GI EXAM MASTER QUESTIONS AND ANSWERS
A 14-year-old boy presents with a 1-week history of acute watery diarrhea with vague abdominal
discomfort and vomiting. He has developed fever, malaise, facial and periorbital edema, and myalgias.
He is experiencing pain and swelling of the calf muscles. The patient ate some food prepared from pork
and game meat in a restaurant 3-4 weeks ago. Blood examination shows moderate eosinophilia.
Most likely etiological agent? - CORRECT ANSWER✅✅✅Trichinella spiralis
A 27-year-old woman presents with intermittent epigastric pain of 6 months duration. She explains that
her pain worsens 2 hours after eating breakfast, particularly cereal and other milk products. She also
endorses symptoms of diarrhea, flatulence, and postprandial bloating. Upon physical exam,
temperature is 98.1°F, blood pressure is 120/80 mm Hg, and there are no signs of epigastric pain on light
or deep palpation.
Diagnosis? - CORRECT ANSWER✅✅✅Lactose intolerance
A 28-year-old woman presents to the emergency department due to a 3-hour history of nausea,
abdominal cramping, vomiting, and watery diarrhea. She recounts her lunch approximately 8 hours ago,
which consisted of a shrimp salad and a diet soda. She denies any neurological or other symptoms. She
also denies any similar problems prior to this episode and was feeling well just before this incident. She
denies fever or recent travel.
Most likely pathogen? - CORRECT ANSWER✅✅✅Vibrio parahaemolyticus.
A 45-year-old chronic alcoholic man presents with history of massive hematemesis. This hematemesis
followed a bout of prolonged vomiting. Patient has been a known alcoholic for 20 years. On
examination, he has a pulse rate of 100/min and a BP of 90/70 mm Hg with cold extremities.
what is most likely to be found on physical exam? - CORRECT ANSWER✅✅✅esophageal lacerations
(mallory weiss)
A 53-year-old man presents with increased difficulty swallowing and occasional regurgitation of his
meals. His symptoms have been occurring with greater frequency and severity over the last 4 months.
He also gets some shortness of breath but attributes that to his weight and lack of physical activity.
,His past medical history is remarkable for chronic heartburn, which he treats intermittently with over-
the-counter antacids. He takes no regular medications and he has no allergies. He has not had any
surgeries. He is a smoker, but he denies use of alcohol and drugs. He works as a building inspector and
he lives with his wife and children.
The patient is obese, but the rest of his physical exam is normal. Blood tests, electrocardiogram, and
chest X-ray are done in the clinic; they are normal. He is referred for endoscopy, and esophageal biopsy
shows specialized intestinal metaplastic cells (of columnar epithelium).
Bes - CORRECT ANSWER✅✅✅Esomeprazole (Barrett's esophagus)
A 52-year-old man presents with heartburn associated with reflux of sour-tasting material into the
mouth. Some of these episodes are accompanied by increased salivation, coughing, and occasional
regurgitation of food. Such episodes have become more frequent during the past 6 months despite
treatment over the past several years with various treatment combinations, including antacids,
histamine 2 receptor antagonists (H2RAs), and protein pump inhibitors (PPIs). He denies any bleeding or
abnormalities in his stools. He is slightly overweight and has mild hypertension, which is well-controlled
with an antihypertensive medication. Vital signs are within normal ranges and the physical examination
is unremarkable. An upper endoscopy reveals a large hiatal hernia and coalescing linear erosions
throughout the esophageal circumference and a 5.5 cm circumferential cherry red patch above the
gastroesophageal junction. Biopsy of - CORRECT ANSWER✅✅✅Laparoscopic fundoplication
An obese 45-year-old woman presents with intermittent epigastric pain of 3 weeks duration. She
explains that her pain worsens in the evenings and when lying down in bed. Her pain worsens when she
eats chocolate. Upon physical exam, temperature is 98.1°F, blood pressure is 120/80 mm Hg, and there
are no signs of epigastric pain on light or deep palpation.
Diagnosis? - CORRECT ANSWER✅✅✅GERD
Early one afternoon, a 12-year-old boy presents with his parents to the ER with lower right abdominal
pain, anorexia, nausea, and vomiting. He rates his pain at 8/10. Pain started around the umbilical area
and has moved to the right lower abdomen worsening since the onset of symptoms of nausea and
vomiting this morning. He denies any known history of gastrointestinal disease or recent illnesses. He
denies any known ill contacts. Vital signs include temperature of 101°F, heart rate 80 bpm and regular,
blood pressure 118/70 mm Hg.
What do you expect to find on physical exam? - CORRECT ANSWER✅✅✅Rovsing sign
, A 63-year-old woman presents with a 6-month history of worsening difficulty in swallowing. Shortly
after swallowing, she feels like something is getting stuck in her upper chest, and the sensation lasts
long enough to begin causing significant chest discomfort just behind her breastbone. The difficulty
swallowing is often extremely variable and intermittent; it has not been progressive. It gets to the point
that she feels like she is going to regurgitate her food, and she is also experiencing substantial episodes
of acid reflux. The difficulty swallowing seems to be worsened by when the patient is extremely stressed
and when she eats hot or cold food. She denies any weight loss, night sweats, or other significant issues.
Physical examination of the patient is otherwise noncontributory. An extensive gastrointestinal
evaluation, which included a comprehensive endoscopic evaluation, is negative.
Medication? - CORRECT ANSWER✅✅✅Diltiazem- calcium channel blocker (esophageal dysphagia)
A 25-year-old man presents for evaluation of intermittent chest pain. He reports a burning sensation in
his chest 1-2 days per week after eating. The symptoms are worse with large meals, eating late at night,
and excessive alcohol consumption. He denies difficulty swallowing, weight loss, night sweats, chest
pain, use of tobacco, or coughing up blood. His vital signs and physical examination are unremarkable.
Most appropriate treatment? - CORRECT ANSWER✅✅✅H2 blockers/dietary modifications
then can try PPI
A 65-year-old man presents because a morsel of meat he had eaten 3 days ago reappeared on his pillow
this morning. About a year ago, he noticed difficulty swallowing—particularly solid foods—which seems
to be worsening. His wife complains about his bad breath, and he notes that people avoid being close to
him. He does not drink, does not smoke, and was in a good health before. His physical examination is
within normal range for his age, except that you notice that he is repeatedly clearing his throat as if he is
embarrassed.
Next best step? - CORRECT ANSWER✅✅✅Barium swallow (Zanker diverticulum)
A 45-year-old man presents with extreme asthenia and weight loss. He has been suffering from celiac
disease for the past 12 years. He is at the highest risk of developing what type of intestinal malignancy? -
CORRECT ANSWER✅✅✅intestinal lymphoma
A 14-year-old boy presents with a 1-week history of acute watery diarrhea with vague abdominal
discomfort and vomiting. He has developed fever, malaise, facial and periorbital edema, and myalgias.
He is experiencing pain and swelling of the calf muscles. The patient ate some food prepared from pork
and game meat in a restaurant 3-4 weeks ago. Blood examination shows moderate eosinophilia.
Most likely etiological agent? - CORRECT ANSWER✅✅✅Trichinella spiralis
A 27-year-old woman presents with intermittent epigastric pain of 6 months duration. She explains that
her pain worsens 2 hours after eating breakfast, particularly cereal and other milk products. She also
endorses symptoms of diarrhea, flatulence, and postprandial bloating. Upon physical exam,
temperature is 98.1°F, blood pressure is 120/80 mm Hg, and there are no signs of epigastric pain on light
or deep palpation.
Diagnosis? - CORRECT ANSWER✅✅✅Lactose intolerance
A 28-year-old woman presents to the emergency department due to a 3-hour history of nausea,
abdominal cramping, vomiting, and watery diarrhea. She recounts her lunch approximately 8 hours ago,
which consisted of a shrimp salad and a diet soda. She denies any neurological or other symptoms. She
also denies any similar problems prior to this episode and was feeling well just before this incident. She
denies fever or recent travel.
Most likely pathogen? - CORRECT ANSWER✅✅✅Vibrio parahaemolyticus.
A 45-year-old chronic alcoholic man presents with history of massive hematemesis. This hematemesis
followed a bout of prolonged vomiting. Patient has been a known alcoholic for 20 years. On
examination, he has a pulse rate of 100/min and a BP of 90/70 mm Hg with cold extremities.
what is most likely to be found on physical exam? - CORRECT ANSWER✅✅✅esophageal lacerations
(mallory weiss)
A 53-year-old man presents with increased difficulty swallowing and occasional regurgitation of his
meals. His symptoms have been occurring with greater frequency and severity over the last 4 months.
He also gets some shortness of breath but attributes that to his weight and lack of physical activity.
,His past medical history is remarkable for chronic heartburn, which he treats intermittently with over-
the-counter antacids. He takes no regular medications and he has no allergies. He has not had any
surgeries. He is a smoker, but he denies use of alcohol and drugs. He works as a building inspector and
he lives with his wife and children.
The patient is obese, but the rest of his physical exam is normal. Blood tests, electrocardiogram, and
chest X-ray are done in the clinic; they are normal. He is referred for endoscopy, and esophageal biopsy
shows specialized intestinal metaplastic cells (of columnar epithelium).
Bes - CORRECT ANSWER✅✅✅Esomeprazole (Barrett's esophagus)
A 52-year-old man presents with heartburn associated with reflux of sour-tasting material into the
mouth. Some of these episodes are accompanied by increased salivation, coughing, and occasional
regurgitation of food. Such episodes have become more frequent during the past 6 months despite
treatment over the past several years with various treatment combinations, including antacids,
histamine 2 receptor antagonists (H2RAs), and protein pump inhibitors (PPIs). He denies any bleeding or
abnormalities in his stools. He is slightly overweight and has mild hypertension, which is well-controlled
with an antihypertensive medication. Vital signs are within normal ranges and the physical examination
is unremarkable. An upper endoscopy reveals a large hiatal hernia and coalescing linear erosions
throughout the esophageal circumference and a 5.5 cm circumferential cherry red patch above the
gastroesophageal junction. Biopsy of - CORRECT ANSWER✅✅✅Laparoscopic fundoplication
An obese 45-year-old woman presents with intermittent epigastric pain of 3 weeks duration. She
explains that her pain worsens in the evenings and when lying down in bed. Her pain worsens when she
eats chocolate. Upon physical exam, temperature is 98.1°F, blood pressure is 120/80 mm Hg, and there
are no signs of epigastric pain on light or deep palpation.
Diagnosis? - CORRECT ANSWER✅✅✅GERD
Early one afternoon, a 12-year-old boy presents with his parents to the ER with lower right abdominal
pain, anorexia, nausea, and vomiting. He rates his pain at 8/10. Pain started around the umbilical area
and has moved to the right lower abdomen worsening since the onset of symptoms of nausea and
vomiting this morning. He denies any known history of gastrointestinal disease or recent illnesses. He
denies any known ill contacts. Vital signs include temperature of 101°F, heart rate 80 bpm and regular,
blood pressure 118/70 mm Hg.
What do you expect to find on physical exam? - CORRECT ANSWER✅✅✅Rovsing sign
, A 63-year-old woman presents with a 6-month history of worsening difficulty in swallowing. Shortly
after swallowing, she feels like something is getting stuck in her upper chest, and the sensation lasts
long enough to begin causing significant chest discomfort just behind her breastbone. The difficulty
swallowing is often extremely variable and intermittent; it has not been progressive. It gets to the point
that she feels like she is going to regurgitate her food, and she is also experiencing substantial episodes
of acid reflux. The difficulty swallowing seems to be worsened by when the patient is extremely stressed
and when she eats hot or cold food. She denies any weight loss, night sweats, or other significant issues.
Physical examination of the patient is otherwise noncontributory. An extensive gastrointestinal
evaluation, which included a comprehensive endoscopic evaluation, is negative.
Medication? - CORRECT ANSWER✅✅✅Diltiazem- calcium channel blocker (esophageal dysphagia)
A 25-year-old man presents for evaluation of intermittent chest pain. He reports a burning sensation in
his chest 1-2 days per week after eating. The symptoms are worse with large meals, eating late at night,
and excessive alcohol consumption. He denies difficulty swallowing, weight loss, night sweats, chest
pain, use of tobacco, or coughing up blood. His vital signs and physical examination are unremarkable.
Most appropriate treatment? - CORRECT ANSWER✅✅✅H2 blockers/dietary modifications
then can try PPI
A 65-year-old man presents because a morsel of meat he had eaten 3 days ago reappeared on his pillow
this morning. About a year ago, he noticed difficulty swallowing—particularly solid foods—which seems
to be worsening. His wife complains about his bad breath, and he notes that people avoid being close to
him. He does not drink, does not smoke, and was in a good health before. His physical examination is
within normal range for his age, except that you notice that he is repeatedly clearing his throat as if he is
embarrassed.
Next best step? - CORRECT ANSWER✅✅✅Barium swallow (Zanker diverticulum)
A 45-year-old man presents with extreme asthenia and weight loss. He has been suffering from celiac
disease for the past 12 years. He is at the highest risk of developing what type of intestinal malignancy? -
CORRECT ANSWER✅✅✅intestinal lymphoma
