Gastroenterology

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Clostridioides difficile Infection

Fecal microbiota transplantation is noninferior to oral vancomycin for patients with a first episode of Clostridioides difficile infection.

  • True
  • False
Volume 41.2 - Question 25

Intravenous Tranexamic Acid in Gastrointestinal Bleeding

Which one of the following statements regarding the use of tranexamic acid in adults with gastrointestinal bleeding is false?  

  • It reduces rebleeding rates.  
  • It reduces failure to control bleeding.  
  • It reduces transfusion requirements.  
  • It does not alter mortality.  
Volume 41.2 - Question 21

Vitamin B12 Deficiency

A 23-year-old female patient is at the office today complaining of fatigue, brain fog, depressed mood, and mood swings. She is a vegetarian. You suspect that she has Vitamin B12 deficiency.
Volume 41.1 - Question 40

Metabolic Dysfunction-Associated Steatotic Liver Disease

Which one of the following statements about metabolic dysfunction-associated steatotic liver disease (MASLD) is false?

  • Weight loss of at least 10% is needed to reduce liver fibrosis.
  • Semaglutide has been shown to exert hepatoprotective effects.
  • SGLT2 inhibitors do not have hepatoprotective effects.
  • No liver-directed pharmacotherapies are available for the treatment of MASLD-related cirrhosis.
Volume 41.1 - Question 32

Steatotic Liver Disease in the Office

Phosphatidylethanol is a biomarker which may identify moderate or heavy alcohol consumption in the past 3 to 4 weeks.

  • True
  • False
Volume 40.5 - Question 29

Statin Use and Risk of Hepatocellular Carcinoma

In patients 40 years or older with chronic liver disease and a baseline Fibrosis-4 (FIB-4) score of 1.3 or higher, statin use is significantly associated with a reduced risk of incident hepatocellular carcinoma.

  • True
  • False
Volume 40.5 - Question 26

Gastric Reflux in Infants

In infants with suspected reflux disease, which one of the following statements is false?

  • Respiratory infections are more frequent during interventions with PPIs.
  • PPIs have been shown to reduce symptoms of suspected reflux disease in infants.
  • Infants’ refluxate is less acidic than that of older age groups.
  • Feed thickeners have been shown to reduce the frequency of regurgitation.
Volume 40.5 - Question 4

Recurrent Bacterial Vaginosis

The use of oral and topical antimicrobial therapy for male partners, when their female partner is treated for bacterial vaginosis, results in a significantly lower recurrence rate of bacterial vaginosis over a period of 12 weeks than the recommended practice of treating women only.

  • True
  • False
Volume 40.5 - Question 1

Steatotic Liver Disease

Weight loss of more than 10% in people who have metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an improvement in fibrosis.

  • True
  • False
Volume 40.4 - Question 34

Peptic Ulcer Disease

Which one of the following statements about the management of peptic ulcer disease is false?

  • Aspirin doses of 75 mg to 91 mg are associated with an increased risk of duodenal ulcer.
  • Alcohol intake is not a risk factor for peptic ulcer disease.
  • Infection with H pylori increases the risk of peptic ulcer disease among individuals taking low doses of aspirin.
  • Use of acetaminophen in doses up to 4g/day is not associated with peptic ulcer disease.
Volume 40.3 - Question 35

GERD Treatment in Infants and Children

Which one of the following statements about the pharmacological treatment of gastroesophageal reflux disease in infants and children is false?

  • H2 blockers may increase the risk of necrotizing enterocolitis in high-risk preterm infants.
  • Proton pumps inhibitors (PPIs) may increase the risk of lower respiratory tract infections.
  • Long-term use of PPIs has been linked to obesity, allergies, and a higher risk of fractures in children.
  • A trial of PPIs for diagnostic purposes is recommended in infants.
Volume 40.3 - Question 11

Conservative Treatment of Infantile GERD

Which one of the following statements about the treatment of gastroesophageal reflux disease in infants is false?

  • Thickened formula may lead to fewer episodes of regurgitation.
  • Amino acid–based formulas are indicated for infants with severe GERD symptoms.
  • Head elevation is recommended.
  • Rice cereal as a thickening agent may cause excessive weight gain.
Volume 40.3 - Question 10

Gastroesophageal Reflux Disease in Infants

Which one of the following symptoms is an alarm symptom of gastroesophageal disease in infants which requires further attention?

  • Projectile vomiting
  • Inconsolable crying
  • Coughing
  • Feeding refusal
Volume 40.3 - Question 9

Ulcerative Colitis

A 36-year-old man presents to your clinic with bloating, loose/watery stools with mucus, and fatigue for the past 3 months. He has experienced two episodes of blood in his stool last week without any anal pain.   He has lost 3 kg since you’ve seen him 6 months ago. He has diffuse abdominal tenderness and a normal rectal examination. Your patient is worried that he has ulcerative colitis (UC). 
Volume 40.21 - Question 11

Non-Alcoholic Fatty Liver Disease

In patients with Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease, which one of the following statements regarding treatment with oral antidiabetic drugs is false?

  • Thiazolidinediones restore lowered plasma adiponectin levels in patients with nonalcoholic steatohepatitis.
  • Sodium-glucose cotransporter 2 inhibitors might be preferred over other oral antidiabetic drugs with respect to nonalcoholic fatty liver disease regression.
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors are not significantly associated with weight change.
  • DPP-4 inhibitors are significantly associated with a lower incidence of adverse liver-related outcomes when compared with sulfonylureas.
Volume 39.6 - Question 40

Non-Erosive Gastro-Esophageal Reflux Disease

Patients with non-erosive gastro-esophageal reflux disease have a higher incidence of esophageal adenocarcinoma than the general population.

  • True
  • False
Volume 39.6 - Question 39

Anal Fissures

Which one of the following statements about the management of anal fissures is false?

  • Sitz baths are recommended as a first-line treatment for anal fissures.
  • Topical calcium channel blockers are as effective as topical nitroglycerin.
  • Botulinum toxin injections are more effective than topical therapies.
  • Lateral internal sphincterotomy is more effective than medical therapy.
Volume 39.6 - Question 38

Inflammatory Bowel Disease in Patients of Childbearing Age

Which one of the following statements regarding inflammatory bowel disease (IBD) is false?

  • Female patients with IBD are recommended to be in remission for at least 6 months before attempting to conceive.
  • Biologic therapies are not recommended during lactation.
  • Folic acid doses of 2-5 mg/day are recommended throughout pregnancy for patients taking sulfasalazine.
  • Planned cesarean delivery is usually recommended and associated with high risk of perianal injury.
Volume 39.6 - Question 16

Colon Cancer

Which one of the following statements about colon cancer in primary care is false? 

  • Colon cancer develops over approximately 10-15 years. 
  • Right-sided tumours have poorer overall survival compared with left-sided ones. 
  • In the setting of limited metastatic disease, patients with Stage IV colon cancer can be considered for surgical resection of lung and liver metastases. 
  • Individuals diagnosed with metastatic disease have a median overall survival of about 12 months. 
Volume 39.5 - Question 41

Urinary Incontinence in Adults

Diarrhea is associated with an increased risk of urge urinary incontinence in adults. 

  • True
  • False
Volume 39.5 - Question 38

Infections from Recreational Water Activities

Which one of the following statements about waterborne infections is false?

  • Nitazoxanide is recommended for the treatment of mild diarrhea induced by cryptosporidium.
  • Giardiasis oocytes can survive in treated swimming pools and hot tubs.
  • Giardiasis symptoms can recur after treatment.
  • Adenovirus causes waterborne illnesses more frequently than does rotavirus.
Volume 35.61 - Question 6

Allopurinol in Cirrhosis

In patients with cirrhosis and hepatic decompensation, allopurinol decreases the recurrence of cirrhosis-related complications. 

  • True
  • False
Volume 39.4 - Question 31

Eosinophilic Esophagitis

Which one of the following statements about eosinophilic esophagitis is false? 

  • Females are 3–4 times more likely than males to develop the condition.    
  • Patients often present initially with a food bolus obstruction in the esophagus.   
  • Topical corticosteroids are an effective treatment.   
  • Elimination of cows’ milk compared to a 6-food elimination diet shows similar symptom remission. 
Volume 39.4 - Question 20

Cirrhosis

Which one of the following statements regarding the use of non-selective beta blockers in the management of cirrhosis in patients older than 16 is false?

  • They can reduce the incidence of ascites in people with clinically significant portal hypertension.
  • They have a greater effect on blood pressure in people with cirrhosis.
  • They are less effective than endoscopic variceal band ligation for preventing oesophageal variceal bleeding.
  • Carvedilol should be avoided in people with severe hepatic impairment.
Volume 39.3 - Question 30

Alcohol-Associated Hepatitis

Which one of the following statements regarding alcohol-associated hepatitis is false?

  • About 50% of patients have underlying cirrhosis and may have co-existing decompensation.
  • Corticosteroids improve 1-year mortality.
  • There is benefit from high-protein and high-calorie diets with vitamin B and D supplementation.
  • Transplantation improves survival.
Volume 39.3 - Question 29

Irritable Bowel Syndrome

Low-dose amitriptyline is superior to placebo for adequate relief of irritable bowel syndrome.

  • True
  • False
Volume 39.3 - Question 26

Hepatitis C

Which one of the following statements about hepatitis C is false?

  • Most patients with hepatitis C are asymptomatic.
  • Globally, less than 5% of patients with hepatitis C have been diagnosed.
  • Undetectable HCV RNA 12 weeks after treatment is considered a virologic cure.
  • All patients need liver-specific follow-up.
Volume 37.3 - Question 22

Treatment of outpatient diverticulitis

Amoxicillin–clavulanate is as effective as metronidazole-with-fluoroquinolone in the treatment of outpatient diverticulitis.

  • True
  • False
Volume 37.3 - Question 21

CBT for children with IBS

Which one of the following statements about irritable bowel syndrome (IBS) in children is false?

  • It accounts for over 25% of all emergency consultations for pediatric abdominal pain.
  • Amitriptyline may have a significant effect in adolescents with IBS.
  • In-person cognitive behavioural therapy has been shown to decrease abdominal pain frequency.
  • Gut-directed hypnotherapy does not reduce pain in children with IBS.
Volume 37.3 - Question 6

SAMP Crohn Disease

20 year old BA presents with intermittent abdominal pain, fever, weight loss and diarrhea. She has been seen several times in the ER and has been tried on “celiac and a FODMAP” diet with no consistent effect. There is no rectal bleeding.  You consider the possibility of Crohn disease and organize further investigations. 
Volume 36.5 - Question 46

Dexlansoprazole

Once-daily dexlansoprazole is more likely to be effective when compared to twice daily use of other proton pump inhibitors.

  • True
  • False
Volume 37.6 - Question 5

Ulcerative Colitis

Which one of the following statements about ulcerative colitis is false?

  • The most common presenting symptom is bloody diarrhea.
  • Recent campylobacter infection is a risk factor.
  • Active tobacco use is a risk factor.
  • Soda consumption is a risk factor.
Volume 37.6 - Question 4

Esophageal Cancer Screening

Over 90% of diagnoses of esophageal adenocarcinoma are made while investigating patients with alarm symptoms. 

  • True
  • False
Volume 36.3 - Question 9

Inflammatory Bowel Disease in Children

Calprotectin testing of children with suspected inflammatory bowel disease (IBD) in primary care accurately distinguishes IBD from a functional gut disorder. 

  • True
  • False
Volume 36.3 - Question 1

Esophageal Motility Disorders

A 60-year-old woman presents to your office with a one-year history of worsening dysphagia for both solids and liquids. She also has associated chest pain that only occurs with eating. She describes food sticking at the base of her neck. She finds her symptoms better if she stands up during eating. She has noted occasional regurgitation of food at night. She has hypertension and osteoarthritis. She is currently taking ramipril and acetaminophen with codeine and has tried ranitidine over the counter with little relief.  
Volume 36.2 - Question 41

Primary Care Following Bariatric Surgery

Which one of the following statements about bariatric surgery is false? 

  • The likelihood of nausea or vomiting is high after gastric banding procedures.    
  • Pain related to eating after bariatric surgery is an indication for a prompt referral back to a bariatric surgeon.    
  • There is a lifelong need to take vitamin supplementation after bariatric surgery.    
  • A patient can expect to reach their maximal weight loss six months after bariatric surgery. 
Volume 36.2 - Question 34

Antacid for Epigastric Pain

Antacid/lidocaine 2% viscous gel is superior to antacid monotherapy in reducing epigastric pain at 30 minutes. 

  • True
  • False
Volume 36.2 - Question 33

Esophageal Motility Disorders

A 60-year-old woman presents to your office with a one-year history of worsening dysphagia for both solids and liquids. She also has associated chest pain that only occurs with eating. She describes food sticking at the base of her neck. She finds her symptoms better if she stands up during eating. She has noted occasional regurgitation of food at night. She has hypertension and osteoarthritis. She is currently taking ramipril and acetaminophen with codeine and has tried ranitidine over the counter with little relief.  
Volume 36.1 - Question 38

Anal Fissures

Which one of the following statements about anal fissures is false?

  • Multiple fissures may indicate a secondary cause.
  • Primary fissures are common in elderly patients.
  • The presence of proximal hypertrophied anal papillae suggests a chronic fissure.
  • Topical diltiazem provides analgesia.
Volume 37.4 - Question 24

Acute Pancreatitis

Which one of the following statements about acute pancreatitis is false? 

  • The solution of choice for fluid resuscitation is Ringer’s lactate.
  • Prophylactic antibiotics are recommended for all admitted patients.
  • Nearly a quarter of patients are diagnosed with diabetes following the first episode.
  • Cholecystectomy during the same admission is advised for mild biliary pancreatitis.
Volume 36.1 - Question 34

Irritable Bowel Syndrome

Which one of the following is not an effective pharmacologic agent for constipation-predominant irritable bowel syndrome (IBS-C)? 

  • Poorly fermented soluble fibre, such as psyllium
  • Insoluble fibre, such as bran 
  • Simple laxatives, such as polyethylene glycol 
  • Guanylate cyclase-C agonists, such as linaclotide and plecanatide 
Volume 36.1 - Question 33

Bariatric Surgery

Which one of the following statements about bariatric surgery when compared to medical management is false? 

  • It is associated with a reduced risk of all types of cancer.  
  • Glycemic control is improved. 
  • Antihypertension medication use is lower initially.  
  • It does not result in greater long-term weight loss than non-surgical therapies.
Volume 36.1 - Question 32

Constipation

Which one of the following statements about chronic constipation is false? 

  • It is defined as a stool frequency of fewer than three bowel movements per week.   
  • It can be due to pelvic floor dysfunction. 
  • An obstruction or mass is a very common cause of chronic constipation. 
  • Routine use of blood tests or imaging is not indicated in the absence of alarm symptoms. 
Volume 38.1 - Question 29

Barrett Esophagus Management

Which one of the following statements about the management of Barrett Esophagus is false? 

  •  Patients with Barrett esophagus have approximately a 3% to 5% risk of developing esophageal adenocarcinoma in their lifetime. 
  • Screening for Barrett esophagus reduces death rates from esophageal adenocarcinoma. 
  • Surveillance endoscopy every 3-5 years is recommended for patients with nondysplastic disease. 
  • Resection of visible neoplastic Barrett esophagus lesions should be followed by ablation. 
Volume 38.1 - Question 28

Diverticular Disease

A 55 year old male patient who is coming to see you in your office for left lower quadrant abdominal pain for the past two days. He is overweight, has a sedentary job, smokes 10 to 15 cigarettes a day and drinks beer on the weekend. He has never had this kind of pain before. He is worried about cancer, although he isn’t aware of any in his family. He denies fever and is still eating a normal diet although he has reduced his portions. You consider diverticulitis as a possible diagnosis.
Volume 38.2 - Question 37

Constipation Management

Which one of the following statements about the management of chronic constipation is false?

  • Increased fluid intake alone has been shown to improve constipation in all patients.
  • Probiotics may improve colonic transit.
  • Biofeedback therapy is superior to laxatives for defecatory dysfunction.
  • Stimulant laxatives are a short-term, second line adjunctive treatment.
Volume 38.2 - Question 29

PPIs and Gastric Cancer

There is a clinically significant increase in the risk of gastric cancer in patients taking a proton pump inhibitor (PPI) compared with those taking H2 receptor antagonists.

  • True
  • False
Volume 38.2 - Question 22

Gastroesophageal Reflux Disease

Which one of the following statements about the treatment of gastroesophageal reflux disease is false?

  • Antacids can decrease the absorption of some other drugs by altering gastric acidity.
  • H2-Receptor Antagonists (H2RAs) have a slower onset of action than PPIs.
  • PPIs are more effective than H2RAs in healing erosive esophagitis.
  • Addition of an H2RA as needed may be helpful for patients who still have symptoms despite twice-daily PPI treatment.
Volume 37.5 - Question 35

Early-Onset Colorectal Cancer

Which one of the following statements regarding early-onset (<50 years of age) colorectal cancer is false?

  • It now accounts for approximately 10% of all new diagnoses of this cancer.
  • An increase in colorectal cancer-related mortality has been observed in the past decade among younger patients.
  • Most cases are due to a hereditary syndrome.
  • More than 70% are detected in the left colon at presentation.
Volume 37.5 - Question 22

Constipation Treatment in Children

Which one of the following statements about the treatment of constipation in children is false?

  • Polyethylene glycol is effective for disimpaction.
  • Maintenance therapy should continue for at least 2 months or at least one month after a good response to treatment.
  • Relapses are common.
  • Lactulose is a first-line maintenance treatment.
Volume 37.5 - Question 5

Irritable Bowel Syndrome

In primary care IBS patients, the use of a FODMAP-lowering diet application is superior to a spasmolytic agent in improving IBS symptoms.

  • True
  • False
Volume 38.4 - Question 29

Treatment of Anal Fissure

Topical treatments with Vitamin E may be more effective than topical nitrates for treatment of chronic anal fissures in adults.

  • True
  • False
Volume 38.4 - Question 23

Ulcerative Colitis

A 36-year-old man presents to your clinic with bloating, loose/watery stools with mucus, and fatigue for the past 3 months. He has experienced two episodes of blood in his stool last week without any anal pain.   He has lost 3 kg since you’ve seen him 6 months ago. He has diffuse abdominal tenderness and a normal rectal examination. Your patient is worried that he has ulcerative colitis (UC). 
Volume 39.1 - Question 41

Drugs for Inflammatory Bowel Disease

Which one of the following statements about drugs for treatment of ulcerative colitis (UC) is false? 

  • Oral aminosalicylates are effective for induction and maintenance of remission in mild UC. 
  • Corticosteroids can be used for maintenance of remission. 
  • In moderate to severe disease, early use of a biologic drug is recommended. 
  • Tumor necrosis factor inhibitors are effective for induction and maintenance of remission. 
Volume 39.1 - Question 36

Spontaneous Bacterial Peritonitis

Which one of the following statements about spontaneous bacterial peritonitis in patients with cirrhosis is false?

  • Diagnosis should be confirmed by culture of ascitic fluid prior to starting antibiotics.
  • Administration of albumin is recommended to reduce risk of death.
  • Patients often present with decompensation of their cirrhosis.
  • Mortality rates remain high even with appropriate antibiotic treatment.
Volume 38.3 - Question 37

Cholecystectomy after Acute Biliary Pancreatitis

In patients with severe acute biliary pancreatitis, early cholecystectomy (within 14 days of admission) is associated with increased postoperative mortality when compared to delayed cholecystectomy. 

  • True
  • False
Volume 39.1 - Question 30

Alcohol-Associated Hepatitis

Which one of the following statements about alcohol-associated hepatitis is false?

  • Glucocorticoids can improve long-term survival.
  • Women are more susceptible to alcohol injury.
  • Mortality from moderate disease is up to 20% at one year.
  • The use of alcohol anticraving drugs has not been rigorously tested in the context of alcohol-associated hepatitis.
Volume 38.3 - Question 23

Hemochromatosis

Which one of the following statements about hemochromatosis is false?

  • The earliest laboratory manifestation is an elevation in the serum ferritin level.
  • Iron elevation is a risk factor for breast cancer.
  • Arthritis may occur even after successful therapeutic phlebotomy.
  • Cardiomyopathy is a rare complication that is potentially reversible with iron-removal therapy.
Volume 38.4 - Question 2

Evaluation, Management and Future Perspectives of Anal Pruritus

Which one of the following statements regarding anal pruritus is false?

  • It is more common among men than women.
  • Some studies have found a link between tobacco use and idiopathic anal pruritus.
  • The use of potent topical steroids is recommended when symptoms are severe.
  • Oral antihistamines have a negligible inhibitory effect on symptoms.
Volume 39.2 - Question 35

Protein-Losing Enteropathy

Which one of the following statements about protein-losing enteropathy is false?

  • It can result in retarded development in children.
  • It can be found in sarcoidosis.
  • Chemotherapy-induced remission of lymphoma can reverse it.
  • Normal findings on biopsy rule out mucosal diagnoses.
Volume 39.2 - Question 33

Wilson’s Disease

Which one of the following statements about Wilson’s disease is false?

  • Dysarthria is often the first prominent neurological symptom.
  • Serum ceruloplasmin level alone is adequate for diagnosis.
  • Acute liver failure may be the first manifestation.
  • Screening of all first-degree relatives is mandatory.
Volume 39.2 - Question 18

Management of Acute Lower Gastrointestinal Bleeding

Which one of the following statements is recommended by the American College of Gastroenterology in the management of acute lower gastrointestinal bleeding?

  • Urgent colonoscopy within 24 hours.
  • Routine use of antifibrinolytics such as tranexamic acid.
  • Resumption of anticoagulation after cessation of bleeding.
  • CT angiography after bleeding has subsided.
Volume 38.6 - Question 38

Polycystic Ovary Syndrome

Which one of the following statements about polycystic ovary syndrome is false?

  • It is the most common endocrinopathy affecting women of childbearing age.
  • Patients may be asymptomatic.
  • The diagnosis in adolescents requires the presence of both oligoanovulation and hyperandrogenism for at least two years postmenarche.
  • Ultrasound findings are recommended as a diagnostic criterion in adolescents.
Volume 38.6 - Question 5

Stercoral Colitis

Which one of the following statements regarding stercoral colitis is false?

  • It occurs most commonly in people with advanced age and psychological or neurological comorbidities
  • The absence of abdominal pain is common.
  • Short-term mortality rates are less than 1%.
  • Evidence-based guidance for management is lacking
Volume 38.6 - Question 1

Eosinophilic Oesophagitis Management

One-food elimination diet is non-inferior to six-food elimination diet therapy for the treatment of eosinophilic oesophagitis.

  • True
  • False
Volume 38.5 - Question 34

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