Gastroenterology 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 31

Welcome to episode 31 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Join me as I continue to cover topic specific PANCE and PANRE review from the Academy course content following the NCCPA™ content blueprint.

This week we will be covering 10 topic specific Gastroenterology board review questions.

Gastroenterology and Nutrition accounts for 10% of your PANCE/PANRE board exam.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full Gastroenterology/Nutrition review includes over 149 GI/Nutrition specific questions and is available to all members of the PANCE and PANRE Academy.

You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
You can listen to the latest episode, take an interactive quiz and download your results below.

Listen Carefully Then Take The Quiz

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Gastroenterology PANCE and PANRE Podcast Quiz

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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: See A for explanation.
D	hyperactive, high-pitched bowel sounds

Question 1 Explanation:

Abdominal distention and high-pitched, hyperactive bowel sounds are common in early intestinal obstruction.

Question 2

Which of the following studies is most appropriate to diagnose celiac disease?

A	Urinary D-xylose test Hint: Urinary D-xylose test assesses the proximal small intestinal mucosa's absorption of carbohydrates but is not specific to celiac disease.
B	Small bowel biopsy
C	Barium contrast x-ray Hint: Barium contrast examination would reveal anatomic abnormalities or blind loop syndrome that may lead to malabsorption but it would not help in the diagnosis of celiac disease.
D	Schilling test Hint: The Schilling test is used to determine the cause of cobalamin malabsorption from pernicious anemia, chronic pancreatitis, achlorhydria and bacterial overgrowth syndrome but has no role in the diagnosis of celiac disease.

Question 2 Explanation:

Definitive diagnosis of celiac disease is made by small bowel biopsy.

Question 3

Which of the following tumor markers is useful in monitoring a patient for recurrence of colorectal cancer after surgical resection?

A	CA-125 Hint: CA-125 tumor marker is useful as a tumor marker in ovarian cancer
B	Carcinoembryonic antigen
C	5-hydroxyindoleacetic acid Hint: 5-hydroxindoleacetic acid is used as a tumor marker in carcinoid syndrome.
D	Alpha-1-fetoprotein Hint: Hepatocellular and testicular cancer can be followed by the use of alpha-1-fetoprotein as a tumor marker.

Question 3 Explanation:

Carcinoembryonic antigen can be used to monitor a patient for the return of colorectal cancer after treatment.

Question 4

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: E. Coli is a frequent cause of traveler's diarrhea. The incubation period for Escherichia coli 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 4 Explanation:

Food poisoning caused by Clostridium perfringens has an incubation period of 8 to 14 hours and results from poorly refrigerated cooked meat.

Question 5

The most common initial presenting symptom of primary biliary cirrhosis is

A	jaundice Hint: Jaundice, palmar erythema and xanthomas appear late in the disease.
B	palmar erythema Hint: See A for explanation.
C	pruritus
D	xanthomas Hint: See A for explanation.

Question 5 Explanation:

Pruritus is the most common initial symptom in primary biliary cirrhosis due to the accumulation of bile salts.

Question 6

Initial pharmacologic treatment of acute hepatic encephalopathy consists of

A	lactulose
B	omega-3-fatty acids Hint: Omega-3-fatty acids have no role in the treatment of hepatic encephalopathy.
C	neomycin Hint: Neomycin, like lactulose, will decrease ammonia production by intestinal bacteria and may have a role in chronic but not acute management of hepatic encephalopathy.
D	mannitol Hint: Mannitol is used as an osmotic diuretic

Question 6 Explanation:

Lactulose acts as an osmotic laxative decreasing ammonia absorption and decreases ammonia production by directly affecting bacterial metabolism.

Question 7

Congenital absence of ganglionic nerve cells innervating the bowel wall is seen in which of the following conditions?

A	Hirschsprung's disease
B	Meckel's diverticulum Hint: Meckel's diverticulum results from the failure of the vitelline duct to separate from the intestine during early gestation leading to an outpouching in the intestinal tract.
C	Chagas disease Hint: Chagas disease results from infection with the Trypanosoma parasite. Chronic Chagas disease may lead to the loss of dorsal motor nuclear cells of the vagus nerve, resulting in megaesophagus and megacolon.
D	Hashimoto's hypothyroidism Hint: Ineffective peristalsis of the colon from hypothyroidism may result in constipation but not Hirschsprung disease

Question 7 Explanation:

Hirschsprung disease, also termed congenital aganglionic megacolon, results from a lack of ganglion cells in the bowel wall.

Question 8

A middle-aged patient is being treated for recurrent diarrhea and peptic ulcer disease that is refractory to adequate standard therapy. Which of the following is the most likely diagnosis?

A	Achlorhydria Hint: The clinical picture of diarrhea with peptic ulcer disease refractory to adequate standard therapy is consistent with gastric acid hypersecretion, not achlorhydria.
B	Drug resistant H. pylori infection Hint: Drug resistant infection from H. pylori has not been reported and would not explain the associated diarrhea.
C	Zollinger-Ellison syndrome
D	Giardiasis Hint: Giardiasis causes acute diarrhea but is not associated with peptic ulcer disease.

Question 8 Explanation:

Zollinger-Ellison syndrome is the result of unregulated release of gastrin resulting in gastric acid hypersecretion. Up to 50% of patients complain of diarrhea along with peptic ulcer disease.

Question 9

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 9 Explanation:

Ataxia, mental deficits, horizontal nystagmus, muscle weakness and atrophy, and cardiomegaly are all clinical findings in thiamine deficiency.

Question 10

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 10 Explanation:

A person immunized against hepatitis B would have a positive anti-HBs with negative HBsAg and negative anti-HBc. Physician Assistant Exam Review Podcast covering Diseases of the Gallbladder and Liver

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Comments

Clinical Research says

March 17, 2019 at 9:42 pm

Hi..
Thank you for all these wonderful and informative blog. This will be very helpful for my research studies as I am preparing for Clinical research fellowship. This will very beneficial for me. Thank you once again.keep sharing such informative blogs

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