Inflammatory Bowel Disease and GIT Disorders (IBD, Malabsorption, PUD) MCQs

Medicine · 95 free questions with answers & explanations.

  1. A 24-year-old woman presents with bloody diarrhea (6–8 times/day), tenesmus, and crampy abdominal pain for 6 weeks. Colonoscopy shows continuous mucosal inflammation from the rectum extending to the splenic flexure, with superficial ulcers, loss of haustral markings, and no skip lesions. Biopsies show crypt abscesses and goblet cell depletion. What is the most likely diagnosis?
  2. A 45-year-old man presents with chronic diarrhea, abdominal bloating, and a 10 kg weight loss over 6 months. Small bowel biopsy shows subtotal villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. Anti-tissue transglutaminase (anti-tTG) IgA antibodies are markedly elevated. What is the definitive treatment?
  3. A 32-year-old man with known Crohn's disease (ileocolonic, perianal fistulae) on mesalazine presents with worsening perianal pain and a fistula draining purulent material. MRI pelvis confirms a complex supra-levator fistula with associated perianal abscess. CRP is 68 mg/L. What is the correct sequence of management?
  4. A 55-year-old man presents with watery diarrhea (8–10 episodes/day), weight loss, and peripheral edema. Endoscopy shows villous atrophy and a thickened, pale-pink appearance of the small bowel mucosa. Biopsy shows PAS-positive, diastase-resistant macrophages in the lamina propria. What is the treatment?
  5. A 32-year-old man with Crohn's disease (Montreal classification: ileocolonic, inflammatory, without perianal disease) is on azathioprine with partial response. He is considered for biologic therapy. Anti-TNF therapy with infliximab is planned. Prior to initiating infliximab, which screening is most critical?
  6. A 45-year-old woman presents with chronic diarrhoea, weight loss, and a skin rash characterised by erythematous migratory plaques on the face, perineum, and extremities with central crusting and superficial blistering. Her glucagon level is markedly elevated. What is the associated tumour?
  7. In the SONIC trial for moderate-to-severe Crohn's disease, which treatment strategy showed superior rates of steroid-free clinical remission at week 26 compared with azathioprine monotherapy or infliximab monotherapy?
  8. In primary sclerosing cholangitis (PSC) associated with IBD, the bowel disease has a characteristic distribution pattern. Which feature is typical of PSC-associated UC?
  9. Coeliac disease enteropathy graded by Marsh classification: Marsh 3c lesion indicates complete villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. Which HLA haplotype combination carries >90% of the population-attributable risk for coeliac disease?
  10. A 28-year-old with newly diagnosed moderate-to-severe Crohn's disease (CDAI 280) involving the ileocolon has failed mesalazine. Biologic therapy is initiated. The mechanism of action of vedolizumab differs from anti-TNF agents in that it:
  11. A 40-year-old woman presents with chronic watery diarrhoea (8–10 stools/day), weight loss 12 kg over 6 months, and steatorrhoea. Duodenal biopsy shows villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. Anti-tTG IgA is strongly positive. She is started on a gluten-free diet. Which is the MOST common extra-intestinal malignancy associated with her underlying diagnosis?
  12. A 55-year-old patient undergoes ileal resection (>100 cm) for Crohn's disease. Which bile acid-related complication and its specific pathophysiology is MOST expected?
  13. A 32-year-old woman with Crohn's disease involving ileum and cecum (L1, A2 — Montreal classification) has failed mesalamine and now requires escalation. Colonoscopy shows deep linear ulcers with cobblestoning. CRP 45 mg/L, fecal calprotectin >1500 µg/g. She has no perianal disease. According to ECCO 2023 guidelines, the preferred induction agent for moderate-severe luminal Crohn's is:
  14. A 45-year-old man with celiac disease (confirmed on duodenal biopsy — villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis, Marsh III) develops worsening diarrhea and weight loss despite strict gluten-free diet for 2 years. Repeat biopsy shows persistent villous atrophy and intraepithelial lymphocytes. The most important condition to exclude is:
  15. A 30-year-old man with Crohn's disease involving the terminal ileum has failed azathioprine and is now on infliximab (IFX). He loses response after 12 months. IFX trough level is 2 μg/mL (low therapeutic), and anti-IFX antibodies are detected at high titer. What is the optimal therapeutic strategy?
  16. A 25-year-old man presents with chronic diarrhea, steatorrhea, and weight loss for 3 years. Duodenal biopsy shows total villous atrophy (Marsh IIIc), crypt hyperplasia, and intraepithelial lymphocytosis. Anti-tissue transglutaminase IgA is strongly positive. Despite 12 months of strict gluten-free diet, he shows no histological improvement. What is the next most important investigation?
  17. According to the ACG 2017 guidelines for Helicobacter pylori management, which test-and-treat strategy is preferred for H. pylori in a patient with functional dyspepsia and no alarm features in a region with >15% clarithromycin resistance?
  18. A 28-year-old man with Crohn's disease involving the terminal ileum and right colon has failed azathioprine therapy. He has deep ulcers on colonoscopy (Montreal classification L2, B1). CRP 28 mg/L. What biological therapy is preferred for induction of remission with the highest efficacy in this phenotype?
  19. A 45-year-old woman with chronic diarrhoea, bloating, and weight loss of 8 kg has positive TTG-IgA antibody (>10× ULN). Duodenal biopsy shows Marsh grade IIIC changes. She is started on a strict gluten-free diet (GFD) but remains symptomatic at 12 months. Which is the most likely cause of non-responsive coeliac disease?
  20. A 34-year-old man with Crohn's disease involving the terminal ileum and ileocolon (L3) has been on infliximab for 18 months. He develops loss of response (Harvey-Bradshaw index worsens, CRP rises to 28 mg/L). Infliximab trough level is 2.1 μg/mL with anti-drug antibodies (ADA) detected at high titre. The most appropriate next step per therapeutic drug monitoring (TDM) algorithms is:
  21. A 45-year-old woman presents with fat malabsorption, osteoporosis, and a skin biopsy showing IgA deposits at the dermal-epidermal junction. Serology reveals anti-tissue transglutaminase IgA elevated. She denies GI symptoms. Duodenal biopsy shows Marsh 3b changes (marked villous blunting with crypt hyperplasia). The most important dietary intervention is:
  22. A 28-year-old woman with established Crohn's disease (ileocolonic, moderate activity) is on azathioprine 2.5 mg/kg/day. She continues to have 4–5 loose stools/day, CRP 28 mg/L, and fecal calprotectin 620 µg/g. She is thiopurine methyltransferase (TPMT) normal. The best escalation is:
  23. A 38-year-old woman presents with iron deficiency anemia, bloating, and diarrhea. Endoscopy shows normal gastric mucosa and duodenal biopsies reveal villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. Serology shows anti-tTG IgA antibody 98 U/mL (normal <7). IgA level is normal. The MOST sensitive and specific serological test for celiac disease is:
  24. A 50-year-old man presents with recurrent peptic ulcers despite eradication of H. pylori (confirmed negative on UBT). Fasting serum gastrin is 850 pg/mL (normal <100). Secretin stimulation test shows a paradoxical rise in serum gastrin to 1400 pg/mL (increase >120 pg/mL). CT scan shows a 1.5 cm mass in the duodenal wall. The diagnosis is:
  25. A 30-year-old woman with Crohn's disease (terminal ileal involvement, CDAI 320, CRP 45 mg/L) has been on azathioprine 2 mg/kg for 6 months with inadequate response. Colonoscopy shows deep ulcers with skip lesions. What is the most appropriate next step per current ECCO and ACG guidelines for moderately-severe luminal Crohn's?
  26. A 45-year-old man with known coeliac disease on a strict gluten-free diet for 3 years continues to have diarrhoea and weight loss. Repeat duodenal biopsy shows villous atrophy persisting. Anti-tTG IgA remains elevated. He admits to accidental gluten exposure. However, a third biopsy after further dietary restriction shows intraepithelial lymphocytosis, villous atrophy, and aberrant CD3+ CD8- intraepithelial lymphocytes on flow cytometry. What complication should be considered?
  27. A 60-year-old man on aspirin 75 mg daily and naproxen for osteoarthritis develops an upper GI bleed. EGD shows a 1.2 cm gastric ulcer. H. pylori testing is negative. He cannot stop aspirin (post-MI secondary prevention). What is the most appropriate long-term management to prevent recurrent peptic ulcer bleeding?
  28. A 32-year-old woman with moderate-to-severe Crohn's disease (CDAI 280) has failed 5-ASA and two courses of steroids. Anti-TNF therapy (adalimumab) is initiated. After 14 weeks she has not achieved clinical remission (CDAI still 230). The MOST appropriate strategy according to current guidelines is:
  29. A 50-year-old man has chronic diarrhoea with steatorrhoea, weight loss, and a serum D-xylose absorption test showing 1.8 g excreted in urine in 5 hours after a 25 g oral dose (normal >4 g). Small bowel biopsy shows subtotal villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. Serology reveals anti-tissue transglutaminase IgA > 10× ULN. The MOST appropriate dietary intervention is:
  30. A 28-year-old man with Crohn's disease (colonic and ileocolonic involvement, CDAI 320) has failed azathioprine therapy. He tests negative for TB and hepatitis B. Per current ACG and ECCO 2023 guidelines, what is the preferred step-up therapy?
  31. Microscopic colitis (MC) is characterized by chronic watery non-bloody diarrhoea with normal colonoscopy. Which two histological subtypes are recognised, and which is more common?
  32. A patient with coeliac disease is identified based on positive serum IgA anti-tissue transglutaminase antibody (anti-tTG IgA >10× upper limit of normal) and total IgA level is normal. HLA-DQ2 positive. Duodenal biopsy is performed. Marsh classification of coeliac disease histology — which Marsh grade shows villous atrophy (subtotal or total) with crypt hyperplasia and increased IELs?
  33. A 28-year-old man with Crohn's disease on azathioprine has active ileocolonic disease (Harvey-Bradshaw Index 12) despite 3 months of optimised therapy. Anti-TNF therapy with adalimumab is initiated. Which monitoring parameter should be checked BEFORE starting adalimumab?
  34. A 25-year-old woman presents with watery diarrhea 10–15 times per day, urgency, and bloody stool. Colonoscopy shows continuous mucosal inflammation from rectum to splenic flexure with loss of haustrations. Biopsy shows crypt abscesses and distorted crypt architecture without granulomas. The diagnosis is ulcerative colitis. For induction of remission in moderate-to-severe UC, the treatment of choice is:
  35. A 45-year-old man with long-standing type 1 diabetes presents with postprandial fullness, nausea, and vomiting of partially digested food eaten hours earlier. Upper GI endoscopy and barium study rule out mechanical obstruction. Gastric emptying scintigraphy shows 65% retention at 4 hours (normal <10%). The FIRST-LINE prokinetic drug of choice is:
  36. A 30-year-old woman with Crohn's disease involving the terminal ileum has been on azathioprine for 2 years. She now presents with worsening abdominal pain, weight loss, and a CRP of 68 mg/L. Colonoscopy shows deep ulcers and stricturing in the terminal ileum. What is the most appropriate next step in management?
  37. A 45-year-old man with longstanding celiac disease on a strict gluten-free diet presents with recurrent small bowel obstruction and weight loss. CT shows thickened jejunal wall with enlarged mesenteric lymph nodes. What is the most likely complication?
  38. A 26-year-old woman with Crohn's disease (ileocolonic, non-stricturing non-penetrating) has failed 5-ASA and azathioprine. Ileocolonoscopy shows deep ulcerations. CRP 42 mg/L, CDAI 340 (severe). She is anti-TNF naïve. Which therapy is recommended as first-line biologic for moderate-to-severe luminal Crohn's disease?
  39. A 45-year-old man presents with chronic diarrhoea, weight loss and fatigue. Duodenal biopsy shows subtotal villous atrophy, crypt hyperplasia and increased intraepithelial lymphocytes (IEL >30/100 epithelial cells). Serum anti-tissue transglutaminase IgA is markedly elevated. He is started on a gluten-free diet (GFD) but after 12 months still has symptoms and elevated IELs on repeat biopsy. Which condition should be considered?
  40. A 62-year-old man on aspirin 75 mg and clopidogrel after recent coronary stent placement develops haematemesis. Upper GI endoscopy shows a 1.5 cm duodenal ulcer with a visible vessel (Forrest Ia). What is the MOST appropriate management of dual antiplatelet therapy in this high-risk upper GI bleed?
  41. A 28-year-old woman with known Crohn's disease (ileocolonic, inflammatory, moderate-to-severe) has failed azathioprine after 9 months. She is now started on adalimumab (anti-TNF). Before starting biologic therapy, the most important infection screening is:
  42. A 55-year-old man presents with recurrent episodes of watery diarrhea (10 stools/day), abdominal pain, weight loss, and a skin rash described as erythematous, necrolytic, annular lesions predominantly on the perineum and lower extremities. Fasting glucose is 240 mg/dL (new onset DM). CT scan shows a 4 cm pancreatic tail mass with hepatic lesions. What is the diagnosis?
  43. A 40-year-old man has a positive urea breath test for H. pylori and a duodenal ulcer on upper GI endoscopy. He is allergic to penicillin. Which H. pylori eradication regimen is appropriate?
  44. A 30-year-old man with known Crohn's disease (ileal and colonic) is on azathioprine 2.5 mg/kg/day and has been in remission for 18 months. He now presents with a perianal fistula and recurrence of abdominal symptoms (CDAI 280). Anti-TNF levels are not applicable (not on anti-TNF). The best next management step is:
  45. A 45-year-old woman presents with chronic diarrhoea, weight loss, and an itchy blistering skin rash on the elbows and buttocks. Anti-tissue transglutaminase (anti-tTG) IgA is markedly elevated. Duodenal biopsy shows villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis (Marsh grade 3b). The skin rash is most consistent with:
  46. A 29-year-old woman with Crohn's disease involving the terminal ileum and proximal colon is on azathioprine and mesalazine. She presents with a severe flare (CRP 78 mg/L, CDAI 380). She fails IV steroids over 5 days. Which biological agent has regulatory approval as induction therapy in this setting?
  47. A 45-year-old man presents with steatorrhoea, weight loss, and fatigue. Laboratory findings: anaemia with macrocytosis, low serum B12, low folate, raised anti-tissue transglutaminase IgA, low serum iron. Duodenal biopsy shows villous atrophy and crypt hyperplasia. He is started on a strict gluten-free diet. After 12 months, symptoms persist with ongoing malabsorption. What complication should be suspected?
  48. A 30-year-old man presents with bloody diarrhoea, abdominal cramps, and fever. Colonoscopy shows continuous mucosal inflammation from rectum to splenic flexure with pseudopolyps. Biopsy shows cryptitis and crypt abscesses without granulomas. He has severe UC (Truelove-Witts criteria). IV hydrocortisone is started. After 3 days there is no improvement. What is the next step?
  49. A 45-year-old woman presents with episodic watery diarrhoea, flushing, and bronchospasm. 24-hour urinary 5-HIAA is markedly elevated. CT abdomen shows a 2 cm ileal mass with liver metastases. Which syndrome does she have and what is the drug of choice for symptom control?
  50. A 38-year-old woman with long-standing coeliac disease presents with IgA deficiency (serum IgA <0.05 g/L). She is still symptomatic on a strict gluten-free diet for 12 months. Which antibody test should be used for serological monitoring in IgA-deficient coeliac disease?
  51. A 34-year-old woman with moderately active ulcerative colitis (Mayo score 8) has failed two biologics (infliximab lost response due to antibodies; vedolizumab inadequate response). She tests positive for anti-nuclear antibody. The current biologic target most appropriate for this refractory UC is:
  52. A 48-year-old man with a history of Crohn's disease (ileocolonic, non-stricturing, non-penetrating) undergoes ileocolonoscopy showing severe mucosal inflammation with deep ulcers. His Harvey-Bradshaw Index is 12. He has had one course of prednisolone and is currently steroid-free. According to ECCO guidelines, the treatment strategy that best achieves deep remission (both clinical and endoscopic) is:
  53. A 62-year-old man with coeliac disease on a strict gluten-free diet for 2 years has persistent diarrhoea and weight loss. Small bowel biopsy shows villous atrophy and increased intraepithelial lymphocytes (IEL > 40/100 enterocytes). Flow cytometry of IELs shows aberrant CD3+/CD8− (surface CD3 negative) phenotype. This finding suggests:
  54. A 32-year-old woman with Crohn's disease has ileocolonic disease, active inflammation, and elevated faecal calprotectin despite 5-ASA therapy. Which therapy has the highest evidence for induction AND maintenance of remission in moderate-to-severe Crohn's disease?
  55. A 40-year-old woman with long-standing coeliac disease maintained on a strict gluten-free diet presents with persistent diarrhoea, weight loss, and CT showing thickening of multiple jejunal loops with mucosal ulceration. Small bowel biopsy shows persistent villous atrophy and intraepithelial T-lymphocytes. Which complication is most likely?
  56. A 55-year-old man on long-term aspirin and ibuprofen presents with a 12 mm gastric ulcer near the incisura. Rapid urease test is positive. After H. pylori eradication and 8 weeks of PPI therapy, what is the next mandatory step?
  57. A 28-year-old man with Crohn's disease has ileocolonic involvement (Harvey-Bradshaw Index 12, elevated CRP, anaemia). He failed mesalazine and is on azathioprine 2 mg/kg for 6 months without remission. Which is the most appropriate step?
  58. A 50-year-old woman with longstanding celiac disease has poor response to a strict gluten-free diet. Duodenal biopsy shows villous atrophy (Marsh grade IIIc) with an aberrant intraepithelial lymphocyte (IEL) population expressing surface CD3 but lacking CD8 (clonal by TCR gene rearrangement). What is the diagnosis?
  59. A 60-year-old man with recurrent peptic ulcer disease tests positive for H. pylori by urea breath test. He previously received clarithromycin-based triple therapy without eradication. Which second-line regimen is most appropriate?
  60. A 30-year-old woman with Crohn's disease (ileocolonic, inflammatory phenotype, CRP 45, faecal calprotectin 1200 μg/g) has failed azathioprine. She is steroid-dependent. Which biologic therapy is preferred as first-line in this setting?
  61. A 45-year-old man presents with severe watery diarrhoea (>10 episodes/day), abdominal cramps, and weight loss. He recently completed a course of clindamycin for a dental abscess. Stool GDH and toxin A/B EIA are both positive. CT abdomen shows colonic wall thickening. What is the appropriate treatment for this first severe episode of Clostridioides difficile infection?
  62. A 42-year-old woman presents with chronic diarrhoea, weight loss, and abdominal bloating for 8 months. Small bowel biopsy shows villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. Anti-tissue transglutaminase IgA is markedly elevated. She is started on a gluten-free diet. After 12 months, she continues to have diarrhoea despite strict dietary compliance. What is the most important consideration?
  63. A 28-year-old woman with Crohn's disease has ileocolonic involvement (L3, B1, inflammatory) with moderate activity (HBI 9). She failed mesalamine and is on azathioprine for 6 months without remission. What is the most appropriate next step per ECCO guidelines?
  64. A 40-year-old man has chronic watery diarrhea 8-10 times/day without blood, abdominal cramps, and 6 kg weight loss over 3 months. Colonoscopy is macroscopically normal. Random colon biopsies show a thickened subepithelial collagen band (>10 µm) under the surface epithelium. The diagnosis is:
  65. A 55-year-old man presents with dysphagia to solids only, progressive over 6 months, with regurgitation of undigested food, and no heartburn. Barium swallow shows a 'bird-beak' tapering at the lower esophagus. Esophageal manometry shows absent peristalsis and incomplete lower esophageal sphincter relaxation. High-resolution manometry confirms integrated relaxation pressure (IRP) >15 mmHg. The diagnosis is:
  66. A 26-year-old woman with Crohn's disease limited to the terminal ileum on azathioprine 2.5 mg/kg/day has persistently elevated CRP and ongoing symptoms. Colonoscopy shows active ulceration with deep linear fissuring. She tests negative for TPMT deficiency. What is the next best step?
  67. A 55-year-old man with longstanding ulcerative colitis (pancolitis for 18 years) is found to have low-grade dysplasia in flat mucosa on surveillance colonoscopy. What is the recommended management?
  68. A 42-year-old man with diarrhoea and weight loss for 6 months is found to have subtotal villous atrophy on duodenal biopsy, positive anti-tissue transglutaminase IgA 58 U/mL, and positive anti-endomysial antibody. He is started on a gluten-free diet. After 12 months he remains symptomatic. Which is the most important next step?
  69. A 32-year-old woman with Crohn's disease involving the terminal ileum (confirmed on ileoscopy and MR enterography) has fistulising perianal disease despite azathioprine. Which biologic agent is considered the most effective for perianal fistulising Crohn's disease?
  70. A 45-year-old man with longstanding ulcerative colitis (pancolitis for 12 years) comes for colonoscopy surveillance. The biopsy shows high-grade dysplasia in a flat mucosa without polypoid change. What is the most appropriate management?
  71. A 28-year-old man with Crohn's disease involving the terminal ileum and right colon has had 3 relapses requiring corticosteroids in 18 months despite azathioprine 2.5 mg/kg/day. The TPMT activity is normal. Which is the MOST appropriate step per ECCO 2023 guidelines?
  72. A 38-year-old woman presents with diarrhoea, weight loss, and megaloblastic anaemia. Endoscopy shows gastric mucosal atrophy with loss of rugae in the body and fundus. Antibodies to intrinsic factor and parietal cells are positive. Serum vitamin B12 is 80 pg/mL. Which is the PRIMARY mechanism of B12 deficiency in this condition?
  73. H. pylori eradication is indicated in which of the following conditions according to the Maastricht VI/Florence Consensus 2022?
  74. A 32-year-old woman with Crohn's disease (ileal involvement, CDAI 320) fails to respond to azathioprine plus infliximab (primary non-response). Anti-infliximab antibodies are detected at high titer. The MOST appropriate next step is:
  75. A 45-year-old man has chronic diarrhoea with weight loss and macrocytic anaemia. Serum anti-TTG IgA is weakly positive. Duodenal biopsy shows subtotal villous atrophy (Marsh-Oberhuber grade 3b). He is started on a strict gluten-free diet but has persistent symptoms after 12 months. The MOST likely explanation is:
  76. A 32-year-old man with Crohn's disease (ileal, inflammatory/non-stricturing) fails azathioprine therapy after 6 months (persistent flares). He is anti-TNF naïve. TPMT genotyping was normal. What is the most appropriate next-line biologic therapy according to ECCO 2023 guidelines?
  77. A 28-year-old woman presents with chronic diarrhea, weight loss, and anemia. Duodenal biopsy shows villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis. Anti-tissue transglutaminase IgA antibody is strongly positive. She is started on a gluten-free diet (GFD). After 12 months on strict GFD, she has persistent symptoms and ongoing villous atrophy on repeat biopsy. No dietary indiscretions found. What is the next diagnostic consideration?
  78. A 28-year-old woman with Crohn's disease involving the terminal ileum and colon (L3, B1 Montreal classification) has failed azathioprine. She is steroid-dependent. Anti-TNF therapy is being considered. Which serological marker in Crohn's disease is associated with complicated disease behaviour (stricturing/penetrating) and ileal involvement?
  79. A 50-year-old man has a 6-month history of diarrhoea, weight loss, and iron deficiency anaemia. Duodenal biopsy on upper GI endoscopy shows villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. IgA anti-tissue transglutaminase (tTG) antibodies are elevated. He is started on a gluten-free diet. After 12 months, diarrhoea persists. The MOST important next step to diagnose refractory coeliac disease is:
  80. In Crohn's disease with fistulising perianal disease refractory to antibiotics and azathioprine, which biologic therapy is specifically approved and has the best evidence for fistula closure?
  81. A 35-year-old woman with celiac disease on a strict gluten-free diet for 2 years has persistent diarrhoea, weight loss, and jejunal biopsy showing persistent villous atrophy with increased intraepithelial lymphocytes (IELs). This most likely represents:
  82. In Zollinger-Ellison syndrome (ZES), which test provides the highest diagnostic sensitivity for confirming hypergastrinaemia in a patient with elevated fasting gastrin and multiple duodenal ulcers?
  83. A 34-year-old woman with moderately active luminal Crohn's disease has failed adequate trials of conventional immunosuppressants (azathioprine and methotrexate). She is now considered for biologic therapy. Which biologic is specifically approved for Crohn's disease with a gut-selective mechanism (anti-integrin)?
  84. A 68-year-old man on aspirin and omeprazole presents with haematemesis. Endoscopy reveals a 12 mm duodenal ulcer with an actively bleeding vessel (Forrest classification Ia). Which is the most critical next step after achieving endoscopic haemostasis?
  85. A 28-year-old man with Crohn's disease has a fistula from the terminal ileum to the sigmoid colon (enteroenteric fistula). He is on infliximab for 12 months with poor fistula response. Montreal classification of his disease is A2L3B3p. Per ECCO 2023 guidelines on complex perianal/internal fistulising Crohn's, the next step is:
  86. A 45-year-old woman with primary sclerosing cholangitis (PSC) and concomitant ulcerative colitis undergoes surveillance colonoscopy. A flat dysplastic lesion 15 mm in diameter is found in the descending colon. Histology confirms low-grade dysplasia (LGD) without visible mass. Per BSG/ECCO 2022 guidelines on dysplasia in IBD, the management is:
  87. A 28-year-old woman with Crohn's disease (ileocolonic, moderate-severe) fails mesalazine and azathioprine over 18 months. She has perianal fistulae. What is the MOST appropriate next-line biologic therapy?
  88. A 45-year-old woman with celiac disease undergoes upper GI endoscopy. Duodenal biopsy shows Marsh Grade 3c changes (complete villous atrophy). She has been on a strict gluten-free diet for 12 months but remains symptomatic with diarrhea and weight loss. Which complication should be MOST suspected?
  89. A 28-year-old woman with Crohn's disease (Montreal classification: ileal/ileocolic location, inflammatory behaviour, frequent relapses) is started on azathioprine. After 8 weeks, she develops fever, arthralgia, and a rash — she is suspected to have azathioprine-induced hypersensitivity. Her TPMT enzyme activity was found to be normal prior to starting. If restarted on a different thiopurine after recovery, what is the correct approach?
  90. A 55-year-old man with longstanding ulcerative colitis (pancolitis for 12 years) undergoes surveillance colonoscopy. Multiple biopsies from a raised irregular plaque near the hepatic flexure show high-grade dysplasia. The remainder of the colon shows no other dysplasia. What is the recommended management per current BSG/ACG surveillance guidelines for indefinite high-grade dysplasia in UC?
  91. A 28-year-old woman presents with 8 weeks of bloody diarrhoea (8–10 episodes/day), tenesmus, and crampy abdominal pain. CRP is 48 mg/L. Stool cultures are negative. Flexible sigmoidoscopy shows continuous mucosal inflammation from the rectum to the splenic flexure with loss of vascular pattern. Biopsy shows crypt abscesses and chronic changes. She scores Mayo 10 (severe UC). She is started on IV methylprednisolone. On day 5 she has persistent 8 stools/day with CRP 32 and temperature 37.8°C. The MOST appropriate next step is:
  92. A 35-year-old man is found to have seronegative coeliac disease on small bowel biopsy (villous atrophy, increased IELs, crypt hyperplasia, Marsh grade IIIb) but anti-tTG IgA is negative. Total IgA is undetectable. What is the APPROPRIATE serological test in this setting?
  93. A 55-year-old man with H. pylori-positive duodenal ulcer is treated with standard triple therapy (omeprazole + amoxicillin + clarithromycin for 14 days). H. pylori eradication rates with this regimen have declined significantly in India due to:
  94. A 28-year-old man with Crohn's disease presents with a perianal fistula and proctoscopy shows no active rectal disease. He has had 2 prior infliximab infusions but developed anti-drug antibodies. Which biologic is MOST appropriate to switch to?
  95. A 45-year-old woman presents with chronic diarrhoea, weight loss, and a skin rash with erythematous vesicles on elbows and knees. Duodenal biopsy shows subtotal villous atrophy with increased intraepithelial lymphocytes. Which HLA types are MOST strongly associated with this condition?
Sponsored

Practise this topic as a timed set and track your accuracy.

Create a free account →