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Gastrointestinal System — Step 1 practice questions
155 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
GI is a pathology-heavy section. Many questions describe a biopsy or an endoscopic finding and expect you to name the lesion, so recognising the classic descriptive phrases matters. Liver disease is disproportionately represented, and the metabolic consequences of hepatic failure connect to biochemistry more often than students expect.
Sample questions
Sample question 1
A patient with longstanding poorly-controlled celiac disease develops worsening symptoms despite strict gluten avoidance, along with weight loss and lymphadenopathy. Which of the following complications should be considered?
Explanations
A. Irritable bowel syndrome as the only consideration
IBS is a diagnosis of exclusion and does not explain this pattern with lymphadenopathy and refractory symptoms in the context of known celiac disease.
B. Simple gluten cross-contamination as the only consideration
While cross-contamination should always be considered/ruled out first, the combination of additional concerning features (lymphadenopathy, significant weight loss) should also prompt evaluation for this more serious complication.
C. Normal, expected celiac disease course requiring no further evaluation
This presentation (worsening despite strict avoidance, plus additional concerning features) is not simply an expected normal course and warrants further evaluation.
D. Iron deficiency anemia as the sole possible explanation
While iron deficiency can occur in celiac disease, the additional concerning features described (lymphadenopathy, refractory course) should prompt broader evaluation beyond just anemia.
E. Enteropathy-associated T-cell lymphoma · correct
Longstanding, poorly-controlled celiac disease carries an increased risk of enteropathy-associated T-cell lymphoma, an uncommon but serious complication that should be considered when symptoms worsen despite dietary adherence, particularly with additional concerning features like significant weight loss and lymphadenopathy.
Sample question 2
A patient with chronic pancreatitis and pancreatic exocrine insufficiency develops steatorrhea. Which of the following enzymes, when deficient, is most directly responsible for this fat malabsorption?
Explanations
A. Pancreatic lipase · correct
Pancreatic lipase is the primary enzyme responsible for dietary fat digestion; its deficiency (as in chronic pancreatitis with exocrine insufficiency) directly causes fat malabsorption and steatorrhea.
B. Amylase
Amylase digests carbohydrates, not fats.
C. Trypsin
Trypsin is involved in protein digestion, not primarily fat digestion.
D. Enterokinase
Enterokinase activates trypsinogen to trypsin; it is not itself the primary fat-digesting enzyme.
E. Carboxypeptidase
Carboxypeptidase is involved in protein digestion, not primarily fat digestion.
Sample question 3
A newborn develops jaundice on day 3 of life, with elevated unconjugated bilirubin and no evidence of hemolysis. Which of the following is the most likely explanation?
Explanations
A. Dubin-Johnson syndrome
Dubin-Johnson syndrome causes CONJUGATED hyperbilirubinemia, not this unconjugated pattern.
B. Biliary atresia
Biliary atresia causes CONJUGATED hyperbilirubinemia (obstructive pattern), not this unconjugated pattern, and typically presents somewhat later with persistent jaundice.
C. Physiologic jaundice from immature UDP-glucuronosyltransferase activity · correct
Physiologic jaundice of the newborn, from transient immaturity of hepatic UDP-glucuronosyltransferase (needed for bilirubin conjugation), classically appears after the first 24 hours (often day 2-3) and resolves within about a week — the most common cause of unconjugated hyperbilirubinemia at this age without hemolysis.
D. Crigler-Najjar syndrome type I
Crigler-Najjar type I causes severe, persistent, life-threatening unconjugated hyperbilirubinemia from a complete enzyme deficiency, a much more severe and different course than typical physiologic jaundice.
E. Choledocholithiasis
Choledocholithiasis causes conjugated hyperbilirubinemia from obstruction, not this unconjugated newborn pattern.
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