Gastroenterology AKT 1-50- MCQ

A 52-year-old man presents to your GP clinic with a history of chronic heartburn, occurring mainly after large meals and when lying flat at night. He has no dysphagia, odynophagia, or weight loss. His medical history includes hypertension, obesity (BMI 33 kg/m²), and type 2 diabetes mellitus. He consumes alcohol socially and has a sedentary lifestyle. He denies smoking. On examination, his blood pressure is elevated, and his waist circumference is 110 cm.

 

Considering his risk factors, which of the following is the strongest independent risk factor for developing gastro-oesophageal reflux disease (GORD) in this patient?

 

A 47-year-old woman comes to see you regarding new onset of frequent heartburn, especially after large meals and when bending forward. She has gained 15 kg over the past year. She also recently started using salbutamol for asthma and uses NSAIDs occasionally for headaches. She denies alcohol consumption but is a current smoker (10 cigarettes/day for 20 years). She has no alarm features.

 

Based on her profile, which of the following is the most modifiable risk factor contributing to her GORD symptoms?

A 55-year-old man presents with persistent heartburn and regurgitation despite a 2-month trial of high-dose proton pump inhibitor (PPI) therapy. He denies dysphagia, weight loss, vomiting, or gastrointestinal bleeding. He has a history of obesity and a hiatus hernia diagnosed incidentally 5 years ago. Endoscopy is normal. Physical examination is unremarkable. You suspect refractory GORD.

 

Which of the following investigations is the most appropriate next step to confirm the diagnosis and assess disease severity?

 

A 62-year-old woman with chronic heartburn and regurgitation undergoes an upper gastrointestinal endoscopy (gastroscopy) because of new-onset dysphagia and unintentional weight loss over the past two months. The endoscopy shows evidence of erosive oesophagitis (Los Angeles Grade C) but no visible mass. Multiple biopsies are taken.

 

Which of the following best explains the role of endoscopy in the investigation of GORD in patients like her?

 

A 48-year-old man with a long history of typical GORD symptoms — daily heartburn and regurgitation — presents to your clinic. He has achieved good symptom control with a standard dose of esomeprazole (a proton pump inhibitor) once daily for the past 6 months. He is concerned about potential long-term side effects of PPIs and asks if he can stop the medication. He has no alarm symptoms, no dysphagia, no anaemia, and no history of Barrett’s oesophagus.

 

What is the most appropriate management strategy at this stage?

 

A 60-year-old woman with GORD and a large sliding hiatus hernia continues to experience significant reflux symptoms despite high-dose PPI therapy and strict lifestyle modifications (weight loss, head-of-bed elevation, avoiding large meals). She is now considering definitive treatment options.

 

According to current Australian guidelines, which of the following is the most appropriate next step in her management?

 

A 58-year-old man with a 15-year history of poorly controlled GORD presents with progressive difficulty swallowing solids and a sensation of food sticking in his lower chest. He denies significant weight loss but reports needing to drink water frequently to help swallow food. He has no significant smoking or alcohol history. An upper endoscopy reveals a smooth, concentric narrowing at the distal oesophagus without any visible mass. Biopsies are negative for malignancy.

 

Which of the following is the most likely complication of his chronic GORD?

 

A 63-year-old male with chronic GORD is found to have an area of salmon-coloured mucosa above the gastro-oesophageal junction on endoscopy. Biopsies confirm the presence of intestinal metaplasia. He is otherwise asymptomatic and has no history of gastrointestinal bleeding or dysphagia.

 

Which of the following best describes the clinical significance of this finding?

 

A 60-year-old man with long-standing GORD was diagnosed with non-dysplastic Barrett’s oesophagus three years ago. He underwent surveillance endoscopy at that time and again recently, with no evidence of dysplasia on repeat biopsy. He remains asymptomatic on low-dose proton pump inhibitor therapy.

 

Based on Australian guidelines, what is the most accurate statement about his prognosis regarding progression to oesophageal cancer?

 

A 55-year-old obese male patient with a history of GORD asks about the long-term outcomes if his reflux symptoms are left untreated. He refuses proton pump inhibitor therapy and has not made any lifestyle changes.

 

Which of the following is the most likely long-term consequence of persistent, untreated moderate-to-severe GORD based on Australian clinical evidence?

 

A 68-year-old man presents for a health check-up. He has a 40-year history of smoking (one pack per day) and drinks approximately 6–8 standard alcoholic beverages daily. He has no history of GORD, Barrett’s oesophagus, or obesity. He has lost 4 kilograms unintentionally over the last 6 months, but otherwise feels well. Considering Australian data on oesophageal cancer,

 

which of the following is the most significant risk factor for oesophageal squamous cell carcinoma in this patient?

 

A 58-year-old obese man with a BMI of 34 kg/m² and a 10-year history of severe, poorly controlled gastro-oesophageal reflux disease (GORD) attends your clinic. He recently had an endoscopy that confirmed Barrett’s oesophagus without dysplasia. He is concerned about cancer risk.

 

Which of the following factors most significantly increases his risk of developing oesophageal adenocarcinoma?

 

A 65-year-old man presents with a three-month history of progressive dysphagia, initially for solids and now for liquids, along with a 7 kg unintentional weight loss. He has a 40-pack-year smoking history and drinks alcohol daily. There is no history of known GORD. You suspect oesophageal carcinoma.

 

What is the first-line investigation that should be arranged to confirm the diagnosis?

 

A 60-year-old woman with newly diagnosed oesophageal adenocarcinoma at the gastro-oesophageal junction is being staged. Her primary tumour was confirmed on endoscopy and biopsy.

 

According to Australian cancer guidelines, which imaging investigation is essential for accurate staging before considering curative treatment?

A 62-year-old man presents with a six-month history of progressive dysphagia, initially to solids and now involving liquids. He has also experienced significant weight loss of 12 kilograms over this period. He has a long-standing history of gastro-oesophageal reflux disease but was never formally investigated. He is a current smoker with a 45-pack-year history. An urgent endoscopy reveals a circumferential mass in the lower oesophagus. Biopsies confirm moderately differentiated adenocarcinoma. A PET-CT scan shows no distant metastases, but some local regional lymph nodes are suspicious for involvement. His cardiopulmonary fitness is assessed and found to be adequate for major surgery.

 

Based on current Australian guidelines, what is the most appropriate next step in his management?

 

A 59-year-old woman is diagnosed with oesophageal squamous cell carcinoma located in the mid-oesophagus. She presents with dysphagia but no evidence of distant metastasis on PET-CT staging. However, her respiratory function tests reveal poor pulmonary reserve, and she has multiple cardiac comorbidities, making her a poor candidate for surgery. She is otherwise motivated and wishes to pursue aggressive treatment if possible.

 

Based on Australian management guidelines for oesophageal cancer, which of the following is the most appropriate definitive treatment plan for this patient given her inoperable status?

 

A 70-year-old man with a recently diagnosed distal oesophageal adenocarcinoma is undergoing staging investigations. Over the past two weeks, he has developed worsening dysphagia to both solids and liquids, associated with severe retrosternal chest pain. He also complains of a persistent, severe cough, especially when drinking liquids. His family notices episodes where he coughs uncontrollably immediately after swallowing. A chest CT scan shows air tracking into the mediastinum and an abnormal communication between the oesophagus and trachea.

 

Based on this presentation, which of the following complications of oesophageal carcinoma is most likely responsible for his current symptoms?

 

A 66-year-old woman with advanced oesophageal squamous cell carcinoma presents to the emergency department with sudden onset of severe haematemesis (vomiting of bright red blood). She has no prior history of liver disease or known varices. Her blood pressure is 90/55 mmHg, heart rate is 115 beats/min, and she appears pale and diaphoretic. Immediate resuscitation is commenced. A bedside endoscopy shows active bleeding from a large ulcerated tumour mass in the mid-oesophagus.

 

Which of the following best describes the most likely cause of her life-threatening complication?

 

A 64-year-old man was diagnosed with distal oesophageal adenocarcinoma after presenting with progressive dysphagia and weight loss. PET-CT staging revealed the tumour was locally advanced with involvement of regional lymph nodes, but no evidence of distant metastases. He underwent neoadjuvant chemoradiotherapy followed by an oesophagectomy with curative intent. Post-surgical pathology confirmed involvement of 3 out of 20 resected lymph nodes. His recovery was uneventful, and he is now asking about his long-term outlook.

 

According to Australian guidelines and current evidence, which of the following factors most strongly influences his prognosis following surgery?

 

A 68-year-old woman with newly diagnosed oesophageal squamous cell carcinoma involving the mid-oesophagus is undergoing staging. PET-CT reveals extensive mediastinal lymphadenopathy and multiple pulmonary nodules consistent with metastatic spread. She is otherwise fit and keen to understand her situation. You explain the findings and discuss her prognosis.

 

Based on current Australian data, what is the most accurate estimate of the five-year survival rate for oesophageal cancer with distant metastases at diagnosis?

 

A 73-year-old man presents to your clinic complaining of a sore mouth, burning sensation on the tongue, and difficulty swallowing. He reports that these symptoms began about a week ago. On examination, you notice white, curd-like plaques on the buccal mucosa and tongue, which can be gently scraped off, revealing erythematous mucosa underneath. His medical history includes type 2 diabetes mellitus, COPD, and atrial fibrillation. He has been using inhaled corticosteroids regularly for the past 3 years and was recently prescribed a short course of oral prednisone for a COPD exacerbation. He is a lifelong non-smoker and drinks alcohol occasionally.

 

Which of the following is the most significant predisposing factor for his current condition?

 

A 32-year-old woman presents with a persistent white coating on her tongue and inner cheeks. She reports discomfort while eating spicy foods and a recent increase in fatigue. She denies smoking, has no history of diabetes, and is not on any regular medications. However, she reveals that she was recently diagnosed with HIV infection during routine antenatal screening and is awaiting her first infectious diseases appointment. Her BMI is 18.5, and she is otherwise clinically stable.

 

Based on this presentation, which of the following is the most likely underlying risk factor for her current oral condition?

 

A 45-year-old man presents with a 3-week history of a sore mouth, a white coating on the tongue, and mild discomfort while eating spicy foods. He reports the lesions can be scraped off, revealing a red surface underneath. He has poorly controlled type 2 diabetes mellitus and reports taking multiple antibiotic courses over the last two months for recurrent urinary tract infections. He is otherwise healthy, denies smoking, and is HIV-negative. On examination, white plaques are seen over the tongue and buccal mucosa. You suspect oropharyngeal candidiasis.

 

What is the most appropriate first-line investigation to confirm the diagnosis?

 

A 52-year-old woman with chronic lymphocytic leukaemia undergoing chemotherapy presents with painful white patches in her mouth and difficulty swallowing. She reports that the symptoms began a few days after starting a new cycle of chemotherapy. Examination shows white plaques on the tongue and inner cheeks, with some extending into the oropharynx. You suspect severe oral candidiasis with possible oesophageal involvement.

 

Which of the following additional investigations is most appropriate to evaluate suspected oesophageal candidiasis in this immunocompromised patient?

 

A 36-year-old woman presents to your general practice with a 1-week history of a sore mouth and white patches on her tongue and inner cheeks. She is otherwise healthy, takes no regular medications, and is not immunocompromised. She recently completed a 10-day course of broad-spectrum antibiotics for a lower respiratory tract infection. On examination, you observe white plaques that can be easily scraped off, revealing erythematous mucosa underneath. There is no evidence of oesophageal involvement.

 

What is the most appropriate first-line treatment for this patient?

 

A 62-year-old man undergoing chemotherapy for non-Hodgkin lymphoma presents with painful oral ulcers, thick white patches on his tongue and palate, and painful swallowing. Examination confirms extensive oral candidiasis. He is febrile and neutropenic, and the infection is suspected to extend into the pharynx and oesophagus.

 

Which of the following is the most appropriate antifungal treatment for this patient?

 

A 67-year-old man with poorly controlled type 2 diabetes and a recent history of oropharyngeal candidiasis presents to the emergency department with worsening dysphagia, fever, and right-sided neck pain. He reports difficulty swallowing solids and liquids, and significant fatigue over the past few days. On examination, he has trismus, mild drooling, and tenderness under the jaw. Flexible nasendoscopy reveals inflamed pharyngeal tissue and pooling of secretions. Blood tests show elevated CRP and neutrophilic leukocytosis.

 

Which of the following is the most concerning potential complication of untreated or invasive oral candidiasis in this patient?

 

A 44-year-old woman with HIV (CD4 count: 180 cells/μL) presents with persistent white plaques in her mouth and painful swallowing. She has been treated twice in the last 3 months for oral candidiasis with short courses of fluconazole, with only partial response. She now reports a 5-kg weight loss, progressive fatigue, and difficulty maintaining oral intake due to pain. Examination confirms extensive candidiasis involving the soft palate and posterior pharynx.

 

Which of the following is the most likely complication of recurrent, inadequately treated oral candidiasis in this patient?

 

A 70-year-old man with chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus presents with recurrent episodes of oral thrush over the past 6 months. He uses inhaled corticosteroids daily and has been treated three times with nystatin oral suspension, each time with only temporary relief. He denies odynophagia but reports frequent relapses within 1–2 weeks of stopping antifungal therapy. He is compliant with medication, rinses his mouth after inhaler use, and maintains reasonable oral hygiene.

 

Which of the following factors is most strongly associated with poor prognosis or recurrence of oropharyngeal candidiasis in this patient?

 

A 50-year-old woman with well-controlled HIV infection (CD4 count 510 cells/μL, undetectable viral load) presents with a new episode of mild oral thrush after taking amoxicillin-clavulanate for a dental abscess. She is otherwise healthy and has never experienced thrush before. She is treated with miconazole oral gel and her symptoms resolve completely within a week. She is concerned about long-term implications and recurrence.

 

Which of the following best describes her prognosis regarding this episode of oral candidiasis?

 

A 58-year-old man presents to your clinic for a routine check-up. On oral examination, you notice a well-demarcated white patch on the lateral border of his tongue that cannot be scraped off. He reports no pain and was unaware of the lesion. His medical history includes hypertension and hyperlipidaemia. He is a current smoker with a 40-pack-year history and consumes alcohol daily. He denies denture use, recent trauma, or oral infections.

 

Which of the following is the strongest independent risk factor for the development of this lesion?

 

A 45-year-old woman presents with a painless white lesion on the inside of her cheek, noticed incidentally while brushing her teeth. The patch has persisted for over two months and does not scrape off. She does not smoke but chews betel quid (areca nut with lime and spices) daily, a practice she has followed since adolescence. She also consumes alcohol on weekends and wears dentures. Examination confirms a non-scrapable white patch with slightly thickened surface.

 

Which of the following is the most likely aetiological factor in her case of oral leukoplakia?

 

A 60-year-old man presents for evaluation of a white lesion on the floor of his mouth that has been present for several months. He is asymptomatic but concerned after reading about oral cancer. The lesion is non-scrapable, homogenous in appearance, and measures approximately 1.5 cm in diameter. He has smoked for 30 years and drinks alcohol daily. On examination, there is no ulceration, induration, or cervical lymphadenopathy.

 

Which of the following is the most appropriate next investigation to assess the lesion?

 

A 52-year-old woman with a history of long-standing leukoplakia on the lateral tongue returns for follow-up. The lesion has increased in thickness and now has a speckled red and white appearance. There is mild induration but no pain or lymphadenopathy. She has never had a biopsy, and this is the first noted change in years.

 

What is the most important reason for performing a biopsy in this clinical context?

 

A 55-year-old man presents for review of a persistent 2 cm white patch on the ventrolateral border of his tongue. The lesion has been present for 9 months and was confirmed as leukoplakia via incisional biopsy 3 months ago, which showed mild epithelial dysplasia. He is a current smoker with a 35-pack-year history and drinks alcohol regularly. He has not made any lifestyle changes since diagnosis. The lesion appears unchanged on repeat examination.

 

What is the most appropriate next step in the management of this patient?

 

A 62-year-old woman with longstanding leukoplakia on her gingiva is found to have moderate epithelial dysplasia on biopsy. She is a non-smoker but uses smokeless tobacco daily. The lesion measures 2.5 cm and is non-homogenous in appearance. On review, the area is irregular, with thickened and erythematous patches. There is no lymphadenopathy.

 

What is the most appropriate management for this patient?

 

A 59-year-old man with a 25-year history of smoking and alcohol use presents for review of a leukoplakic lesion on the lateral tongue, which has been present for over a year. The lesion was previously biopsied and confirmed to show moderate dysplasia. He missed his last follow-up and now reports increased thickness and mild pain in the area. Examination reveals a nodular white lesion with central ulceration and surrounding induration. No cervical lymphadenopathy is noted.

 

What is the most serious complication associated with progression of oral leukoplakia in this context?

 

A 68-year-old woman with a 3 cm verrucous white lesion on the floor of her mouth was diagnosed with oral leukoplakia six months ago. The lesion has now become firm and ulcerated with new-onset paraesthesia of the lower lip. She also reports recent weight loss and difficulty eating. Examination reveals poor dental hygiene and palpable ipsilateral submandibular lymphadenopathy.

 

Which of the following findings most strongly suggests that a complication has already occurred?

 

A 61-year-old man with a history of smoking and betel nut chewing presents for follow-up of a leukoplakic lesion on the ventrolateral tongue. The lesion was excised two months ago, and histopathology confirmed severe epithelial dysplasia but no invasive carcinoma. He has since stopped tobacco and areca nut use. On review, the surgical site is healing well, and there are no new oral lesions.

 

Which of the following factors will have the greatest positive impact on his long-term prognosis?

 

A 70-year-old woman with no smoking or alcohol history is being monitored for a homogenous leukoplakia on the buccal mucosa. The lesion was biopsied 18 months ago and showed no dysplasia. It has remained stable in size and appearance during routine reviews. She is concerned about the likelihood of developing cancer in the future.

 

What is the most accurate statement regarding her prognosis?

 

A 24-year-old man presents with a long-standing history of intermittent dysphagia to solids, particularly when eating meats and bread. He often needs to drink large amounts of water to pass food and has had two previous food bolus impactions requiring emergency department visits. He denies heartburn, odynophagia, or significant weight loss. His medical history is notable for childhood asthma and allergic rhinitis, for which he still takes occasional antihistamines. His father has a history of eczema and hay fever. Physical examination is unremarkable.

 

Given his clinical presentation and background, which of the following is the strongest risk factor for developing eosinophilic oesophagitis in this patient?

 

A 32-year-old woman reports a five-year history of intermittent dysphagia, particularly when eating dry foods like crackers and chicken. She has had several episodes of food getting stuck in her throat, one of which required endoscopic removal. She denies heartburn, regurgitation, or significant weight loss. Past medical history includes severe atopic dermatitis and seasonal allergic rhinitis. Her younger brother has a diagnosis of eosinophilic oesophagitis. She is otherwise healthy and not taking any regular medications.

 

Based on her presentation, which of the following additional factors most increases her likelihood of having eosinophilic oesophagitis?

 

A 29-year-old man presents with a three-year history of intermittent dysphagia to solid foods, particularly meats and bread. He reports needing to drink water frequently to help swallow food and occasionally experiences food impaction requiring emergency care. He has a history of asthma and eczema. He was trialled on high-dose proton pump inhibitors (PPI) for two months without significant improvement in symptoms. An upper endoscopy reveals concentric rings (“trachealisation”) and longitudinal furrows in the oesophagus, but no ulceration or mass lesion.

 

Which of the following is the definitive investigation required to confirm the diagnosis of eosinophilic oesophagitis?

 

A 35-year-old woman with a background of atopic dermatitis presents with progressive dysphagia for solid foods. She recently underwent an upper gastrointestinal endoscopy, which showed narrowing of the mid-oesophagus with mucosal rings but no ulceration or mass. Multiple biopsies were taken from different segments of the oesophagus. Histopathology shows more than 20 eosinophils per high-power field in both the proximal and distal oesophageal biopsies.

 

Which of the following additional investigations is most appropriate to exclude differential diagnoses before confirming eosinophilic oesophagitis?

 

A 31-year-old man with a history of asthma and eczema presents following an endoscopic diagnosis of eosinophilic oesophagitis. His endoscopy showed multiple concentric rings and linear furrows, and oesophageal biopsies confirmed high eosinophil counts. He completed an 8-week high-dose proton pump inhibitor (PPI) trial without significant improvement in symptoms or histology. He continues to experience intermittent food impaction and moderate dysphagia. He is otherwise healthy and highly motivated to avoid invasive treatments.

 

According to current Australian guidelines, what is the most appropriate next step in managing his eosinophilic oesophagitis?

 

A 38-year-old woman with newly diagnosed eosinophilic oesophagitis is reluctant to start pharmacological treatment and asks about non-drug approaches. She experiences moderate dysphagia but no food impaction. She has a history of multiple food allergies, including milk and wheat products. You discuss dietary strategies with her as part of initial management.

 

Which of the following dietary interventions has the strongest evidence for inducing remission in eosinophilic oesophagitis?

 

A 35-year-old man with a history of eosinophilic oesophagitis presents to the emergency department after experiencing sudden onset chest discomfort and an inability to swallow following a meal of steak. He reports that food feels stuck mid-chest. He has had similar but less severe episodes previously that resolved spontaneously. His background includes poorly controlled EoE with no consistent use of swallowed corticosteroids. On examination, he is drooling but is haemodynamically stable. An urgent endoscopy is performed, revealing an impacted food bolus at the mid-oesophagus and multiple concentric rings with mucosal fragility.

 

What is the most likely complication of poorly controlled eosinophilic oesophagitis in this patient?

 

A 42-year-old woman with known eosinophilic oesophagitis, diagnosed five years ago, presents with progressive dysphagia to solids over the past 12 months. She denies weight loss, regurgitation, or odynophagia. She has been inconsistent with follow-up and treatment. An upper endoscopy shows a diffusely narrowed oesophagus with multiple rings, strictures, and mucosal fragility. Biopsies still show active eosinophilic inflammation.

 

Which of the following long-term complications has most likely developed as a result of chronic, poorly controlled eosinophilic oesophagitis?

 

A 28-year-old man was diagnosed with eosinophilic oesophagitis two years ago following multiple food bolus impactions and progressive dysphagia. He has been well-controlled on swallowed budesonide therapy and has made significant dietary modifications, avoiding common allergens. His symptoms are now minimal, and a follow-up endoscopy shows substantial mucosal healing, with reduced eosinophil counts on biopsy. He asks about his long-term outlook and the risk of developing severe complications.

 

Which of the following best describes his prognosis based on current Australian and international data?

 

A 40-year-old woman with eosinophilic oesophagitis presents for review after several years of intermittent symptoms. She has been inconsistently adherent to topical corticosteroid therapy and has not followed a dietary elimination plan. She now reports slowly worsening dysphagia and avoidance of many solid foods. An endoscopy reveals concentric rings, mucosal furrows, and some fixed narrowing of the mid-oesophagus. Biopsies confirm ongoing active eosinophilic inflammation.

 

Which of the following statements best reflects the prognosis for poorly controlled eosinophilic oesophagitis?