AMC MCQ - Australian Medical Council Multiple Choice Questions Gastroenterology and Surgery Questions and Answers 1 — Questions and Answers
Question 1: A 58-year-old man with a long history of GORD undergoes a surveillance endoscopy. Biopsies from a 4 cm segment of columnar-lined oesophagus confirm Barrett's oesophagus with low-grade dysplasia. The finding of low-grade dysplasia is confirmed by a second specialist pathologist. According to Australian guidelines, what is the most appropriate next step in management?
- Repeat endoscopy with biopsies in 2-3 years.
- Commence annual endoscopic surveillance.
- Refer for endoscopic radiofrequency ablation.
- Repeat endoscopy with Seattle protocol biopsies in 6 months. (Correct answer)
Correct answer: Repeat endoscopy with Seattle protocol biopsies in 6 months.
According to Australian guidelines for the management of Barrett's oesophagus, if low-grade dysplasia is confirmed by a second pathologist, the recommended action is to repeat the endoscopy in 6 months with meticulous Seattle protocol biopsies (quadrantal biopsies every 1 cm). This is to closely monitor for progression to high-grade dysplasia or adenocarcinoma. Annual surveillance may be considered later if subsequent endoscopies are negative for dysplasia. A 2-3 year interval is appropriate for long-segment Barrett's without dysplasia. Endoscopic ablation is typically reserved for confirmed and persistent high-grade dysplasia or early adenocarcinoma.
Question 2: A 45-year-old woman presents with a 2-week history of epigastric pain, nausea, and early satiety. A urea breath test is positive for Helicobacter pylori. She has no known drug allergies. According to current Australian Therapeutic Guidelines, which of the following is the most appropriate first-line eradication therapy?
- A proton pump inhibitor, amoxicillin, and metronidazole for 7 days.
- A proton pump inhibitor, clarithromycin, and metronidazole for 14 days.
- A proton pump inhibitor, amoxicillin, and clarithromycin for 7-14 days. (Correct answer)
- Bismuth quadruple therapy for 14 days.
Correct answer: A proton pump inhibitor, amoxicillin, and clarithromycin for 7-14 days.
Current Australian guidelines recommend standard triple therapy as the first-line treatment for H. pylori eradication. This regimen consists of a proton pump inhibitor (PPI) combined with amoxicillin and clarithromycin. The recommended duration is typically 7 to 14 days, with 14 days potentially offering higher eradication rates. While other regimens exist, they are generally considered for second-line therapy or in areas with high clarithromycin resistance.
Question 3: A 22-year-old man presents to the emergency department with a 24-hour history of central abdominal pain that has now migrated to the right iliac fossa. He has a low-grade fever, anorexia, and tenderness on palpation at McBurney's point. His inflammatory markers are raised. What is the definitive management for uncomplicated acute appendicitis?
- Intravenous antibiotics and observation for 48 hours.
- Laparoscopic appendicectomy. (Correct answer)
- Urgent CT scan of the abdomen and pelvis.
- Percutaneous drainage of the appendix.
Correct answer: Laparoscopic appendicectomy.
The definitive and standard treatment for uncomplicated acute appendicitis is surgical removal of the appendix, known as an appendicectomy. A laparoscopic (keyhole) approach is most commonly used. While antibiotics are given pre-operatively and may be used as a sole treatment in some selected, uncomplicated cases, surgery remains the definitive management to prevent complications like perforation. A CT scan may be used if the diagnosis is uncertain, but it is not the definitive management itself. Percutaneous drainage is for an established appendix abscess, not uncomplicated appendicitis.
Question 4: According to the National Bowel Cancer Screening Program in Australia, what is the recommended screening method and interval for an asymptomatic 55-year-old person at average risk of colorectal cancer?
- Annual immunochemical faecal occult blood test (iFOBT).
- Colonoscopy every 10 years.
- Flexible sigmoidoscopy every 5 years.
- Biennial immunochemical faecal occult blood test (iFOBT). (Correct answer)
Correct answer: Biennial immunochemical faecal occult blood test (iFOBT).
The current Australian National Bowel Cancer Screening Program recommends biennial (every two years) screening with an immunochemical faecal occult blood test (iFOBT) for asymptomatic people at average risk, starting from age 50 and continuing to age 74. Recent guideline updates also support starting iFOBT screening from age 45. Colonoscopy is the investigation for a positive iFOBT or for those at higher risk, not for primary screening in the average-risk population.
Question 5: A 48-year-old man presents with severe epigastric pain radiating to his back, associated with nausea and vomiting. His serum lipase is markedly elevated. An ultrasound reveals gallstones in the gallbladder but no common bile duct dilatation. He is diagnosed with mild, gallstone-induced pancreatitis. His symptoms resolve with conservative management. What is the most appropriate next step to prevent recurrence?
- Discharge with a low-fat diet and follow-up in 6 months.
- Laparoscopic cholecystectomy during the same hospital admission. (Correct answer)
- Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy.
- Ursodeoxycholic acid therapy.
Correct answer: Laparoscopic cholecystectomy during the same hospital admission.
For patients with mild biliary pancreatitis, guidelines recommend performing a laparoscopic cholecystectomy during the index (same) hospital admission once the pancreatitis has resolved. This is to prevent recurrent attacks of pancreatitis, which are common if the gallbladder is left in situ. Delaying surgery increases the risk of recurrence. ERCP is indicated for concurrent cholangitis or confirmed common bile duct stones, not for uncomplicated gallstone pancreatitis. Dietary advice is important but not sufficient to prevent recurrence.
Question 6: Which of the following is considered a primary 'alarm' symptom in a patient with gastro-oesophageal reflux disease (GORD) that warrants urgent endoscopic investigation?
- Regurgitation after meals.
- Waterbrash.
- Dysphagia. (Correct answer)
- Epigastric burning relieved by antacids.
Correct answer: Dysphagia.
Dysphagia (difficulty swallowing) is a significant 'red flag' or 'alarm' symptom in patients with GORD. It may indicate a complication such as an oesophageal stricture or malignancy and requires urgent investigation, typically with an endoscopy. While the other symptoms are characteristic of GORD, they are not considered alarm features in the absence of other signs.
AMC MCQ - Australian Medical Council Multiple Choice Questions Gastroenterology and Surgery Questions and Answers 1
A 58-year-old man with a long history of GORD undergoes a surveillance endoscopy.
Biopsies from a 4 cm segment of columnar-lined oesophagus confirm Barrett's oesophagus with low-grade dysplasia.
The finding of low-grade dysplasia is confirmed by a second specialist pathologist.
According to Australian guidelines, what is the most appropriate next step in management?