Family Practice Exam Gastrointestinal Medicine 1 — Questions and Answers
Question 1: Which of the following is the first-line treatment regimen for H. pylori eradication?
- Triple therapy (PPI + amoxicillin + clarithromycin) (Correct answer)
- PPI monotherapy for 8 weeks
- Bismuth quadruple therapy alone
- Metronidazole monotherapy for 14 days
Correct answer: Triple therapy (PPI + amoxicillin + clarithromycin)
Triple therapy with a PPI, amoxicillin, and clarithromycin for 14 days is the standard first-line regimen for H. pylori eradication in areas with low clarithromycin resistance.
Question 2: A 45-year-old patient reports heartburn and regurgitation occurring at least twice weekly for 6 months. What is the most appropriate first-line pharmacological treatment?
- Proton pump inhibitor (e.g., omeprazole) (Correct answer)
- H2 receptor antagonist (e.g., famotidine)
- Calcium-based antacid
- Surgical fundoplication referral
Correct answer: Proton pump inhibitor (e.g., omeprazole)
PPIs provide superior acid suppression compared to H2 blockers and are the first-line pharmacological therapy for chronic GERD.
Question 3: According to Rome IV criteria, which of the following is NOT a diagnostic criterion for irritable bowel syndrome (IBS)?
- Unintentional weight loss >10 lbs (Correct answer)
- Recurrent abdominal pain at least 1 day per week for 3 months
- Pain related to defecation
- Pain associated with a change in stool frequency or form
Correct answer: Unintentional weight loss >10 lbs
Unintentional weight loss is a red-flag symptom suggesting organic disease and is not part of the Rome IV IBS criteria; its presence warrants further workup.
Question 4: Which antibody test is the preferred initial screening test for celiac disease in patients with adequate IgA levels?
- Anti-tissue transglutaminase IgA (anti-tTG IgA) (Correct answer)
- Anti-gliadin IgG
- Anti-endomysial IgM
- Anti-deamidated gliadin peptide IgM
Correct answer: Anti-tissue transglutaminase IgA (anti-tTG IgA)
Anti-tTG IgA is the single best screening test for celiac disease due to its high sensitivity (>95%) and specificity (~95%) and is recommended by all major guidelines.
Question 5: A 62-year-old otherwise healthy patient is diagnosed with uncomplicated acute diverticulitis (no abscess, no perforation, mild symptoms). What is the most appropriate management?
- Outpatient treatment with oral antibiotics and liquid diet (Correct answer)
- Emergent surgical consultation for resection
- Intravenous antibiotics with hospital admission
- Urgent colonoscopy within 24 hours
Correct answer: Outpatient treatment with oral antibiotics and liquid diet
Uncomplicated diverticulitis in immunocompetent patients with mild symptoms can be safely managed outpatient with oral antibiotics and dietary modification.
Question 6: According to current USPSTF guidelines, at what age should average-risk asymptomatic adults begin colorectal cancer screening?
- 45 years (Correct answer)
- 50 years
- 40 years
- 55 years
Correct answer: 45 years
In 2021, the USPSTF updated its recommendation to begin colorectal cancer screening at age 45 for average-risk adults due to rising incidence in younger populations.
Question 7: Which of the following is the most common etiology of peptic ulcer disease in the United States?
- Helicobacter pylori infection (Correct answer)
- Chronic NSAID use
- Zollinger-Ellison syndrome
- Stress-related mucosal disease
Correct answer: Helicobacter pylori infection
H. pylori infection is responsible for approximately 70–90% of duodenal ulcers and 60–70% of gastric ulcers, making it the leading cause of peptic ulcer disease.
Family Practice Exam Gastrointestinal Medicine 1
Which of the following is the first-line treatment regimen for H. pylori eradication?