How Much You Know About Gastroenterology? Trivia Quiz

2.

A 55-year-old male is found to have three hyperplastic polyps on a routine screening colonoscopy. He has no personal or family history of colon cancer. This patient’s next colonoscopy should be in

1 year
3 years
5 years
10 years

Correct Answer

A. 10 years

Explanation

Based on the information provided, the patient is 55 years old and has three hyperplastic polyps on a routine screening colonoscopy. Hyperplastic polyps are generally considered to have a very low risk of developing into cancer. Therefore, the patient can safely wait for a longer interval before the next colonoscopy. The recommended interval for a follow-up colonoscopy in this case would be 10 years, as there is no personal or family history of colon cancer.

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3.

A 57-year-old male has laboratory screening performed prior to his annual examination. One of his six fecal occult blood tests is positive. A CBC, chemistry panel, lipid panel, and prostate-specific antigen level are all normal. Which one of the following would be the most appropriate course of action?

Repeat the fecal occult blood testing in 3 months
Perform a rectal examination in the office, and if a stool guaiac is negative repeat the fecal occult blood testing in 3 months
Refer for colonoscopy
Refer for flexible sigmoidoscopy
Refer for pre- and post-contrast CT of the abdomen and pelvis

Correct Answer

A. Refer for colonoscopy

Explanation

Based on the information provided, the most appropriate course of action would be to refer the patient for a colonoscopy. This is because a positive fecal occult blood test can indicate the presence of colorectal cancer or other gastrointestinal conditions, and a colonoscopy is the gold standard for diagnosing these conditions. It allows for direct visualization of the colon and the ability to take biopsies or remove any abnormal growths. Repeat testing in 3 months may not be sufficient if there is a potential underlying issue that needs to be addressed promptly. A rectal examination or other imaging tests would not provide the same level of diagnostic accuracy as a colonoscopy.

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4.

A 56-year-old female with well-controlled diabetes mellitus and hypertension presents with an 18-hour history of progressive left lower quadrant abdominal pain, low-grade fever, and nausea. She has not been able to tolerate oral intake over the last 6 hours. An abdominal examination reveals significant tenderness in the left lower quadrant with slight guarding but no rebound tenderness. Bowel sounds are hypoactive. Rectal and pelvic examinations are unremarkable. Which one of the following is recommended as the initial diagnostic procedure in this situation?

CT of the abdomen and pelvis
Abdominal and pelvic ultrasonography
A barium enema
Colonoscopy
Laparoscopy

Correct Answer

A. CT of the abdomen and pelvis

Explanation

CT of the abdomen and pelvis is recommended as the initial diagnostic procedure in this situation because the patient's symptoms and physical examination findings are consistent with acute diverticulitis. CT scan is the most accurate imaging modality to confirm the diagnosis of diverticulitis and assess the severity of the condition. It can identify complications such as abscess formation, perforation, or fistula. CT scan also helps in ruling out other differential diagnoses such as ovarian torsion or appendicitis. This procedure provides valuable information for guiding further management decisions.

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5.

A 64-year-old white male presents to the emergency department with a 48-hour history of left lower quadrant pain. After a thorough history and a physical examination, you conclude that the patient has diverticulitis. The patient is allergic to metronidazole (Flagyl). You recommend a clear-liquid diet, a follow-up visit with his primary care physician in 48 hours, and treatment with

Amoxicillin
Amoxicillin/clavulanate (Augmentin)
Ciprofloxacin (Cipro)
Doxycycline
Azithromycin (Zithromax)

Correct Answer

A. Amoxicillin/clavulanate (Augmentin)

Explanation

The correct answer is amoxicillin/clavulanate (Augmentin) because it is a broad-spectrum antibiotic that covers both aerobic and anaerobic bacteria, which are commonly involved in diverticulitis. As the patient is allergic to metronidazole, amoxicillin/clavulanate is a suitable alternative as it provides coverage against the bacteria causing the infection. The other options, ciprofloxacin, doxycycline, and azithromycin, may not provide adequate coverage or may not be as effective in treating diverticulitis. Therefore, amoxicillin/clavulanate is the most appropriate choice in this case.

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6.

A 65-year-old asymptomatic female is found to have extensive sigmoid diverticulosis on screening colonoscopy. She asks whether there are any dietary changes she should make. In addition to increasing fiber intake, which one of the following would you recommend?

Limiting intake of dairy products
Limiting intake of spicy foods
Limiting intake of wheat flour
Limiting intake of nuts
No limitations on other intake

Correct Answer

A. No limitations on other intake

Explanation

There is no need for the patient to limit intake of any specific food other than increasing fiber intake. Sigmoid diverticulosis is often associated with a low-fiber diet, so increasing fiber intake is recommended to prevent complications such as diverticulitis. However, there is no evidence to suggest that limiting intake of dairy products, spicy foods, wheat flour, or nuts would have any impact on diverticulosis. Therefore, the patient does not need to make any specific dietary limitations other than increasing fiber intake.

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2

7.

A 69-year-old male presents with a 2-week history of fever, fatigue, weight loss, and mild diarrhea. He is found to have a mildly tender mass in the left lower quadrant of the abdomen.The most likely diagnosis is

Crohn’s disease
Ulcerative colitis
Celiac disease
Diverticulitis
Lymphoma

Correct Answer

A. Diverticulitis

Explanation

The most likely diagnosis in this case is diverticulitis. Diverticulitis is characterized by inflammation and infection of small pouches called diverticula that develop in the walls of the colon. The symptoms mentioned, such as fever, fatigue, weight loss, and mild diarrhea, are commonly seen in diverticulitis. The presence of a mildly tender mass in the left lower quadrant of the abdomen further supports this diagnosis. Crohn's disease and ulcerative colitis are inflammatory bowel diseases, but they typically present with different symptoms and do not usually involve the formation of masses. Celiac disease is an autoimmune disorder triggered by gluten consumption and does not typically cause abdominal masses. Lymphoma may present with similar symptoms, but the presence of a mass makes diverticulitis more likely.

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8.

Which one of the following is associated with ulcerative colitis rather than Crohn’s disease?

The absence of rectal involvement
Transmural involvement of the colon
Segmental noncontinuous distribution of inflammation
Fistula formation
An increased risk of carcinoma of the colon

Correct Answer

A. An increased risk of carcinoma of the colon

Explanation

Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects the colon and rectum. One of the key distinguishing features of ulcerative colitis is the increased risk of carcinoma of the colon, which refers to the development of colon cancer. This increased risk is not typically associated with Crohn's disease, another type of inflammatory bowel disease. Therefore, the presence of an increased risk of colon cancer is more closely associated with ulcerative colitis rather than Crohn's disease.

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9.

An 82-year-old male nursing-home resident is sent to the emergency department with lower abdominal pain and bloody diarrhea. He has a history of multi-infarct dementia, hypertension, and hyperlipidemia. On examination he is afebrile, and a nasogastric aspirate is negative for evidence of bleeding. Which one of the following is the most likely cause of this patient’s bleeding?

Peptic ulcer disease
Ischemic colitis
Diverticular bleeding
Angiodysplasia
Infectious colitis

Correct Answer

A. Ischemic colitis

Explanation

The most likely cause of the patient's bleeding is ischemic colitis. This is supported by the patient's age, history of multi-infarct dementia, and the presence of lower abdominal pain and bloody diarrhea. Ischemic colitis occurs when there is a decrease in blood flow to the colon, leading to inflammation and injury to the intestinal lining. This can result in symptoms such as abdominal pain and bloody diarrhea.

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10.

A 39-year-old female presents with lower abdominal/pelvic pain. On examination, with the patient in a supine position, you palpate the tender area of her abdomen. When you have her raise both legs off the table while you palpate the abdomen, her pain intensifies. Which one of the following is the most likely diagnosis?

Appendicitis
A hematoma within the abdominal wall musculature
Diverticulitis
Pelvic inflammatory disease
An ovarian cyst

Correct Answer

A. A hematoma within the abdominal wall musculature

Explanation

Raising both legs off the table while palpating the abdomen causing an increase in pain suggests a hematoma within the abdominal wall musculature. This is because the action of raising the legs increases intra-abdominal pressure, which can put pressure on the hematoma and cause pain. Appendicitis, diverticulitis, pelvic inflammatory disease, and ovarian cysts would not typically be affected by this maneuver.

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How Much You Know About Gastroenterology? Trivia Quiz

On his first screening colonoscopy, a 67-year-old male is found to have a 0.5-cm adenomatous polyp with low-grade dysplasia. According to current guidelines, when should this patient have his next colonoscopy?

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A 55-year-old male is found to have three hyperplastic polyps on a routine screening colonoscopy. He has no personal or family history of colon cancer. This patient’s next colonoscopy should be in

A 65-year-old asymptomatic female is found to have extensive sigmoid diverticulosis on screening colonoscopy. She asks whether there are any dietary changes she should make. In addition to increasing fiber intake, which one of the following would you recommend?

A 69-year-old male presents with a 2-week history of fever, fatigue, weight loss, and mild diarrhea. He is found to have a mildly tender mass in the left lower quadrant of the abdomen.The most likely diagnosis is

Which one of the following is associated with ulcerative colitis rather than Crohn’s disease?