ACG Gastrointestinal Disease Diagnosis and Management 3

Question 1

What is the most common cause of acute liver failure (ALF) in the United States?

Accepted Answer

Acetaminophen toxicity

Answer

Acetaminophen overdose, both intentional and unintentional, accounts for approximately 46% of acute liver failure cases in the US, making it the single most common cause.

Question 2

Charcot's triad of findings is classic for which biliary emergency?

Accepted Answer

Acute cholangitis

Answer

Charcot's triad — fever with rigors, jaundice, and right upper quadrant pain — is the classic presentation of acute cholangitis caused by biliary obstruction and ascending bacterial infection.

Question 3

Which endoscopic finding on esophageal varices most strongly predicts imminent hemorrhage in a patient with portal hypertension?

Accepted Answer

Red wale signs on the varix surface

Answer

Red wale signs — longitudinal red streaks on the surface of esophageal varices — are the endoscopic finding most predictive of imminent variceal bleeding in portal hypertension.

Question 4

What is the first-line treatment for mild-to-moderate active ulcerative colitis according to ACG guidelines?

Accepted Answer

Oral 5-aminosalicylic acid (5-ASA) with topical 5-ASA therapy

Answer

Oral 5-ASA agents (such as mesalamine) combined with topical 5-ASA therapy are the ACG-recommended first-line treatment for mild-to-moderate active ulcerative colitis.

Question 5

Which medication class is most strongly associated as a trigger for microscopic colitis in older women presenting with chronic watery non-bloody diarrhea?

Accepted Answer

Proton pump inhibitors (PPIs) and NSAIDs

Answer

Microscopic colitis (collagenous and lymphocytic subtypes) is strongly associated with PPIs, NSAIDs, SSRIs, and statins, with withdrawal of the offending agent being a key part of initial management.

ACG - American College of Gastroenterology Practice Test

ACG - American College of Gastroenterology Practice Test

ACG Gastrointestinal Disease Diagnosis and Management 3