GI Examination and History c) Acute pancreatitis.

d) Renal colic.
1. Odynophagia is one of the common GI e) Peptic ulcer.
symptoms, which of the following is FALSE 6. Mr. Bilal, a 55-year-old man, presents with
regarding odynophagia? pain in his epigastrium which lasts for 30
a) Odynophagia is pain on swallowing, often minutes or more at a time and has started
precipitated by drinking hot liquids. recently. Which of the following should be
b) It can be present with or without dysphagia. considered?
c) May indicate esophageal ulceration or a) Peptic ulcer
esophagitis from GERD, esophageal b) Pancreatitis
candidiasis, or esophageal cancer. c) Myocardial ischemia
d) It implies intact mucosal sensation. d) All of the above
2. A 20-year-old NNU medical student who has 7. Which of the following we do NOT ask about
had abdominal pain for 3 days. It started at for a vomitus:
his umbilicus and was associated with a) Color.
nausea and vomiting. He was unable to find b) Content.
a comfortable position. Yesterday, the pain c) Smell.
became more severe and constant. Now, he d) Amount.
hesitates to walk, because any motion e) Taste.
makes the pain much worse. It is localized 8. In patients with dysphagia, you should ask
just medial and inferior to his iliac crest on which of the following questions?
the right. Which of the following is most a) Is it intermittent or progressive?
likely? b) At which level you feel food sticks?
a) Peptic ulcer c) Is it recent or longstanding?
b) Cholecystitis d) Associated with pain or heartburn or not?
c) Pancreatitis e) All of the above.
d) Appendicitis 9. When taking history of a patient with a chief
3. In patients with sudden onset of severe compliant of vomiting, you should ask about
abdominal pain, rapidly progressing to all of the following EXCEPT:
become generalised and constant, you a) The patient’s medication.
should think of: b) Taste of the vomitus.
a) Perforation due to colorectal cancer, or c) Association with meals.
diverticular disease. d) Association with weight loss.
b) A ruptured Abdominal Aortic Aneurysm. e) Color of the vomitus.
c) Mesenteric infarction. 10. Nausea typically accompany vomiting
d) All of the above. caused by all of the following
4. Non-alimentary causes of abdominal pain gastrointestinal conditions EXCEPT:
include all of the following EXCEPT: a) Cholecystitis.
a) Testicular torsion b) Appendicitis.
b) Diabetic ketoacidosis c) Dyspepsia.
c) Renal colic d) Gastroenteritis.
d) Myocardial infarction e) Hepatitis.
e) Herpes zoster 11. A cause of vomiting without preceding
5. When taking a history of a patient with nausea:
abdominal pain, the patient said that his a) Small bowel obstruction.
pain is relieved by sitting upright, you b) Gastroenteritis.
should think of: c) Cholecystitis.
a) Acute appendicitis. d) Raised intracranial pressure.
b) Acute cholecystitis. e) None of the above.
12. Samah was diagnosed with hypertension 10 b) Normal stool color suggests obstructive
years ago, she came to the hospital jaundice.
complaining of vomiting and headache, c) Itching may be a sign of obstructive
what is the most probable diagnosis? jaundice.
a) Bowel obstruction d) Painful obstructive jaundice suggests
b) Increased Intracranial pressure cholangiosarcoma.
c) esophagitis 18. Dysguesia means:
d) Myocardial inarction a) Foul smelling sensation.
13. A cause of vomiting without preceding b) Altered smelling sensation.
nausea: c) Altered taste sensation.
a) Small bowel obstruction. d) Foul taste sensation.
b) Gastroenteritis. 19. You are palpating the abdomen and feel a
c) Cholecystitis. small mass. Which of the following would
d) Raised intracranial pressure. you do next?
e) None of the above. a) Ultrasound
14. Mr. Mohammad is a 60-year-old man who b) Examination with the abdominal muscles
presents with vomiting. He denies seeing tensed
any blood with emesis, which has been c) Surgery referral
occurring for 2 days. He does note a dark, d) Determine size by percussion
granular substance resembling the coffee 20. During the gastrointestinal system
left in the filter after brewing. What do you examination, you were examining the
suspect? patient’s cervical lymph nodes and noticed
a) Bleeding from a diverticulum an enlargement of the left supraclavicular
b) Bleeding from a peptic ulcer lymph nodes, this is termed:
c) Bleeding from a colon cancer a) Hoover's sign.
d) Bleeding from cholecystitis b) Troisier’s sign.
15. Constipation is caused by all of the c) Rovsign's sign.
following EXCEPT: d) Murphy’s sign.
a) Colorectal cancer. 21. The best site to look for jaundice is:
b) Irritable bowel syndrome. a) Upper part of the sclera
c) Thyrotoxicosis. b) Mucus membrane
d) Hypercalcemia. c) Tongue
e) Immobility due to stroke. d) Lower part of sclera
16. Which of the following is true about e) Palmar creases
abdominal pain? 22. A sign of chronic iron deficiency in nails is:
a) Peptic ulcer pain is usually experienced in a) Leukonychia
the hypogastrium b) Koilonychia
b) The pain of irritable bowel syndrome is c) Splinter hemorrhage
usually well localized d) Clubbing
c) The pain of esophagitis is usually 23. Gastrointestinal causes of finger clubbing
retrosternal in site does NOT include:
d) The pain of pancreatitis usually radiates to a) Liver cirrhosis.
the groin b) Gastroenteritis.
17. Which of the following is true about c) Inflammatory bowel disease.
jaundice? d) Malabsorption syndromes.
a) Pale stools and dark urine are
characteristic of the jaundice of hemolytic
anemia.
24. Astrexis in patient with suspected liver 30. During the gastrointestinal examination, you
disease indicates: have placed the stethoscope diaphragm to
a) Alcohol –induced liver disease. the right of the umbilicus and listened for 2
b) Ascites. minutes with no audible bowel sounds, you
c) Jaundice. may think of all of the following EXCEPT:
d) Hepatic encephalopathy. a) Bowel obstruction.
25. In a jaundiced patient, spider naevi, palmar b) Paralytic ileus.
erythema and ascites, which of the following c) Peritonitis.
is mostly suspected? d) None of the above.
a) Alcohol-induced chronic liver disease. 31. Which of the following is true about an
b) Obstructive jaundice due to pancreatic abdominal mass?
cancer. a) A pulsatile mass is always due to an aortic
c) Cholangiosarcoma. aneurysm
d) All of the above. b) An enlarged kidney is dull to percussion
26. Which of the following is true of c) A left iliac fossa mass may be due to cecal
hepatomegaly? cancer
a) Emphysema is a cause. d) Palpable liver does not always mean
b) The liver enlarges downwards from the left hepatomegaly
hypochondrium. 32. Which of the following is a feature of an
c) The presence of jaundice, spider naevi and examination of a patient with peritonitis?
palmar erythema suggest alcohol as a a) Involuntary guarding.
cause b) Rebound tenderness.
d) The liver is usually resonant to percussion c) Absent bowel sounds.
27. Regarding palpation during gastrointestinal d) Broad-like rigidity in generalized peritonitis.
examination of a patient complaining of e) All of the above.
abdominal pain, which of the following 33. A young patient presents with a left-sided
should you do? mass in her abdomen. You confirm that it is
a) Begin with light superficial palpation starting present in the left upper quadrant. Which of
from the site of pain. the following would support that this
b) Ask the patient to relax his abdominal represents an enlarged kidney rather than
muscles by lifting their head. her spleen?
c) Observe the patient’s face throughout the a) A palpable “notch” along its edge.
palpation for any sign of discomfort. b) A dullness on percussion.
d) None of the above. c) Mass moving inferiorly on inspiration.
28. A pulsatile liver indicates a(an): d) A resonant on percussion.
a) Hepatocellular carcinoma. 34. You are in the emergency room assessing a
b) Alcoholic fatty liver disease. patient with abdominal pain and fever. You
c) Tricuspid regurgitation. are performing an abdominal examination to
d) Right heart failure. assess for peritoneal signs. Which one of
29. While gently palpating the right upper the following is NOT a peritoneal sign?
quadrant of a patient with abdominal pain a) Rebound tenderness
during inspiration, the patient stopped the b) Involuntary guarding
respiration abruptly and complained of an c) Rigidity of the abdomen
evoked pain, this is called: d) Voluntary guarding
a) Rovsing’s sign.
b) Murphy’s sign.
c) Iliopsoas sign.
d) Grey Turner’s sign.
35. A 15-year-old high school student presents
to the clinic with a 1-day history of nausea
and anorexia. He describes the pain as
generalized yesterday, but today it has
localized to the right lower quadrant. You
palpate the left lower quadrant and the
patient experiences pain in the right lower
quadrant. What is the name of this sign?
a) Psoas sign
b) Murphy’s sign
c) Rovsing’s sign
d) Troisier’s sign
36. A 40-year-old flight attendant presents to
your office for evaluation of abdominal pain.
It is worse after eating, especially if she has
a meal that is spicy or high in fat. She has
tried over-the-counter antacids, but they
have not helped the pain. After examining
her abdomen, you strongly suspect
cholecystitis. Which sign on examination
increases your suspicion for this diagnosis?
a) Psoas sign
b) Rovsing’s sign
c) Murphy’s sign
d) Grey Turner’s sign
37. When the examiner’s hand is placed on the
patient’s right knee and the patient is asked
to raise his or her right thigh against the
examiner’s hand, if this process was painful,
this is called:
a) Psoas sign
b) Rovsing’s sign
c) Murphy’s sign
d) Grey Turner’s sign