphylococcus aureus has an incubation period of 1 to 6 hours and also characteristically has vomiting associated with it.
B
Clostridium perfringens
C
Escherichia coli
Hint:
The incubation period for Escherichia coli and Salmonella is greater than 16 hours.
D
Salmonella
Hint:
Salmonella is the cause of typhoid fever. Diarrhea will often be from poultry or pork or following raw egg ingestion. The incubation period is usually 8 to 14 days
Question 3 Explanation: 
Food poisoning caused by Clostridium perfringens has an incubation period of 8 to 14 hours and results from poorly refrigerated cooked meat. Read more about this blueprint topic: Click Here
Question 4
A 3 year-old presents with profuse watery diarrhea for the past three days. The child vomited twice yesterday, but not today. On exam, the child is febrile, with pulse of 142, respiratory rate of 18, and blood pressure of 60/40 mmHg. On exam, the child is alert and responsive, with no focal findings. Which of the following is the most appropriate intervention?
A
Antibiotic therapy
Hint:
In the US, infectious gastroenteritis is most frequently due to a virus. Antibiotic therapy may be second-line in cases where the causative organism is bacterial, is identified, and symptoms continue.
B
Begin soft diet
Hint:
See D for explanation.
C
IV fluids
Hint:
See D for explanation.
D
Oral rehydration
Question 4 Explanation: 
The goal of therapy for a child with severe gastroenteritis and dehydration is to restore fluid loss. Oral rehydration with an appropriate electrolyte solution is the best option if the child is not actively vomiting and is alert enough to take oral fluids. IV fluids should be reserved for those who are unable to take fluids orally. Read more about this blueprint topic: Click Here
Question 5
A 72 year-old male presents to the ED complaining of acute onset of severe diffuse abdominal pain of four hours duration. He states that he has vomited twice since the onset of pain. He also complains of three days of constipation. He is afebrile and the physical examination is noteworthy for a distended, diffusely tender abdomen with normoactive bowel sounds. His rectal exam reveals hemoccult positive brown stool. Medications include omeprazole (Prilosec) for GERD, digoxin and warfarin (Coumadin) for atrial fibrillation, OTC multivitamins and stool softeners. The abdominal and chest x-rays show no abnormalities. Which of the following is the most likely diagnosis?
A
Acute cholecystitis
Hint:
Acute cholecystitis causes right upper quadrant pain with radiation into the shoulder and does not cause hemoccult positive stools.
B
Mesenteric infarction
C
Perforated duodenal ulcer
Hint:
Abdominal and chest x-rays would reveal free air under the diaphragm in a ruptured duodenal ulcer and a small bowel obstruction would reveal air-fluid levels with distended bowel loops.
D
Small bowel obstruction
Hint:
Abdominal and chest x-rays would reveal free air under the diaphragm in a ruptured duodenal ulcer and a small bowel obstruction would reveal air-fluid levels with distended bowel loops.
Question 5 Explanation: 
Acute onset of severe diffuse abdominal pain in a person with atrial fibrillation warrants the suspicion of mesenteric infarction. Vomiting and constipation may be seen, along with occult blood in the stool. Bowel sounds may be normal. Read more about this blueprint topic: Click Here
Question 6
Which of the following treatments is the most appropriate for a patient with an acutely tender, fluctuant perirectal mass?
A
Fistulectomy
Hint:
There is no fistula present; therefore, a fistulectomy is not indicated.
B
Drainage of an abscess
C
Antibiotic therapy
Hint:
Antibiotic therapy is not indicated unless there is extensive cellulitis, or the patient is immunocompromised, has diabetes mellitus, or has valvular heart disease.
D
Removal of an anal fissure
Hint:
Anal fissures are linear tears. Indications for operative management include persistent pain, lack of healing, and recurrence.
Question 6 Explanation: 
Perirectal abscesses should be treated by drainage as soon as a diagnosis is established. Read more about this blueprint topic: Click Here
Question 7
Which of the following is suggestive of thiamine deficiency?
A
Ataxia
B
Bleeding
Hint:
A deficiency of Vitamin K would result in bleeding and an elevated prothrombin time.
C
Cheilosis
Hint:
Cheilosis, mucocutaneous lesions at the corners of the mouth, is the result of riboflavin deficiency.
D
Diarrhea
Hint:
A deficiency of niacin will result in diarrhea, dementia, and dermatitis.
Question 7 Explanation: 
Ataxia, mental deficits, horizontal nystagmus, muscle weakness and atrophy, and cardiomegaly are all clinical findings in thiamine deficiency. Read more about this blueprint topic: Click Here
Question 8
Which of the following would be consistent for a person who has a successful response to the hepatitis B immunization series?
A
HBsAg positive; anti-HBc positive; anti-HBs negative
Hint:
A positive HBsAg and positive anti-HBc with a negative anti-HBs would indicate either acute infection or chronic hepatitis B infection.
B
HBsAg negative; anti-HBc positive; anti-HBs positive
Hint:
A negative HBsAg with a positive anti-HBc and a positive anti-HBs would indicate a previous infection of hepatitis B.
C
HBsAg negative; anti-HBc negative; anti-HBs positive
D
HBsAg negative; anti-HBc negative; anti-HBs negative
Hint:
A person with a negative HBsAg, anti-HBc and anti-HBs is nonimmune and has never received the hepatitis B immunization series.
Question 8 Explanation: 
A person immunized against hepatitis B would have a positive anti-HBs with negative HBsAg and negative anti-HBc. Read more about this blueprint topic: Click Here
Question 9
A 20 year-old male presents with a mass in the groin. On examination with the patient standing, a mass is noted that extends into the scrotum. The patient denies any trauma. The most likely diagnosis is
A
an indirect inguinal hernia
B
a direct inguinal hernia
Hint:
A direct inguinal hernia is symmetrical, round and disappears easily with the patient lying down. It is the result of a weakness in the inguinal external ring. Hernial contents may radiate anteriorly rather than into the scrotum.
C
an obturator hernia
Hint:
Obturator hernias are more commonly seen in elderly women and are rarely palpable in the groin.
D
a femoral hernia
Hint:
Femoral hernias are rare in males and do not typically reduce with lying down.
Question 9 Explanation: 
An indirect inguinal hernia is caused by a patent processus vaginalis and the hernial contents may be felt in the ipsilateral scrotum. Read more about this blueprint topic: Click Here
Question 10
A 3 week-old male infant presents with recurrent regurgitation after feeding that has progressed to projectile vomiting in the last few days. The mother states that the child appears hungry all of the time. She denies any diarrhea in the child. Which of the following clinical findings is most likely?
A
Bile-stained vomitus
Hint:
Gastric obstruction, such as that seen with pyloric stenosis, causes vomiting that is not bilious.
B
Hemoccult positive stools
Hint:
Blood-streaked vomitus, but not hemoccult positive stools, may be seen in pyloric stenosis.
C
Olive-sized mass in the right upper abdomen
D
Sausage-shaped mass in the upper-mid abdomen
Hint:
A sausage-shaped mass may be noted in intussusception, not pyloric stenosis.
Question 10 Explanation: 
An olive-sized mass may be palpated in the right upper abdomen in pyloric stenosis and if found, is pathognomonic for pyloric stenosis. Read more about this blueprint topic: Click Here
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