Gastroenterology 51-100 MRQ

First-Line Management of Barrett’s Oesophagus

A 56-year-old male with chronic gastro-oesophageal reflux disease (GORD) was recently diagnosed with Barrett’s oesophagus without dysplasia during an upper endoscopy. He has a 10-year history of acid reflux, and his symptoms improve with proton pump inhibitors (PPIs). He is overweight and has a family history of oesophageal adenocarcinoma.

He asks about the best way to manage his condition and reduce his risk of progression to cancer.

Which of the following are first-line management strategies for Barrett’s oesophagus without dysplasia? Select four (4) correct answers.

Management of Barrett’s Oesophagus with High-Grade Dysplasia

A 61-year-old male with Barrett’s oesophagus is found to have high-grade dysplasia on routine surveillance endoscopy. He is asymptomatic but has a family history of oesophageal adenocarcinoma. His gastroenterologist discusses treatment options to prevent progression to oesophageal cancer.

Which of the following are appropriate management strategies for high-grade dysplasia in Barrett’s oesophagus? Select four (4) correct answers.

A 59-year-old male with long-standing Barrett’s oesophagus presents with progressive difficulty swallowing solids, mild weight loss, and occasional upper abdominal discomfort. He has been on proton pump inhibitors (PPIs) for several years but has not had a follow-up endoscopy in over five years. He denies vomiting, hematemesis, or severe pain.

An upper endoscopy reveals a narrowing in the lower oesophagus with mucosal irregularities, and biopsy confirms low-grade dysplasia with inflammatory changes.

Which of the following are potential complications of Barrett’s oesophagus? Select four (4) correct answers.

A 65-year-old male with Barrett’s oesophagus presents with progressive weight loss, worsening dysphagia, and postprandial chest discomfort. He has a history of smoking and obesity but denies hematemesis or severe pain. His most recent endoscopy one year ago showed intestinal metaplasia without dysplasia.

On examination, he appears cachectic, and laboratory results reveal iron deficiency anemia.

Which of the following are serious complications of Barrett’s oesophagus that require immediate attention? Select four (4) correct answers.

A 48-year-old male presents with burning epigastric pain that worsens at night and improves after eating. He has a history of chronic NSAID use for osteoarthritis and drinks two cups of coffee daily. He denies smoking but drinks alcohol occasionally. A recent upper endoscopy reveals a 1.5 cm gastric ulcer in the antrum with surrounding erythema.

Which of the following are established risk factors for gastric ulcers? Select four (4) correct answers.

A 60-year-old female presents with persistent epigastric discomfort, nausea, and occasional vomiting. She has been taking aspirin daily for cardiovascular protection and reports chronic stress related to her work. She denies smoking but drinks alcohol socially.

An upper endoscopy confirms the presence of a 2 cm gastric ulcer in the lesser curvature of the stomach. The gastroenterologist discusses modifiable and non-modifiable risk factors contributing to her condition.

Which of the following are significant risk factors for gastric ulcer development? Select four (4) correct answers.

A 65-year-old female presents with progressive epigastric pain, unintentional weight loss, and recurrent nausea over the past three months. She has a history of chronic H. pylori infection and has been taking low-dose aspirin for cardiovascular disease. She denies hematemesis but has experienced black, tarry stools.

On examination, she is pale, and her abdominal exam reveals epigastric tenderness without guarding or rigidity.

Which of the following are clinical features that may indicate a complicated gastric ulcer? Select four (4) correct answers.

A 55-year-old male presents with burning epigastric pain that worsens after meals and occasional nausea and bloating. He has a history of chronic NSAID use for osteoarthritis. He denies weight loss, vomiting, or hematemesis. His physical examination is unremarkable except for mild epigastric tenderness.

You suspect a gastric ulcer and decides to confirm the diagnosis.

Which of the following are most appropriate investigations for diagnosing a gastric ulcer? Select four (4) correct answers.

A 62-year-old male with a history of chronic epigastric pain and intermittent melena presents with progressive fatigue and weight loss over the past three months. He has been taking NSAIDs for chronic arthritis. His physician is concerned about a complicated or malignant gastric ulcer and orders further investigations.

Which of the following are appropriate investigations for assessing complications or malignancy in a gastric ulcer? Select four (4) correct answers.

A 50-year-old male presents with burning epigastric pain that worsens after eating and improves slightly with antacids. He has been using ibuprofen for chronic back pain for the past six months. A recent upper gastrointestinal endoscopy confirms a 1.5 cm gastric ulcer in the antrum, with a negative biopsy for malignancy.

Which of the following are first-line management strategies for a non-complicated gastric ulcer? Select four (4) correct answers.

A 65-year-old male with a known gastric ulcer presents with new-onset persistent nausea, early satiety, and unintentional weight loss (4 kg in 2 months). His recent endoscopy shows a non-healing ulcer despite 8 weeks of PPI therapy, and biopsy results are negative for malignancy.

Which of the following are appropriate next steps in managing a non-healing or complicated gastric ulcer? Select four (4) correct answers.

A 58-year-old male with a history of gastric ulcer diagnosed six months ago presents to the emergency department with sudden severe epigastric pain that started a few hours ago. He describes the pain as sharp, persistent, and spreading across his abdomen. He feels nauseated but has not vomited. His vital signs reveal hypotension (BP 90/60 mmHg) and tachycardia (HR 110 bpm).

On examination, he has generalized abdominal tenderness with rigidity (board-like abdomen).

Which of the following are potential complications of gastric ulcers in this patient? Select four (4) correct answers.

A 65-year-old female with a history of chronic gastric ulcers presents with progressive nausea, vomiting, early satiety, and weight loss over the past two months. She reports abdominal bloating after meals and has been experiencing persistent postprandial discomfort.

On examination, she has epigastric distension but no tenderness. A succussion splash is heard on auscultation of the abdomen.

Which of the following are likely complications of chronic gastric ulcers in this patient? Select four (4) correct answers.

A 52-year-old male presents with burning epigastric pain that has been gradually worsening over the past three months. The pain typically occurs 1–2 hours after meals and is associated with nausea, bloating, and occasional vomiting. He has been taking over-the-counter ibuprofen for chronic knee pain. He denies weight loss but mentions that antacids provide temporary relief.

On examination, his vital signs are stable, and he has mild epigastric tenderness without guarding or rebound tenderness.

Which of the following differential diagnoses should be considered before confirming gastric ulcer? Select four (4) correct answers.

A 62-year-old female presents with progressive fatigue, pallor, and numbness in her hands and feet over the past six months. She also reports occasional dizziness and difficulty with balance. She has a history of autoimmune thyroid disease but no significant gastrointestinal symptoms. Blood tests reveal macrocytic anemia with low vitamin B12 levels and positive intrinsic factor antibodies.

Which of the following are likely causes of pernicious anemia in this patient? Select four (4) correct answers.

A 58-year-old male presents with progressive weakness, tingling in his lower limbs, and forgetfulness. He has a history of gastroesophageal reflux disease (GORD) and has been on long-term proton pump inhibitors (PPIs). Laboratory tests show macrocytic anemia with low serum vitamin B12 and elevated methylmalonic acid levels.

Which of the following are potential causes of pernicious anemia in this patient? Select three (3) correct answers.

A 58-year-old female presents with progressive fatigue, numbness in her feet, and difficulty walking over the past six months. She also reports occasional forgetfulness and mood changes. Her physical examination reveals pallor, mild icterus, and decreased vibratory sensation in both lower limbs.

You suspect pernicious anemia and orders further investigations.

Which of the following are most appropriate investigations for diagnosing pernicious anemia? Select four (4) correct answers.

A 65-year-old male presents with progressive fatigue, weakness, and shortness of breath. He has numbness in his hands and feet and reports occasional difficulty remembering recent events. His complete blood count (CBC) shows macrocytic anemia (MCV 112 fL), low hemoglobin (Hb 9.5 g/dL), and low reticulocyte count.

Which of the following are useful investigations for confirming pernicious anemia and assessing its severity? Select four (4) correct answers.

A 62-year-old female presents with progressive fatigue, numbness in her feet, and difficulty walking for the past six months. Blood tests reveal macrocytic anemia (MCV 115 fL), low serum vitamin B12 levels, and positive intrinsic factor antibodies. She has no history of gastrointestinal surgery or dietary restrictions.

Which of the following are appropriate first-line management strategies for pernicious anemia? Select four (4) correct answers.

A 68-year-old male with long-standing pernicious anemia presents for routine follow-up. He has been receiving monthly intramuscular vitamin B12 injections but reports persistent fatigue and mild numbness in his feet. His hemoglobin has improved, but his serum B12 remains low, and he has mild macrocytosis (MCV 102 fL) on a blood test.

Which of the following are appropriate next steps in the management of this patient? Select four (4) correct answers.

A 64-year-old female with long-standing pernicious anemia presents with progressive difficulty walking, numbness in her legs, and memory issues over the past six months. She has been receiving monthly intramuscular vitamin B12 injections, but her symptoms persist.

On examination, she has pallor, diminished vibratory sensation in both feet, and a positive Romberg sign. Laboratory tests show macrocytic anemia (MCV 112 fL), normal serum B12 levels, and elevated methylmalonic acid (MMA) and homocysteine levels.

Which of the following are complications of pernicious anemia that may explain this patient’s symptoms? Select four (4) correct answers.

A 67-year-old male with a 10-year history of pernicious anemia presents with persistent fatigue, weight loss (5 kg in three months), and early satiety. He has been compliant with intramuscular vitamin B12 injections, and his neurological symptoms have improved. However, he recently developed epigastric discomfort and occasional black stools.

His physician is concerned about long-term complications of pernicious anemia.

Which of the following are potential complications of long-standing pernicious anemia? Select four (4) correct answers.

A 66-year-old male presents with fatigue, weight loss, and difficulty walking. He reports progressive tingling in his hands and feet, worsening over the past few months. His symptoms have not improved despite taking over-the-counter iron supplements.

He has a history of long-standing gastroesophageal reflux disease (GORD) and has been taking proton pump inhibitors (PPIs) for over 10 years.

Which of the following historical findings would raise suspicion for pernicious anemia? Select four (4) correct answers.

A 32-year-old male presents with intermittent abdominal pain, chronic diarrhea, and weight loss over the past six months. He also reports fatigue and occasional blood in his stool. His past medical history is unremarkable, but his

You are concerned about inflammatory bowel disease (IBD), specifically Crohn’s disease.

Which of the following are recognized risk factors for developing Crohn’s disease? Select four (4) correct answers.

A 29-year-old female presents with chronic diarrhea, recurrent abdominal cramping, and perianal pain. She also reports oral ulcers and occasional joint pain. Her symptoms have been worsening, and she has lost 4 kg in the past three months.

Her mother has rheumatoid arthritis.

Which of the following risk factors increase her likelihood of developing Crohn’s disease? Select four (4) correct answers.

A 28-year-old female presents with intermittent abdominal pain, prolonged episodes of diarrhea, and recent weight loss (4 kg in 2 months).. Her symptoms worsen with stress and certain foods.

On examination, she has tenderness in the right lower quadrant

Which of the following clinical features are commonly associated with Crohn’s disease? Select four (4) correct answers.

A 34-year-old male presents with chronic diarrhea, abdominal pain, and weight loss over the past six months. He has also experienced occasional blood in his stool and perianal discomfort. A physical examination reveals pallor, right lower quadrant tenderness, and perianal skin tags.

You suspect Crohn’s disease and orders diagnostic investigations.

Which of the following are appropriate investigations to confirm a diagnosis of Crohn’s disease? Select four (4) correct answers.

A 29-year-old female presents with recurrent diarrhea, abdominal cramping, and weight loss. She also reports joint pain and mouth ulcers. A physical examination reveals mild perianal skin tags and tenderness in the right lower quadrant.

Her physician orders investigations to assess the severity and extent of her suspected Crohn’s disease.

Which of the following investigations are useful in evaluating Crohn’s disease and its complications? Select four (4) correct answers.

A 30-year-old male with recently diagnosed Crohn’s disease presents with abdominal pain, chronic diarrhea, and weight loss. His colonoscopy revealed inflammatory changes with skip lesions in the terminal ileum, and biopsy confirmed non-caseating granulomas.

His symptoms are moderate in severity, and he has no signs of fistulas or strictures.

Which of the following are appropriate initial management options for this patient? Select four (4) correct answers.

A 45-year-old male with long-standing Crohn’s disease presents with progressive abdominal pain, nausea, and worsening fatigue over the past few weeks. He reports a 15-pound weight loss over the last three months and has had episodes of bloating and vomiting. His symptoms worsen after meals.

On examination, he has abdominal distension and hyperactive bowel sounds.

Which of the following are common complications of Crohn’s disease? Select four (4) correct answers.

A 38-year-old female with Crohn’s disease affecting the terminal ileum presents with progressive fatigue, joint pain, and chronic diarrhea. She also reports painful perianal lesions and persistent abdominal pain despite treatment with azathioprine.

On examination, she has mild pallor, a perianal fissure, and right lower quadrant tenderness.

Which of the following complications of Crohn’s disease could explain this patient’s symptoms? Select four (4) correct answers.

A 28-year-old female presents with chronic diarrhea, intermittent abdominal pain over the past six months. She also reports occasional blood in her stool and fatigue. You suspect Crohn’s disease and wants to gather a detailed history.

Which of the following important history questions are most relevant in evaluating suspected Crohn’s disease? Select four (4) correct answers.

A 32-year-old male presents with diarrhea, crampy abdominal pain, and fatigue.. You suspect Crohn’s disease and wants to take a comprehensive history.

Which of the following important history questions are important to ask in a patient suspected of having Crohn’s disease? Select four (4) correct answers.

A 29-year-old male presents with bloody diarrhea, urgency, and tenesmus for the past two months. He has no history of travel or recent antibiotic use. His symptoms have gradually worsened, and he has lost 5 kg unintentionally.

You are concerned about inflammatory bowel disease and wants to evaluate risk factors for ulcerative colitis.

Which of the following are recognized risk factors for ulcerative colitis? Select four (4) correct answers.

A 35-year-old female presents with intermittent episodes of bloody diarrhea, abdominal cramps, and rectal urgency for the past six months. She has no travel history but reports taking ibuprofen regularly for migraines. She has never smoked and recently transitioned to a plant-based diet.

Her doctor considers ulcerative colitis and reviews potential risk factors.

Which of the following risk factors are associated with the development of ulcerative colitis? Select four (4) correct answers.

A 30-year-old male presents with chronic diarrhea, rectal bleeding, and abdominal cramping for the past four months. He reports increased urgency and tenesmus but denies perianal disease. His symptoms have progressively worsened, and he has lost 4 kg unintentionally.

On examination, he has mild pallor and left lower quadrant tenderness. His physician suspects ulcerative colitis and orders investigations.

Which of the following investigations are most useful in confirming the diagnosis of ulcerative colitis? Select four (4) correct answers.

A 45-year-old female with suspected ulcerative colitis presents with bloody diarrhea, weight loss, and increased stool frequency for the past six months. She has no history of travel or recent antibiotic use. Laboratory tests show mild anemia and elevated C-reactive protein (CRP).

Her doctor orders investigations to confirm the diagnosis and assess disease severity.

Which of the following investigations are useful in diagnosing and monitoring ulcerative colitis? Select four (4) correct answers.

A 32-year-old male presents with bloody diarrhea, urgency, and abdominal cramping for the past six months. His symptoms have worsened over the last few weeks, and he now has 6-8 bowel movements per day. A colonoscopy confirms moderate ulcerative colitis with continuous inflammation extending to the sigmoid colon.

Which of the following are appropriate management strategies for this patient? Select four (4) correct answers.

A 45-year-old female with severe ulcerative colitis presents with bloody diarrhea (12 bowel movements/day), weight loss, and fever. She has been on oral mesalazine and azathioprine, but her symptoms have worsened. A colonoscopy shows extensive colonic inflammation with deep ulcers.

Which of the following are appropriate next steps in management? Select four (4) correct answers.

A 38-year-old male with long-standing ulcerative colitis presents with worsening abdominal pain, distension, and fever over the past 24 hours. He reports severe diarrhea (12 bowel movements/day) and increasing fatigue. On examination, he appears toxic, tachycardic (HR 110 bpm), and has a distended, tender abdomen with reduced bowel sounds.

You are concerned about a life-threatening complication of ulcerative colitis and orders an urgent abdominal X-ray.

Which of the following are recognized complications of ulcerative colitis? Select four (4) correct answers.

A 50-year-old female with ulcerative colitis diagnosed 15 years ago presents for a routine check-up. She has been in clinical remission on mesalazine, but her physician discusses long-term complications of UC.

Which of the following are recognized complications of ulcerative colitis? Select four (4) correct answers.