Mock Gastroenterology Module 5

What is the primary mechanism of action of bulevirtide in the treatment of hepatitis D?

A 45-year-old man develops stage III cancer of the caecum. His father died of metastatic bowel cancer associated with the presence of multiple polyps throughout the colon.

The most likely underlying inherited genetic abnormality is in the:

Pancreatic enzymes involved in digestion of protein are released as proenzymes into the duodenal lumen, where they are activated.

Which enzyme plays the pivotal role in activating these proenzymes?

Which of the following patient groups will most likely benefit from treatment with cetuximab?

Which statement is correct regarding gastrin?

Where is cholecystokinin (CCK) secreted from?

The body produces endogenous glucose via all of the following mechanisms EXCEPT:

What is the recommended treatment regimen for acute hepatitis C infection in a patient who has not spontaneously cleared the virus?

A female patient presents with new-onset ascites. Portal and hepatic vein pressures are measured during transjugular liver biopsy. Portal vein pressure is 32 mmHg and free hepatic vein pressure is 12 mmHg.

What is the most likely etiology of this patient’s ascites?

Which of the following conditions is UNLIKELY to cause a raised fasting serum gastrin of 1200 pg/mL [0–180]?

A 35-year-old man sees a gastroenterologist due to ongoing epigastric pain that has failed to respond to twice-daily oral omeprazole. He has a fasting gastrin level of 650 pg/mL (normal range: 0–180 pg/mL).

What is the most likely cause of his elevated gastrin level?

In patients with chronic pancreatitis, which of the following lifestyle modifications is most likely to reduce the risk of developing pancreatic calcifications?

Which of the following medications is most effective as prophylaxis against post-ERCP pancreatitis (PEP)?

Which is the most useful serological test to diagnose autoimmune pancreatitis?

Cytotoxin-associated gene A (CagA)-positive Helicobacter pylori strains are most strongly associated with which of the following conditions?

Which of the following conditions is NOT typically associated with vitamin B12 deficiency?

Coeliac disease is associated with HLA

All of the following conditions cause a decrease in resting lower esophageal sphincter (LES) pressure EXCEPT:

A 45-year-old man presents with a one-week history of anorexia, vomiting, and abdominal pain. He denies any fever but has noted his sclerae to be icteric over the last three days. He has a history of intravenous drug use up to the age of 25 years. There are no recent prescribed or over-the-counter medications. He drinks the equivalent of 100 g of alcohol per day, with frequent heavy intake on weekends.

Examination confirms icterus, but there are no peripheral stigmata of chronic liver disease. There is moderate to severe tenderness in the right upper quadrant. The liver is percussed at 18 cm in the midclavicular line. There is no splenomegaly.

Laboratory results:

• White cell count: 12.5 × 10⁹/L [3.5–10.5]
• Haemoglobin: 145 g/L [125–165]
• Platelet count: 345 × 10⁹/L [150–450]
• Sodium: 132 mmol/L [135–150]
• Potassium: 4.1 mmol/L [3.5–5.0]
• Urea: 8.2 mmol/L [3.5–8.0]
• Creatinine: 0.10 mmol/L [0.06–0.10]
• Bilirubin: 125 μmol/L [7–21]
• ALP: 235 U/L [40–110]
• GGT: 976 U/L [10–40]
• AST: 760 U/L [15–40]
• ALT: 300 U/L [15–40]
• Albumin: 34 g/L [35–45]

The most likely explanation for this clinical scenario is:

A 45-year-old woman presents with a three-year history of recurrent rash, characterized as palpable purpura over both legs. Some of these lesions have ulcerated.

Laboratory results:

• Serum creatinine: 0.10 mmol/L [0.06–0.11]
• ALT: 51 U/L [15–50]
• AST: 64 U/L [15–45]
• Hepatitis C antibody: Positive
• Cryoglobulins: Positive with 8% cryoprecipitate
• Urinalysis: Normal

What is the most appropriate management?

A 30-year-old medical officer sustains a needle-stick injury while treating a trauma patient in the emergency department. She underwent a three-dose course of hepatitis B vaccine 10 years earlier and was documented to be hepatitis B surface antibody (anti-HBs) positive one year after vaccination. On repeat testing following this incident, she is now found to be anti-HBs negative. The source patient is an intravenous drug user and is hepatitis B surface antigen (HBsAg) positive. HIV and hepatitis C serology on the source patient are negative.

In addition to counselling, which of the following is the most appropriate immediate action?

A 40-year-old man was found to have elevated liver enzymes and positive hepatitis C serology since 2000. Liver biopsy showed chronic active hepatitis consistent with hepatitis C. He now presents with purpuric rash on his knees, joint pains, and Raynaud’s phenomenon.

Which one of the following is the most appropriate next investigation?

A 67-year-old man has recently commenced haemodialysis for renal failure secondary to chronic glomerulonephritis. He receives immunisation with three separate doses of hepatitis B vaccine according to the recommended protocol. Six weeks after the third dose, his anti-hepatitis B surface antibody (anti-HBs) level is negative.

Which one of the following is the most appropriate course of action?

What is the best interpretation of the following hepatitis B serological results?

A 44-year-old man has chronic HBV infection with evidence of decompensated cirrhosis. He is commenced on lamivudine.

His HBV viral load trajectory:

• At commencement: 10⁸ IU/mL (very high)
• At 12 weeks: 10⁴ IU/mL
• At 6 months: 10⁵ IU/mL (1 log rise from nadir — virological breakthrough)
• ALT remains elevated

What is the most appropriate next step in his management?

Which of the following is considered the most important factor in determining the need for antiviral therapy in chronic hepatitis B infection?

Which hepatitis B genotype carries the worst clinical outcome?

What defines chronicity in Hepatitis B infection?