Gastroenterology Module 1

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

Which of the following is most strongly associated with a lower risk of developing colorectal cancer in the future?

Higher adenoma detection rate at colonoscopy by a skilled physician

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Smoking cessation 6 weeks prior to colonoscopy

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Routine colonoscopy twice yearly

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Regular exercise and a low fiber diet

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Lower adenoma detection rate at colonoscopy by a skilled physician

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

Which of the following metabolite patterns would indicate thiopurine resistance (preferential shunting)?

Low 6-TGN / High 6-MMP

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Low 6-TGN / Absent 6-MMP

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Low 6-TGN / Low 6-MMP

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High 6-TGN / High 6-MMP

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Absent 6-TGN / Low 6-MMP

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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 regimen for her?

8 weeks of daily fixed-dose combination of glecaprevir and pibrentasvir.

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4 weeks of Telaprevir followed by 24 weeks of pegylated interferon and ribavirin

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24 weeks of interferon and ribavirin

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24 weeks of pegylated interferon and ribavirin, shortened to 16 weeks if rapid virological response at week 4

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48 weeks of pegylated interferon and ribavirin

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Which of the following drugs is a nonstructural protein 5B (NS5B) polymerase inhibitor used in the treatment of hepatitis C?

Sofosbuvir

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Velpatasvir

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Daclatasvir

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Elbasvir

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Ledipasvir

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Which of the following medications carries the highest risk of hepatitis B reactivation?

Rituximab

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Inflximab

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Natalizumab

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Azathioprine

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Methotrexate

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A 56-year-old man presents with a long history of gastro-oesophageal reflux symptoms. Upper GI endoscopy reveals severe oesophagitis without stricture. Proton pump inhibitor therapy is commenced with complete symptom relief.

Six weeks later, repeat upper endoscopy is performed. Biopsies of the distal oesophagus show intestinal metaplasia with no dysplasia, consistent with Barrett’s oesophagus. The Barrett’s segment measures 4 cm.

What is the most appropriate next action?

repeat endoscopy in 3 years.

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double the dose of proton pump inhibitor

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refer for anti-reflux surgery.

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check autoimmune markers

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continue current therapy

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GLP-1 receptor agonists, initially developed for type 2 diabetes, have shown benefit in which of the following liver conditions?

Primary biliary cholangitis

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Chronic Hepatitis C

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Inflammatory bowel disease

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Metabolic dysfunction-associated steatohepatitis (MASH, formerly NASH)

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Primary sclerosing cholangitis

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A 32-year-old man with a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine presents with 5 days of worsening crampy abdominal pain and eight to ten loose bowel movements per day. He had recent sinusitis treated with antibiotics. He has not travelled recently.

On examination: temperature 38.3°C, postural hypotension (BP 130/76 sitting, 105/60 standing), pulse 90 sitting, 120 standing. Abdomen is diffusely tender without rebound or guarding.

Laboratory: Hb 123 g/L, WCC 28 × 10⁹/L with 15% band forms, platelets 234 × 10⁹/L.

IV fluids are started and stool studies are obtained.

What is the most appropriate next step in management?

Start oral vancomycin

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Increase dosage of Azathioprine

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Start oral mesalamine

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Small bowel radiographic studies

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Start intravenous vancomycin

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A 65-year-old man is admitted with recurrent diarrhoea following prolonged IV ceftriaxone use. He was previously treated with oral vancomycin for C. difficile infection and has now relapsed. Repeat stool testing confirms C. difficile toxin. Oral Fidaxomicin was commenced but failed to improve his symptoms.

Which of the following interventions is most likely to resolve this man’s recurrent C. difficile infection?

Faecal microbiota transplantation

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Vancomycin 125 mg po Q6hr for 14 days.

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One off dose of intravenous actoxumab (10mg/kg).

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Vancomycin 125 mg po Q6hr for 14 days with bowel lavage

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Intravenous metronidazole 500mg Q8hr with bowel lavage

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With regards to colorectal cancer screening, which 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?

Fecal Immunochemical test (FIT) every year from age 45.

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Colonoscopy every 5 years from age 45

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Digital rectal exam every 2 years from age 45

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Refer for genetic screening

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Flexible sigmoidoscopy every 12 months

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A 30-year-old previous IV drug user is found to have the following serology:

HBsAg: Positive
HBeAg: Negative
Anti-HBe (eAb): Positive
HBV DNA: Not detected
ALT and AST: Normal

What is his current hepatitis B status?

HBeAg-negative chronic HBV infection (inactive carrier state)

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Acute hepatitis B

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HBeAg-positive chronic hepatitis B

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Recent HBV immunisation

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Resolved Hep B

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In the treatment of Helicobacter pylori eradication, which of the following antibiotics should NOT be re-used in an Australian patient who has failed initial PPI-based clarithromycin-containing triple therapy?

Tetracycline

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Clarithromycin

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Metronidazole

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Rifabutin

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Levofloxacin

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Which of the following is NOT included in the multitarget stool DNA testing (Cologuard) for colorectal cancer screening?

CARD 15 mutation

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KRAS mutations

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NDRG4 methylation

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BMP3 methylation

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Haemoglobin immunoassay

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Recent studies have suggested the role of Leptin in obesity.

What is the primary function of leptin in energy homeostasis?

Inhibits food intake and increases energy expenditure

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Stimulates food intake and reduces energy expenditure

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Stimulation food intake and increases energy expenditure

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Inhibits food intake and reduces energy expenditure

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Inhibits food intake only

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An 18-year-old woman 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:

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?

Laxative abuse.

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Crohn disease.

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Cryptosporidium infection.

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Giardia infection.

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Hyperthyroidism

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Which of the following is NOT an indication for liver transplantation?

Cirrhosis without evidence of hepatic decompensation or portal hypertension

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Primary biliary cholangitis with intractable pruritus

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Primary sclerosing cholangitis with recurrent cholangitis

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Type 1 hepatorenal syndrome

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Hepatocellular carcinoma with 3 lesions confined to the liver measuring 1cm each

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

metabolic syndrome

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chronic graft rejection

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de novo malignancy

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chronic kidney disease

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chronic biliary strictures

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A 40-year-old man with chronic alcohol abuse presents feeling generally unwell after a week of heavy drinking. He is confused and tremulous with multiple spider naevi. His INR is elevated.

Abnormality in which of the following parameters (in addition to the elevated INR) would indicate a poor prognosis?

Bilirubin

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Urea

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ALT

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GGT

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Arterial ammonia

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Hepcidin regulates systemic iron absorption primarily by inhibition of which process?

enterocyte basolateral iron release

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enterocyte brush border iron reduction

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enterocyte apical iron uptake

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iron oxidation by hephaestin

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iron binding to transferrin

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Patients with inflammatory bowel disease may present with extraintestinal manifestations. Which of the following can occur independently of active intestinal inflammation?

Anterior uveitis

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Oral ulcers

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Erythema nodosum

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Large joint arthritis

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Episcleritis

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In patients with Crohn’s disease, which of the following genetic variants is most strongly associated with ileal stricturing disease and early need for surgery?

NOD2/CARD15

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PTPN22

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IRGM

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STAT4

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IL23R

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Ustekinumab is a monoclonal antibody used for induction and maintenance therapy in Crohn’s disease and ulcerative colitis. It targets the p40 subunit shared by which cytokines?

IL-12 and IL-23

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IL-2

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TNF-α

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IL-6 and IL-17

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IL-6 and IL-1

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In the evaluation of IBD-unclassified (IBD-U), a blood test showing pANCA positive and ASCA negative would lean more towards a diagnosis of:

Ulcerative colitis

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Crohns

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Indeterminate colitis

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Ischaemic colitis

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Infectious colitis

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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

Past Hepatitis B infection

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Previous Hepatitis B vaccination

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Chronic Hepatitis B infection

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Acute Hepatitis B infection

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Pre-core mutant infection

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Which of the following extra-colonic malignancies is most strongly associated with Lynch syndrome (hereditary non-polyposis colorectal cancer)?

Endometrial cancer

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Melanoma

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Sarcoma

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Leukaemia

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Renal cell cancer

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The landmark IMbrave150 trial (Finn et al., NEJM 2020) demonstrated that the combination of atezolizumab and bevacizumab in unresectable hepatocellular carcinoma was shown to:

have better overall and progression-free survival outcomes than sorafenib

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improve quality of life

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increase incidence of intracerebral hemorrhage

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prolong disease-free survival

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reduce incidence of portal vein thrombosis.

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

αFP measurement is essential as part of the work up of HCC

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αFP is elevated in HCV and untreated HBV

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Only a small proportion of tumours at an early stage present with abnormal αFP serum levels

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αFP levels at a value of 20ng/ml has good sensitivity but low specificity.

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αFP levels at a value of 200ng/ml has high specificity for HCC.

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Which of the following hormone is an appetite stimulant?

Ghrelin

Correct Incorrect Correct answer

Leptin

Correct Incorrect Correct answer

Cholecystokinin

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Glucagon-like peptide 1 (GLP-1)

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Pancreatic polypeptide

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

Melanosis coli.

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colonic polps

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normal mucosa

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lymphycytic colitis

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rectal histiocytosis

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A 24-year-old healthcare worker sustains a needlestick injury while collecting blood. The source patient is HCV antibody-positive, HIV-negative, and HBsAg-negative. The wound bled initially and was washed.

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

Perform baseline testing for HCV antibodies and HCV RNA with subsequent referral to a specialist if positive

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Prophylaxis with pooled gamma globulin

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Treatment with interferon α if hepatitis occurs

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Treatment with lamivudine if hepatitis occurs

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Prophylaxis with lamivudine

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Gastroenterology Module 1

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