Copy of Gastroenterology Module 1

A 65 year old man is about to undergo a colonoscopy as part of a bowel cancer surveillance next month.

Which of the following will place him at a lower risk of developing colorectal cancer in the future?

Azathioprine is a type of thiopurine that is used in the management of inflammatory bowel disease.

Which of the following marker would indicate thiopurine resistance?

A 30 year old woman with newly diagnosed Hepatitis C presents for treatment. Her viral genotype is 3 with low viral load. There is no evidence of cirrhosis.

What would be the optimal treatment for her?

Which of the following drug is a Nonstructural protein 5B (NS5B) inhibitor recommended for the treatment of Hepatitis C?

Which of the following medication has the highest risk for Hepatitis B reactivation?

A 56-year-old man presents with a long history of symptoms suggestive of gastro-oesophageal reflux. He undergoes an upper GI endoscopy which reveals severe oesophagitis but without evidence of a stricture. Proton pump inhibitor therapy is commenced with complete relief of symptoms.

Six weeks later, he undergoes a further upper endoscopy. Biopsies of this area are taken which show intestinal metaplasia with no dysplasia.

The next most appropriate action is to:

Liraglutide is a Glucagon-like peptide-1 (GLP-1) receptor agonists that is increasingly being used in the treatment of type 2 diabetes. But apart from diabetes, which of the following condition is it also useful for?

A 32-year-old man is evaluated in the emergency department for a 5- day history of worsening crampy abdominal pain and eight to ten loose bowel movements a day. The patient has a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine; before this episode, he had one or two bowel movements of well formed stool a day. The patient had sinusitis recently, which resolved with antibiotic therapy. He has otherwise been healthy and has not traveled recently, had contact with sick persons, or been noncompliant with medication.

On physical examination, the temperature is 38.3 C , the blood pressure is 130/76 mm Hg sitting and 105/60 mm Hg standing, the pulse rate is 90/min sitting and 120/min standing, and the respiration rate is 18/min. The abdomen is diffusely tender without rebound or guarding.

Laboratory studies reveal hemoglobin 123 g/L, leukocyte count of 28 – 109/L with 15% band forms, and platelet count of 234 – 109/L.

Intravenous fluids are started and stool studies are obtained.

Which of the following is the most appropriate next step in the management of this patient?

A 65 year old man is admitted with episodes of diarrhea following prolonged use of IV Ceftriaxone.

He had previously been treated with oral Vancomycin for c.difficile infection and now returns with a similar symptom.

Repeat stool specimen reveals presence of C.difficile toxin, therefore oral metronidazole was commenced but unfortunately failed to improve his symptoms.

Which of the following intervention is likely to resolve this man’s ongoing diarrhea?

With regards to colorectal cancer screening, which of the following is the most appropriate screening investigation for a 45 year old man who has one first-degree relative diagnosed with CRC at age 55 years?

A 30 year old previous IV drug user is found to have the following serology:
HBsAg +
HBeAg –
eAb +
HBV DNA is <10(5) copies/ml.
ALT and AST are normal.

What is his hepatitis status?

In the treatment of Helicobacter pylori eradication, which of the following antibiotic is NOT useful in a patient who has failed initial PPI triple therapy?

Which of the following is NOT included in the multitarget Stool DNA testing for colorectal cancer?

Recent studies have suggested the role of Leptin in obesity.

What is the main function of Leptin?

A 18-year-old lady presents with a three-month history of diarrhoea with significant weight loss. Stool investigations reveal no bacterial or viral pathogens. Colonoscopy is macroscopically normal. Colonic biopsies show melanosis coli.

Stool electrolytes are as follows:
sodium 22 mmol/L
potassium 15 mmol/L
chloride 32 mmol/L
stool pH 6.0
stool osmolality 300 mosm/kg

Which of the following is the most likely cause of the persistent diarrhoea?

The following are all indications for liver transplantation except?

What is the most common long term complication of liver transplantation?

A 40 year old man with a long history of alcohol abuse presents feeling generally unwell following a week of heavy alcohol intake. On examination, he is noted to be confused and tremulous with multiple spider naevi.

Other than an elevated INR, abnormality in which of the following parameters would indicate a poor prognosis?

Hepcidin and ferroportin regulate systemic iron absorption by inhibition of:

Patients with inflammatory bowel disease could present with extraintestinal manifestations.

Which of the following signs could occur even without any active inflammatory bowel disease?

In patients with Crohn’s disease, which of the following genetic variants would lead to early initial surgery due to stricturing disease?

Ustekinumab has been recently shown to be a useful drug for the induction and maintenance of Crohn’s disease. It is a monoclonal antibody to the p40 subunit of which cytokine/s?

IBD-unclassified (IBD-U) is a diagnosis that covers the “grey” zone of diagnostic uncertainty between Ulcerative colitis and Crohn’s Disease and several serological markers have been identified to aid with the diagnosis.

Therefore, a blood test that shows pANCA positive and ASCA negative would lean more towards a diagnosis of:

A patient in your clinic presents with the following test results.

What is this patient’s Hepatitis B status?

Hepatitis B surface antigen Not detected
Hepatitis B surface antibody Detected
Hepatitis B core antibody Detected
Hepatitis B e antigen Not detected
Hepatitis B e antibody Detected

Which of the following is an extra-colonic malignancy that is most strongly associated with hereditary non-polyposis colon cancer (HNPCC)?

Sorafenib therapy in advanced hepatocellular carcinoma will most likely

Which of the following statements regarding the use of Alphafetoprotein (αFP) in the diagnosis of Hepatocellular carcinoma (HCC) is incorrect?

Which of the following hormone is an appetite stimulant?

What is the most characteristic finding in endoscopic examination of the colon in patients with laxative abuse?

A 24-year-old woman consults you after a needle stick injury. She pricked her finger while collecting blood. The wound bled initially and she washed it. The source patient is HCV (hepatitis C antibody)- positive, HIV (human immunodeficiency virus)-negative and HBsAg (hepatitis B surface antigen)-negative.

In addition to acute and convalescent serology and regular liver function tests, which one of the following is the best management strategy?