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Gastroenterology Flashcards

6 cards from real ABIM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 45-year-old woman with primary biliary cholangitis has an alkaline phosphatase of 4x normal and pruritus. Which medication is first-line?

    Answer: Ursodeoxycholic acid (UDCA)

    UDCA is the first-line treatment for PBC, improving liver biochemistry, slowing histological progression, and improving transplant-free survival.

  2. A 30-year-old man presents with recurrent abdominal pain, weight loss, and terminal ileal involvement on imaging showing 'cobblestone' mucosa and skip lesions. What is the diagnosis?

    Answer: Crohn disease

    Crohn disease characteristically involves any part of the GI tract with transmural inflammation, skip lesions, and cobblestoning, most commonly affecting the terminal ileum.

  3. A 68-year-old man with jaundice, weight loss, and painless jaundice has a CT showing a mass in the head of the pancreas with dilated biliary and pancreatic ducts (double duct sign). What is the next step?

    Answer: EUS-guided FNA for tissue diagnosis

    EUS-guided FNA provides tissue diagnosis for pancreatic masses with high sensitivity and specificity while simultaneously staging local extension before definitive surgery.

  4. A patient with alcohol-related cirrhosis has hepatic encephalopathy. Ammonia is elevated. Which treatment reduces recurrence of hepatic encephalopathy?

    Answer: Rifaximin plus lactulose

    Rifaximin (a non-absorbable antibiotic) combined with lactulose is more effective than lactulose alone in preventing recurrence of overt hepatic encephalopathy.

  5. A 55-year-old woman presents with epigastric pain, early satiety, and unintentional weight loss for 4 months. Upper endoscopy shows a gastric ulcer. What is the most critical next step?

    Answer: Biopsy the ulcer edges to exclude malignancy

    All gastric ulcers require biopsy to exclude gastric cancer, as malignant ulcers can appear benign endoscopically.

  6. A 70-year-old man with chronic constipation presents with acute onset left-sided colonic pain and CT showing a 12 cm sigmoid loop with a 'whirl sign'. What is the diagnosis?

    Answer: Sigmoid volvulus

    Sigmoid volvulus presents with a massively dilated sigmoid colon and characteristic whirl sign or 'coffee bean' sign on imaging; urgent endoscopic decompression is the initial treatment.