Free practice quiz
ABIM Gastroenterology Prep Course (GI): free quiz
10 questions from the program. See your score right away, then unlock the explanation of every answer.
- Question 1 of 10
A 68-year-old man reports 5 months of dysphagia. Food feels stuck behind the sternum. Initially this occurred only with steak and bread, but now it occurs with soft foods; liquids still pass. He has lost 6 kg and has new iron-deficiency anemia. He has a 40-pack-year smoking history and chronic reflux. Examination is unremarkable. Which pattern recognition and next step are most appropriate?
Dysphagia Pattern Recognition
Progression from solids toward soft foods indicates mechanical esophageal obstruction; weight loss and anemia are alarm features, so prompt EGD with biopsy is required. D is tempting because achalasia causes substernal sticking, but motility disorders affect solids and liquids early. A is wrong because there is no coughing, nasal regurgitation, or initiation difficulty. A can cause intermittent solid-food dysphagia or impaction, but progressive symptoms plus anemia and weight loss raise cancer concern.
Diagnose mechanical obstruction; order urgent EGD/biopsy; treat based on pathology; escalate for malignancy staging or obstruction. - Question 2 of 10
A 67-year-old patient develops odynophagia while taking an oral medication known to cause pill esophagitis. Endoscopy demonstrates localized mucosal injury, and the clinician suspects that the tablet remained in contact with the esophageal lining during swallowing. Which anatomical circumstance most strongly supports this proposed mechanism?
A. Correct. Pill-induced esophagitis commonly occurs at anatomic narrowings, where medication contact with the esophageal lining may contribute to localized injury. This location is an important clue when the history includes an implicated oral medication.
B. Incorrect. Characteristic endoscopic patterns of infection help distinguish infectious etiologies, but they do not directly support the proposed mechanism of localized pill injury.
C. Incorrect. Immunocompromise is particularly relevant to Candida, CMV, and HSV esophagitis. It does not by itself explain localized medication-associated injury at an anatomic narrowing.
D. Incorrect. Endoscopic findings supporting CMV would favor an infectious explanation for the inflammation rather than the proposed pill-contact mechanism.
- Question 3 of 10
A 59-year-old woman undergoes upper endoscopy for persistent upper abdominal discomfort. A gastric polyp is identified, and the gastroenterologist explains that histologic classification is important because different gastric polyp types have different malignant potential. Which of the following polyp types generally carries the greatest risk of progression to gastric adenocarcinoma?
A: Incorrect. Sporadic fundic gland polyps without dysplasia generally have low malignant potential compared with gastric adenomas.
B: Incorrect. Hyperplastic gastric polyps can have neoplastic potential, but nondysplastic hyperplastic polyps generally carry less direct malignant risk than adenomatous polyps.
C: Incorrect. A benign mucosal fold is not an adenomatous neoplasm and does not carry the characteristic malignant potential of a gastric adenoma.
D: Correct. Gastric adenomatous polyps are important premalignant epithelial lesions. Their association with dysplasia and potential progression to gastric adenocarcinoma makes histologic recognition and appropriate neoplasia-directed management essential.
- Question 4 of 10
A 38-year-old woman with established celiac disease returns because diarrhea and bloating have continued after she was advised to follow a gluten-free diet. During the visit, she acknowledges intermittently consuming foods containing gluten because she believed small amounts were acceptable. What is the most appropriate next step in evaluating her persistent symptoms?
A: Incorrect. Refractory celiac disease is an important consideration in persistent symptoms, but continued gluten exposure must be addressed before attributing symptoms to refractory disease.
B: Incorrect. Small-bowel lymphoma and adenocarcinoma are major complications of celiac disease, but persistent diarrhea with acknowledged gluten ingestion does not justify automatically assuming malignancy.
C: Correct. Persistent symptoms despite a prescribed gluten-free diet require careful assessment of actual gluten exposure. The patient's admitted consumption provides a potentially correctable explanation that should be addressed before pursuing a refractory diagnosis.
D: Incorrect. Autoimmune enteropathy belongs in the differential diagnosis, but an established celiac diagnosis should not be discarded without reassessment, particularly when ongoing gluten exposure is already identified.
- Question 5 of 10
A 34-year-old woman has 8 months of crampy lower abdominal pain occurring several days weekly. Pain improves after defecation and is associated with more frequent loose stools; loose stools occur on 40% of stool days and hard stools on fewer than 10%. She has no rectal bleeding, nocturnal diarrhea, fever, weight loss, or family history of colorectal cancer. Examination is normal. Hemoglobin, C-reactive protein, and tissue transglutaminase IgA are normal.
IBS Diagnostic Features
IBS-D is recurrent abdominal pain associated with defecation and altered stool form/frequency, without alarm features; loose stools on at least 25% and hard stools on less than 25% of abnormal stool days support IBS-D. Microscopic colitis is tempting because diarrhea is nonbloody, but it usually causes chronic watery, often nocturnal diarrhea in older adults and requires colonic biopsies. Celiac disease can mimic IBS-D, but negative tissue transglutaminase IgA and no malabsorptive features argue against it. Ulcerative colitis would suggest rectal bleeding, urgency, elevated inflammatory markers, or endoscopic inflammation.
Diagnose IBS when Rome-pattern pain and bowel change occur without alarms; order limited testing such as CBC, CRP, and celiac serology in IBS-D; treat with diet and bowel-directed therapy. - Question 6 of 10
Four hospitalized patients are being evaluated for colitis-related complications. The gastroenterology service must identify the patient requiring the highest immediate concern for toxic megacolon. Which patient has the most concerning presentation?
A: Correct. Severe infectious colitis can lead to toxic megacolon, particularly when systemic toxicity, abdominal distention, ileus, and colonic dilation occur together. This combination should prompt urgent multidisciplinary escalation.
B: Incorrect. Mild, clinically stable colitis without abdominal distention lacks the major warning findings described for toxic megacolon.
C: Incorrect. Improvement without systemic toxicity or colonic dilation is less concerning for fulminant deterioration than the combination of findings in option A.
D: Incorrect. Although inflammatory colitis can be complicated by toxic megacolon, the absence of systemic deterioration, ileus, and distention makes this presentation less immediately concerning than severe infectious colitis with all the characteristic warning signs.
- Question 7 of 10
1. A 34-year-old woman with ulcerative colitis reports new eye redness, discomfort, and blurred vision despite improvement in her gastrointestinal symptoms. Her gastroenterologist suspects an inflammatory process related to her underlying disease. Which of the following is the most appropriate next step?
A: Incorrect. Extraintestinal manifestations do not universally parallel intestinal disease activity. Improvement in bowel symptoms does not exclude inflammatory eye disease.
B: Incorrect. Medication toxicity can mimic extraintestinal disease, but it should remain a competing consideration rather than an unconfirmed diagnosis.
C: Correct. Uveitis is a recognized extraintestinal manifestation of inflammatory bowel disease. New ocular symptoms warrant evaluation for this complication, with ophthalmology involvement reflecting the importance of multidisciplinary management.
D: Incorrect. Infection is an important alternative explanation, but assuming infection without considering uveitis overlooks a classic extraintestinal manifestation.
- Question 8 of 10
A 32-year-old man with Crohn disease has persistent abdominal symptoms despite his current maintenance regimen. Cross-sectional imaging demonstrates active intestinal inflammation and an adjacent intra-abdominal abscess. His gastroenterologist is considering escalation of immunosuppressive therapy. What is the most appropriate next step?
A: Incorrect. Although active Crohn inflammation may eventually require intensified treatment, escalating immunosuppression before controlling an abscess reverses the recommended management sequence.
B: Correct. In Crohn disease complicated by an intra-abdominal abscess, the abscess must be controlled before immunosuppressive therapy is escalated. This establishes the appropriate priority when inflammatory and penetrating complications coexist.
C: Incorrect. Addressing intestinal inflammation alone does not adequately manage a recognized abscess. The abscess requires attention before treatment escalation.
D: Incorrect. Delaying abscess control until after intensified immunosuppression is inconsistent with the principle that abscess management precedes immunosuppressive escalation.
- Question 9 of 10
A 58-year-old man is hospitalized with acute pancreatitis. During the first several days, his abdominal pain improves, but he continues to have organ failure despite ongoing supportive management. Which finding is the strongest indicator of an unfavorable prognosis?
A: Incorrect. Improvement in abdominal pain does not outweigh the prognostic significance of persistent organ failure. Pancreatitis severity requires assessment of systemic and organ complications rather than symptoms alone.
B: Incorrect. Early CT imaging may underestimate pancreatic necrosis. An initially reassuring scan does not eliminate the risk of a severe clinical course.
C: Correct. Persistent organ failure is a major indicator of worse prognosis in acute pancreatitis. Its continued presence warrants heightened concern even when abdominal symptoms improve.
D: Incorrect. Resolution of systemic inflammatory findings is not the strongest adverse prognostic feature. Persistent organ failure remains particularly concerning.
- Question 10 of 10
A 72-year-old man presents with progressive yellowing of his skin and a 7-kg unintentional weight loss over 3 months. He denies abdominal pain, and laboratory testing confirms hyperbilirubinemia. He was also diagnosed with diabetes mellitus 4 months ago despite having no previous history of hyperglycemia. Which diagnosis should be prioritized in the evaluation?
A — Correct: Painless jaundice, unexplained weight loss, and newly diagnosed diabetes constitute a classic constellation of clues for pancreatic adenocarcinoma. Their coexistence should prompt evaluation for pancreatic malignancy.
B — Incorrect: Although diabetes is present, uncomplicated diabetes does not adequately account for the concurrent painless jaundice and significant weight loss. New diabetes is itself an important clue to pancreatic adenocarcinoma.
C — Incorrect: Biliary colic does not adequately explain the combination of painless jaundice, weight loss, and new diabetes. These findings collectively warrant investigation for pancreatic malignancy.
D — Incorrect: A functional pain disorder does not explain objective jaundice and progressive weight loss, particularly in a patient reporting no abdominal pain.
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