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Gastroenterology Flashcards

6 cards from real ABIM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 50-year-old man is found to have hemochromatosis (HFE C282Y homozygous) with ferritin 1,800 ng/mL and transferrin saturation 75%. Liver biopsy shows grade 2 fibrosis. What is the first-line treatment?

    Answer: Therapeutic phlebotomy weekly

    Therapeutic phlebotomy (venesection) is the first-line treatment for hereditary hemochromatosis, effectively depleting iron stores and preventing progression of organ damage.

  2. A 35-year-old woman presents with chronic diarrhea, bloating, and weight loss. Small bowel biopsy shows villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis. Serologic testing shows positive anti-tissue transglutaminase IgA. What is the diagnosis?

    Answer: Celiac disease

    Celiac disease is diagnosed by positive anti-tTG IgA antibodies combined with duodenal biopsy showing villous atrophy and intraepithelial lymphocytosis on a gluten-containing diet.

  3. A patient with Clostridium difficile (CDI) has a third recurrence of mild-to-moderate disease. What is the preferred treatment?

    Answer: Fecal microbiota transplantation (FMT)

    FMT is highly effective for recurrent CDI (>90% cure rate) and is recommended by guidelines for patients with multiple recurrences.

  4. A 60-year-old man has an MELD score of 28 and is listed for liver transplantation. He develops acute kidney injury with a creatinine rise from 0.9 to 2.8 mg/dL over 2 weeks. Urine sediment is bland. What is the diagnosis?

    Answer: Hepatorenal syndrome type 1 (HRS-AKI)

    HRS-AKI (formerly type 1 HRS) is a rapid functional renal failure in cirrhosis with bland urine sediment, no response to volume challenge, and absence of other AKI causes.

  5. A patient with alcoholic hepatitis has a Maddrey discriminant function of 38. He has no infection or GI bleeding. What is the most appropriate treatment?

    Answer: Prednisolone 40 mg/day for 28 days

    Prednisolone is recommended for severe alcoholic hepatitis (Maddrey DF ≥32) in the absence of contraindications (infection, GI bleeding, renal failure), reducing short-term mortality.

  6. A 45-year-old man with chronic hepatitis C (genotype 1a) is started on direct-acting antiviral therapy. Twelve weeks after completing treatment, HCV RNA is undetectable. What does this represent?

    Answer: Sustained virological response (SVR) — considered cured

    Sustained virological response (SVR) is defined as undetectable HCV RNA 12 weeks after completing therapy and is considered a cure with >99% durability.