Internal Medicine Gastroenterology Disorders Questions and Answers

Question 1

A 32-year-old male is newly diagnosed with moderate-to-severe ileocolonic Crohn's disease.
He has not received prior treatment.
According to the most recent American Gastroenterological Association (AGA) guidelines, which of the following is the most appropriate initial therapeutic approach?

Accepted Answer

Early initiation of an anti-TNF agent such as infliximab

Answer

Step-up therapy starting with oral mesalamine

Answer

A prolonged course of oral corticosteroids as monotherapy

Answer

A 12-week course of broad-spectrum antibiotics

Question 2

A 28-year-old woman presents with chronic diarrhea, bloating, and newly diagnosed iron deficiency anemia. Celiac disease is suspected. Which of the following is the most appropriate initial serologic test for this condition in an adult who is not IgA deficient?

Accepted Answer

Tissue transglutaminase (tTG)-IgA antibody

Answer

Anti-gliadin antibodies (AGA), IgG and IgA

Answer

Anti-endomysial antibodies (EMA), IgA

Answer

Genetic testing for HLA-DQ2/DQ8

Question 3

A 50-year-old man with a history of heavy alcohol use is admitted with severe epigastric pain radiating to the back and a serum lipase level five times the upper limit of normal. He is diagnosed with acute pancreatitis. Which of the following interventions is considered the cornerstone of early management?

Accepted Answer

Aggressive intravenous fluid resuscitation

Answer

Prophylactic antibiotic administration

Answer

Immediate ERCP with sphincterotomy

Answer

Placement of a nasogastric tube for bowel rest

Question 4

A 62-year-old man with cirrhosis and ascites presents with a fever of 38.5°C (101.3°F) and diffuse abdominal pain. A diagnostic paracentesis is performed. Which of the following ascitic fluid findings is diagnostic for spontaneous bacterial peritonitis (SBP)?

Accepted Answer

Polymorphonuclear (PMN) leukocyte count of 350 cells/mm³

Answer

Serum-ascites albumin gradient (SAAG) > 1.1 g/dL

Answer

Total protein > 2.5 g/dL

Answer

Positive bacterial culture with a PMN count of 100 cells/mm³

Question 5

A 48-year-old patient requires treatment for a newly diagnosed *Helicobacter pylori* infection. The local clarithromycin resistance rate is known to be over 20%. According to the latest ACG guidelines, which of the following is a recommended first-line therapy?

Accepted Answer

Bismuth quadruple therapy for 14 days

Answer

Clarithromycin-based triple therapy for 7 days

Answer

Levofloxacin-based triple therapy for 10 days

Answer

Dual therapy with a PPI and amoxicillin for 14 days

Question 6

A 46-year-old asymptomatic woman presents for a health maintenance visit. She reports that her father was diagnosed with colon cancer at age 54. According to current USPSTF and ACG guidelines, what is the most appropriate screening recommendation for this patient?

Accepted Answer

Begin screening now with a colonoscopy

Answer

Begin screening at age 50 with colonoscopy

Answer

Begin screening now with a multi-target stool DNA test every 3 years

Answer

Begin screening at age 44 with an annual fecal immunochemical test (FIT)