Internal Medicine Exam Gastroenterology and Hepatology 4

Question 1

A 58-year-old man with alcoholic cirrhosis (Child-Pugh C) develops a variceal bleed. After stabilization with octreotide and endoscopic band ligation, what is the most important next step to prevent recurrent bleeding?

Accepted Answer

Non-selective beta-blocker plus repeat band ligation

Answer

Secondary prophylaxis of variceal bleeding requires combination therapy with non-selective beta-blockers (nadolol or propranolol) plus endoscopic variceal ligation, which is superior to either alone.

Question 2

A 45-year-old man presents with nausea, right upper quadrant pain, and AST/ALT >1000 U/L after a camping trip where he consumed wild mushrooms. What toxin is most likely responsible?

Accepted Answer

Amatoxin from Amanita phalloides

Answer

Amatoxin (alpha-amanitin) from Amanita phalloides causes severe hepatotoxicity by inhibiting RNA polymerase II; it is the most common cause of fatal mushroom poisoning.

Question 3

A 30-year-old woman presents with iron deficiency anemia, bloating, and a positive tissue transglutaminase IgA antibody. Small bowel biopsy shows subtotal villous atrophy. What is the first-line treatment?

Accepted Answer

Strict lifelong gluten-free diet

Answer

A strict lifelong gluten-free diet is the cornerstone of celiac disease treatment and leads to mucosal healing, resolution of symptoms, and correction of nutritional deficiencies.

Question 4

A 65-year-old man with a 3 cm hepatocellular carcinoma (HCC) on a background of cirrhosis has a Child-Pugh A score and no extrahepatic spread. Which staging criteria determines treatment eligibility for curative resection?

Accepted Answer

Barcelona Clinic Liver Cancer (BCLC) criteria

Answer

The BCLC staging system is the most widely used guideline for HCC that links staging to prognosis and treatment allocation, including candidacy for resection.

Question 5

A 52-year-old woman is found to have a 2 cm polyp in the sigmoid colon on colonoscopy. Pathology shows a tubulovillous adenoma with high-grade dysplasia. When should the next surveillance colonoscopy be performed?

Accepted Answer

3-6 months to verify complete removal, then 1 year

Answer

After resection of high-grade dysplasia or large adenomas, a short-interval colonoscopy (3-6 months) confirms complete removal, followed by surveillance at 1 year per current guidelines.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Gastroenterology and Hepatology 4