ITE Gastroenterology and Hepatology Questions and Answers

Question 1

A 62-year-old man with decompensated alcoholic cirrhosis undergoes a diagnostic paracentesis for new-onset ascites.
His medical history is negative for prior spontaneous bacterial peritonitis (SBP).
The ascitic fluid analysis reveals a total protein of 1.1 g/dL, a serum-ascites albumin gradient (SAAG) of 1.8 g/dL, and an absolute neutrophil count (ANC) of 80 cells/mm³.
His serum creatinine is 1.4 mg/dL and total bilirubin is 3.5 mg/dL.
According to current AASLD guidelines, which of the following is the most appropriate next step regarding SBP prophylaxis?

Accepted Answer

Initiate long-term prophylaxis with a daily oral fluoroquinolone or trimethoprim-sulfamethoxazole.

Answer

No prophylaxis is needed as he has never had an episode of SBP.

Answer

Administer a one-time dose of intravenous ceftriaxone and discharge.

Answer

Initiate prophylaxis only if the ascitic fluid culture becomes positive.

Question 2

A 28-year-old woman presents with a one-year history of intermittent abdominal cramping, bloating, and chronic diarrhea. She reports unintentional weight loss of 10 lbs. Laboratory studies reveal a microcytic anemia with a hemoglobin of 10.5 g/dL. She is currently consuming a regular diet. According to the American College of Gastroenterology (ACG), which of the following is the most appropriate initial serologic test for celiac disease?

Accepted Answer

Tissue transglutaminase (tTG) IgA antibody plus total serum IgA

Answer

Anti-gliadin IgG antibody

Answer

HLA-DQ2 and HLA-DQ8 genetic testing

Answer

Anti-Saccharomyces cerevisiae antibodies (ASCA)

Question 3

A 45-year-old man with a history of dyspepsia undergoes an upper endoscopy which reveals a 1.5 cm duodenal ulcer. A biopsy is positive for Helicobacter pylori. The patient has no known drug allergies. The local clarithromycin resistance rate is known to be over 20%. Which of the following is the most appropriate first-line eradication therapy?

Accepted Answer

A proton pump inhibitor (PPI), bismuth subsalicylate, metronidazole, and tetracycline for 14 days

Answer

A proton pump inhibitor (PPI), clarithromycin, and amoxicillin for 14 days

Answer

A proton pump inhibitor (PPI) and amoxicillin for 10 days

Answer

A proton pump inhibitor (PPI), metronidazole, and amoxicillin for 14 days

Question 4

A 40-year-old man presents for a routine health evaluation. He is asymptomatic but reports that his father was diagnosed with colon cancer at age 48. He has no other personal or family history of cancer. According to current U.S. Preventive Services Task Force (USPSTF) and ACG guidelines, what is the most appropriate recommendation for colorectal cancer screening for this patient?

Accepted Answer

Begin screening now with colonoscopy.

Answer

Begin screening with colonoscopy at age 50.

Answer

Begin screening now with a stool-based test (FIT).

Answer

No screening is necessary until he develops symptoms.

Question 5

A 34-year-old male with a history of alcohol abuse presents to the emergency department with severe, constant epigastric pain radiating to the back, nausea, and vomiting for the past 12 hours. His serum lipase is 2500 U/L. Vital signs are stable, and there are no signs of organ failure. According to the 2024 ACG guidelines, which of the following is the most critical initial management step?

Accepted Answer

Moderately aggressive intravenous fluid resuscitation with Lactated Ringer's solution

Answer

Immediate ERCP to assess for biliary obstruction

Answer

Administration of prophylactic broad-spectrum antibiotics

Answer

Placement of a nasogastric tube for gastric decompression

Question 6

A 30-year-old woman is diagnosed with moderate-to-severe ulcerative colitis affecting the left side of her colon. She has failed to respond to a 4-week course of high-dose oral and rectal 5-aminosalicylic acid (5-ASA) agents. Which of the following medication classes is an appropriate next step to induce remission?

Accepted Answer

Oral corticosteroids

Answer

Loperamide

Answer

Long-term broad-spectrum antibiotics

Answer

Cholestyramine