9 USMLE Gastroenterology Quick Review Questions with Answers (Set 2)

These 9 quick USMLE review questions test high-yield facts that show up again and again on the exam: Gilbert syndrome, alcoholic hepatitis, esophageal adenocarcinoma, primary biliary cholangitis, liver metastases, duodenal ulcer, HIV esophagitis, vitamin B12 testing and C. difficile. Each question includes the correct answer.

Written by Dr. Ray Makar, MD, author of the Repeated USMLE Questions eBook series.

Prefer video? Watch daily USMLE case questions on MedFocus by Dr. Ray on YouTube.

How to use this page: read the question, pick your answer, then tap Show Answer and Explanation.

Questions

Question 1. Which of the following laboratory tests could be slightly increased in Gilbert’s syndrome?

A- Bilirubin, direct
B- Bilirubin, indirect
C- Haptoglobin
D- Triglyceride

B- Bilirubin, indirect- Mild indirect hyperbilirubinemia is not harmful in Gilbert’s syndrome unless it is associated with stress or illness.
The correct answer is B

 

Question 2. A 60-year-old man complains of sudden onset of fever, jaundice, right upper abdominal pain and ascites. Liver biopsy shows areas of swelling and necrosis with neutrophilic infiltration. What is the diagnosis?

A- Acetaminophen toxicity
B- Alcoholic hepatitis
C- Budd-Chiari syndrome
D- Fatty liver

B- Alcoholic hepatitis- Alcoholic hepatitis typically presents with fever, jaundice, right upper quadrant pain, and elevated liver enzymes. Histology shows hepatocyte swelling, necrosis, and neutrophilic infiltration, often with Mallory bodies. Acetaminophen toxicity shows massive centrilobular necrosis, Budd–Chiari shows hepatic congestion due to venous obstruction, and fatty liver shows fat accumulation without significant neutrophilic inflammation.
The correct answer is B

 

Question 3. Which of the following is the most common cancer of the lower third of esophagus in non-alcoholic, non-smoker patients?

A- Adenocarcinoma
B- Melanoma
C- Sarcoma
D- Squamous cell carcinoma

A- Adenocarcinoma- It is strongly associated with Barrett esophagus. Squamous cell carcinoma is the most common in the first and middle parts of esophagus worldwide
The correct answer is A

 

Question 4. Which of the following enzymes is markedly elevated in primary biliary cholangitis?

A- Alanine aminotransferase (ALT)
B- Aspartate aminotransferase (AST)
C- Acid phosphatase
D- Alkaline phosphatase

D- Alkaline phosphatase- Primary biliary cholangitis is a chronic autoimmune liver disease characterized by the progressive destruction of intrahepatic bile ducts. The most markedly elevated enzyme in this condition is alkaline phosphatase, which is typically associated with cholestasis.
The correct answer is D

 

Question 5. An old patient presents with multiple tumors on the liver. Which of the following is the most common site of the primary tumor?

A- Breast
B- Colon
C- Kidney
D- Lung

B- Colon- Because liver shared blood vessels with GI tract, colon is the most likely site of the primary tumor followed by the lung.
The correct answer is B

 

Question 6. Which one of the following is most likely normal in duodenal ulcer?

A- Fasting serum gastrin
B- Parietal cell mass
C- Pepsin secretion
D- Response of gastrin to food

A- Fasting serum gastrin- Other choices are all elevated in duodenal ulcers
The correct answer is A

 

Question 7. Which of the following esophageal disorders is the most likely a complication of HIV infection?

A- Achalasia
B- Adenocarcinoma
C- Candida esophagitis
D- Esophageal varices

C- Candida esophagitis- Due to low immunity, others are distractions and not common with HIV.
The correct answer is C

 

Question 8. Which of the following tests would most likely indicates the etiology of vitamin B12 deficiency anemia?

A- Complete blood count (CBC)
B- Coomb’s test
C- Osmotic fragility test
D- Schilling test

D- Schilling test- Schilling test differentiates between pernicious anemia and vitamin B12 malabsorption
The correct answer is D

 

Question 9. Which of the following organisms is responsible for antibiotic-associated colitis?

A- Clostridium difficile
B- Clostridium botulinum
C- Clostridium perfringens
D- Clostridium tetani

A- Clostridium difficile- Clostridium difficile (C. difficile) is the primary organism responsible for antibiotic-associated colitis (also known as C. difficile infection or CDI). Antibiotics can disrupt the normal gut microbiota, allowing C. difficile to overgrow and produce toxins (Toxin A and Toxin B) that damage the colonic mucosa, leading to diarrhea, abdominal pain, and potentially life-threatening complications like pseudomembranous colitis.
The correct answer is A

 

High-yield points from this set

  • Gilbert syndrome causes mild indirect hyperbilirubinemia.
  • Adenocarcinoma is the most common cancer of the lower esophagus in Western countries.
  • Primary biliary cholangitis markedly raises alkaline phosphatase.
  • Candida esophagitis is common in HIV.

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