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 pathophysiology of hepatopulmonary syndrome (HPS)?

Ventilation-perfusion mismatch due to intrapulmonary vascular dilations.

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Increased hepatic production of angiotensin II leading to systemic vasoconstriction.

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Pulmonary arteriovenous shunting secondary to portal hypertension.

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Decreased nitric oxide production resulting in pulmonary vasoconstriction.

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Increased production of endothelin leading to pulmonary artery hypertension.

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In a patient with paracetamol-induced liver failure, which of the following criteria would be an indication for liver transplant according to the King’s College criteria?

INR of 7

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Arterial pH of 7.4 (after rehydration).

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Serum creatinine 250 µmol/L

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Grade 2 encephalopathy

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Serum bilirubin of 200 micromol/L

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A 65-year-old male with a history of alcoholic liver cirrhosis presents to the emergency department with complaints of increasing abdominal distension and discomfort. Physical examination reveals a tense abdomen with shifting dullness. Laboratory tests show hypoalbuminemia and elevated liver enzymes. An ultrasound confirms the presence of a large amount of ascitic fluid.

A large volume paracentesis is performed, draining 8 litres of ascitic fluid. Following the procedure, the patient’s blood pressure drops, and he becomes tachycardic.

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

Giving 20% albumin at a rate of 1 bottle for every 2 litres drained.

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Administer intravenous frusemide following the large volume paracentesis.

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Monitoring the patient's vital signs on an hourly basis.

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Ordering a blood transfusion to stabilize the patient's haemodynamics.

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Refer him to the critical care unit for a One-on-One patient care.

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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, the patient had a dysplastic polyp detected in the colitic area during a colonoscopy within the last 5 years.

What is the recommended timing for colonoscopy 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 likely to be 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 a history of cirrhosis presents with ascites and 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 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 significantly improves survival rates?

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?

Reduction of liver fibrosis and cirrhosis

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Eradication of the underlying autoimmune response

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Normalization of liver enzyme levels

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Prevention of bile duct obstruction

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Reversal of liver damage

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HIV modifies the natural history of Hepatitis B virus in the following ways, except?

More severe necroinflammatory activity

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Higher rate of chronic infection

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More commonly HBeAg positive

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Lower rate of HBeAg seroconversion

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Higher DNA levels

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What is the strongest predictor of future cirrhosis and hepatocellular cancer in patients with Hepatitis B?

Level of circulating serum HBV DNA

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Persistently elevated ALT

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Hepatitis e antigen positivity

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Hepatitis surface antigen positivity beyond 6 months

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Hepatitis core antigen positivity beyond 6 months

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A 38-year-old female with a history of HIV and chronic Hepatitis B co-infection is being managed on Emtricitabine-Tenofovir (Truvada) as part of her antiretroviral therapy. Two months after initiating this treatment, she presents with fatigue, mild jaundice, and abdominal discomfort.

Her recent laboratory tests reveal a significant elevation in liver enzymes (AST and ALT). Additional investigations, including serologies for Hepatitis A, C, and D, return negative. Her CD4 count is 500 cells/mm³, and her HIV viral load is undetectable. An ultrasound of the abdomen shows no signs of cirrhosis or liver steatosis.

Given this clinical presentation and laboratory findings, what is the most likely cause of her elevated liver enzymes?

What is the most likely cause?

Immune reconstitution sydrome (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 of HBV from a pregnant carrier to her newborn baby.

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A bite to a two-year-old by a chronic carrier.

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

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Horizontal transmission of HBV from a chronic carrier to his/her 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 and ribavirin for 12 weeks

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Pegylated interferon and ribavirin

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Pegylated interferon monotherapy

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Prednisone

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sofosbuvir and ribavirin for 24 weeks

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The natural progression of Hepatitis C is unlikely to be influenced by:

Genotype

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Alcohol

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Fatty liver

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Haemochromatosis

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Duration of infection

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Which of the following is a predictor of poor response to treatment in Hepatitis C?

Genotype 3 infection

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Genotype 2 infection

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Female gender

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Weight of <75kg

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IL28B receptor genotype CC.

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What has historically been the most important factor affecting response to treatment of Hepatitis C ?

Genotype

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Duration of infection

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Mode of acquisation

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Age at acquisation

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Absence of other liver disease

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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

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Coagulopathy

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Encephalopathy

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Renal failure

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A 69-year-old male with a background of familial hemochromatosis, recently diagnosed with acute myeloid leukemia (AML) following a bone marrow biopsy, initiated treatment with gemtuzumab.

Within two weeks of starting therapy, he developed a new onset of jaundice, an enlarged liver, and significant weight gain due to fluid accumulation.

What is the next step in management?

Commence Defibrotide

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Plasma exchange

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Urgent laparotomy

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Hemodialysis

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Pegylated interferon

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A 55 year old man with compensated cirrhosis secondary to alcohol abuse is found to have a solitary liver nodule

What is the most likely diagnosis?

hepatocellular carcinoma

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hemangioma

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adenoma

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fibronodular hyperplasia

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nodular regenerative hyperplasia

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This condition is less likely to cause Hepatocellular carcinoma:

Autoimmune hepatitis

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Hepatitis B

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Hepatitis C

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Alcoholic cirrhosis

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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.

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

What is the best diagnostic test?

24hr urinary copper excretion

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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 in autoimmune hepatitis Type II?

Cyp450 2D6

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Cyp450 1A2

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Cyp450 2C9

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Cyp540 2C19

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Cyp450 3A2

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Which of the following medication has the potential of slowing down the progression of primary biliary cholangitis?

Ursodeoxycholic acid.

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Prednis(ol)one

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Colchicine

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Methotrexate

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Cyclosporin

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In acute severe attack of ulcerative colitis that is not responding to conventional treatment with intravenous Hydrocortisone, which intervention is most effective and safe as rescue therapy?

Infliximab

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Mesalazine

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metronidazole

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Azathioprine

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methotrexate

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What is the antibiotic of choice for acute pouchitis?

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 giving intravenous high dose omeprazole to patients with suspected peptic ulcer bleeding BEFORE their endoscopy?

Reduces the need for endoscopic intervention

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Improvement in mortality

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Reduces the rates of re-bleeding

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Reduces the risk of needing major surgery

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Reduces need for blood transfusion

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In patients who have failed initial therapy for H pylori eradication, there is now the option to go for salvage therapy with a rifabutin triple therapy or a bismuth quadruple therapy. However, when comparing these two regimes, how effective was Ribabutin triple therapy compared 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

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Bismuth quadruple therapy had higher eradication rates

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High intake of sweetened drinks has been linked to the risk of developing which type of cancer?

Liver cancer

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Breast cancer

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Lung cancer

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Colon cancer

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Skin cancer

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Gastroenterology Module 6

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