Mock Gastroenterology Module 6

Which of the following best describes the role of lactulose in the treatment of hepatic encephalopathy?

Lactulose reduces serum ammonia levels by promoting its excretion in the faeces.

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Lactulose acts as a sedative to calm down the patient and improve mental clarity.

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Lactulose directly reduces inflammation in the brain, alleviating hepatic encephalopathy symptoms.

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Lactulose stimulates liver regeneration, improving liver function and reducing encephalopathy.

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Lactulose inhibits the absorption of toxins from the gut, preventing their entry into the bloodstream and brain.

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Which of the following best describes the primary pathophysiological mechanism of hepatopulmonary syndrome (HPS)?

Intrapulmonary vascular dilatations leading to ventilation-perfusion mismatch and impaired oxygenation.

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Increased hepatic production of angiotensin II leading to systemic vasoconstriction.

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Increased pulmonary artery pressures due to vascular remodelling and obliterative vasculopathy.

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Decreased nitric oxide production resulting in pulmonary vasoconstriction.

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Increased production of endothelin-1 leading to pulmonary artery hypertension.

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In a patient with paracetamol-induced acute liver failure, which of the following findings would contribute to meeting the King’s College Criteria for consideration of liver transplantation?

INR of 7 with a serum creatinine of 350 μmol/L and Grade IV encephalopathy

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Arterial pH of 7.4 after adequate fluid resuscitation with Grade III encephalopathy

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Serum creatinine of 450 µmol/L and a serum bilirubin of 200 μmol/L

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INR of 6 with a serum creatinine of 200 μmol/L and Grade II encephalopathy

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INR of 6.5 with a serum bilirubin of 200 μmol/L

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A 65-year-old male with alcoholic liver cirrhosis presents with tense ascites. An ultrasound confirms a large volume of ascitic fluid. A large-volume paracentesis (LVP) is planned to drain approximately 8 litres.

What is the most appropriate intervention to prevent post-paracentesis circulatory dysfunction (PPCD)?

Administering intravenous 20% albumin at 6–8 grams per litre of ascitic fluid removed.

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Administering intravenous frusemide following the large-volume paracentesis.

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Monitoring vital signs hourly without additional intervention.

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Ordering a blood transfusion to stabilise haemodynamics.

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Immediate transfer to the intensive care unit for invasive haemodynamic monitoring.

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A 45-year-old patient with ulcerative colitis involving more than 50% of the colon presents with primary sclerosing cholangitis (PSC) and a family history of colorectal cancer in a first-degree relative under the age of 50. Additionally, a dysplastic polyp was detected in the colitic area during a colonoscopy within the last 5 years.

What is the recommended interval for colonoscopic surveillance in this individual?

Annually

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Every 3 years

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Every 5 years

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Every 10 years

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Every 2 years

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Which of the following diseases is most commonly associated with pyoderma gangrenosum?

Crohn’s disease.

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Celiac disease

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Haemochromatosis.

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Irritable bowel syndrome.

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Wilson’s disease.

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Which of the following adverse effects of azathioprine represents an absolute contraindication for its future use?

Pancreatitis

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Myelosuppression

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Hepatitis

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Lymphoma

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Non-melanoma skin cancer

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A 55-year-old male with cirrhosis and ascites presents with worsening kidney function. To diagnose hepatorenal syndrome–acute kidney injury (HRS-AKI), which of the following criteria must be met?

Cirrhosis with ascites along with an increase in serum creatinine ≥0.3 mg/dL (26.5 μmol/L) within 48 hours

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Absence of shock.

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Cirrhosis with ascites along with Increase in serum creatinine ≥0.1 mg/dl (8.8 μmol/L) within 24 hours.

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No resolution after 2 days of diuretic withdrawal.

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No recent treatment with nephrotoxic drugs.

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Which of the following is the most effective treatment for hepatorenal syndrome–acute kidney injury (HRS-AKI) that most significantly improves long-term survival?

Orthotopic liver transplant

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Frusemide

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Continuous albumin infusion

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Renal replacement therapy

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Terlipressin

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What is the primary goal of Elafibranor therapy in the management of Primary Biliary Cholangitis?

Improvement of cholestatic liver biochemistries (alkaline phosphatase and bilirubin normalisation)

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Eradication of the underlying autoimmune response

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Direct reduction of liver fibrosis and prevention of cirrhosis

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Prevention of bile duct obstruction

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Reversal of established liver damage

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HIV modifies the natural history of hepatitis B virus (HBV) infection in the following ways, EXCEPT:

More severe necroinflammatory activity on liver biopsy

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Higher rate of chronicity after acute infection

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More rapid progression to fibrosis and cirrhosis

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Lower rate of HBeAg seroconversion

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Higher HBV DNA levels

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What is the strongest predictor of future cirrhosis and hepatocellular carcinoma (HCC) in patients with chronic hepatitis B?

Level of circulating serum HBV DNA

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Persistently elevated ALT

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Persistent HBeAg positivity

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Persistence of hepatitis B surface antigen (HBsAg) beyond 6 months

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Presence of HBcAg in liver biopsy

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A 38-year-old female with HIV and chronic hepatitis B co-infection commences antiretroviral therapy (ART) including emtricitabine-tenofovir (Truvada) and dolutegravir.

Her baseline CD4 count was 150 cells/mm³. Two months later, she presents with fatigue, mild jaundice, and abdominal discomfort.

Laboratory tests reveal significantly elevated AST and ALT. Serologies for hepatitis A, C, and D are negative. Her CD4 count is now 450 cells/mm³, and her HIV viral load is undetectable. Abdominal ultrasound shows no cirrhosis or steatosis.

What is the most likely cause of her elevated liver enzymes?

Hepatitis B related Immune Reconstitution Inflammatory Syndrome (HBV-IRIS)

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Drug-induced hepatotoxicity from Emtricitabine-Tenofovir

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Acute Hepatitis A infection

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Hepatic steatosis

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Reactivation of Hepatitis C

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In a non-immunized recipient, the following mode of transmission of hepatitis B virus (HBV) will most likely result in chronic carrier status:

Vertical transmission from a pregnant HBV carrier to her newborn baby

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A bite from a chronic carrier to a two-year-old

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Blood transfusion from a chronic carrier to a 60-year-old.

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Horizontal transmission from a chronic carrier to a five-year-old sibling

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Needle-stick injury to a 21-year-old from a contaminated needle

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A patient with HCV genotype 2 infection develops a blistering rash whenever he goes in the sun. He has a low viral load.There is no evidence of cirrhosis or other liver disease .

What is the most appropriate treatment?

Sofosbuvir/velpatasvir for 12 weeks

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Glecaprevir/pibrentasvir (Maviret) for 12 weeks

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Sofosbuvir/velpatasvir for 8 weeks

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Sofosbuvir/ribavirin for 12 weeks

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Sofosbuvir/velpatasvir for 24 weeks

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The natural progression of chronic hepatitis C towards fibrosis and cirrhosis is unlikely to be significantly influenced by which of the following factors?

HCV Genotype

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Alcohol consumption

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Coexistent fatty liver disease

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Coexistent haemochromatosis or hepatic iron overload

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Duration of infection

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The following are predictors of poor outcome in patients with paracetamol overdose, EXCEPT:

Raised AST

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Metabolic acidosis (pH <7.30)

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Coagulopathy (INR >3.0)

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Encephalopathy

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Renal failure (creatinine >200 μmol/L)

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A 69-year-old male with a background of hereditary haemochromatosis is diagnosed with acute myeloid leukaemia (AML) and initiated on gemtuzumab ozogamicin.

Two weeks after commencing therapy, he develops progressive jaundice, tender hepatomegaly, and rapid weight gain due to fluid retention.

What is the most appropriate next step in management?

Commence defibrotide

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Start intravenous N-acetylcysteine infusion

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Commence high-dose intravenous methylprednisolone

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Commence intravenous unfractionated heparin

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List for urgent orthotopic liver transplantation

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A 55-year-old man with compensated cirrhosis secondary to alcohol use disorder is found to have a solitary liver nodule on surveillance ultrasound.

What is the most likely diagnosis?

Hepatocellular carcinoma (HCC)

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Haemangioma

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Hepatic Adenoma

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Focal Nodular Hyperplasia (FNH)

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Nodular regenerative hyperplasia

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Which of the following conditions is LEAST likely to be associated with the development of hepatocellular carcinoma (HCC)?

Autoimmune hepatitis

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Chronic hepatitis B

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Chronic hepatitis C

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Alcoholic cirrhosis

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Hereditary haemochromatosis

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An 18-year-old man presents with a 12-month history of unsteady gait, resting tremor, slurred speech, and rigidity.

Kayser-Fleischer (KF) rings were seen on slit-lamp examination.

Laboratory tests reveal elevated transaminases, low serum copper, and low serum caeruloplasmin levels.

What is the best initial diagnostic test?

24-hour urinary copper excretion

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Antinuclear antibody (ANA)

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Anti-mitochondrial antibodies

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MRI brain

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Anti-smooth muscle antibodies

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Which of the following is the target antigen of anti-liver kidney microsomal type 1 (anti-LKM-1) antibodies in autoimmune hepatitis Type II?

CYP450 2D6

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CYP450 1A2

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CYP450 2C9

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CYP450 2C19

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CYP450 3A4

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Which of the following medications has the strongest evidence for slowing the histological and clinical progression of primary biliary cholangitis (PBC)?

Ursodeoxycholic acid

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Obeticholic acid (OCA)

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Elafibranor

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Bezafibrate

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Seladelpar

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In a patient experiencing an acute severe attack of ulcerative colitis that has not responded to 3–5 days of intravenous corticosteroids, which of the following is the most effective rescue therapy?

Infliximab

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Tofacitinib

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Vedolizumab

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Ustekinumab

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Azathioprine

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Which antibiotic is the preferred first-line treatment for acute pouchitis, based on its tolerability and side-effect profile?

Ciprofloxacin

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Metronidazole

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Amoxycillin

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Gentamicin

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Vancomycin

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What is the main benefit of administering intravenous high-dose omeprazole to patients with suspected peptic ulcer bleeding BEFORE endoscopy?

Reduces the need for endoscopic intervention

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Improves mortality

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Reduces rates of rebleeding

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Reduces the risk of requiring surgery

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Reduces need for blood transfusion

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In patients who have failed initial therapy for Helicobacter pylori eradication, rifabutin triple therapy and bismuth quadruple therapy are both salvage options.

When comparing these two regimens, how did rifabutin triple therapy compare to bismuth quadruple therapy in terms of eradication rates?

Both therapies had similar eradication rates

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Neither therapy had satisfactory eradication rates

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Rifabutin triple therapy had higher eradication rates but with significantly higher adverse effects.

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Bismuth quadruple therapy had higher eradication rates with significantly lower adverse effects.

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Rifabutin triple therapy had higher eradication rates with significantly lower adverse effects.

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High intake of sugar-sweetened beverages has been most strongly linked to an increased risk of developing which type of cancer, particularly in younger adults?

Liver cancer

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Breast cancer

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Lung cancer

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Colorectal cancer

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Skin cancer

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Mock Gastroenterology Module 6

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