A) Methotrexate B) Colchicine C) Obeticholic acid D) Bezafibrate E) Prednisolone Answer & Explanation Answer: C – Obeticholic acid Inadequate response to UDCA (ALP >1.67× ULN or bilirubin elevated) – add obeticholic acid (FDA/EMA approved). Bezafibrate is an alternative but not first-line in guidelines. Methotrexate and colchicine have no proven benefit. A 70-year-old man with a 2-day history of severe, constant upper abdominal pain radiating to the back. Serum lipase is normal. CT abdomen shows a dilated common bile duct (15 mm) and a 2 cm pancreatic head mass. What is the most appropriate next step?
A) Repeat serum lipase in 24 hours B) Endoscopic ultrasound with fine needle aspiration (EUS-FNA) C) MRCP D) CA 19-9 E) Diagnostic laparoscopy Answer & Explanation Answer: B – EUS-FNA Pancreatic head mass + obstructive symptoms – EUS-FNA is the best next step for tissue diagnosis. MRCP if biliary anatomy unclear but tissue needed. CA 19-9 is not diagnostic. A 25-year-old man with Crohn’s disease (ileocolonic) on azathioprine presents with acute severe right iliac fossa pain, fever, and vomiting. CT shows a 4 cm phlegmonous mass with an adjacent small-bowel loop and no free air. What is the most appropriate management? best of five mcqs for the gastroenterology sce pdf
A) Intravenous terlipressin alone B) Band ligation of varices C) Injection sclerotherapy D) Balloon tamponade with a Sengstaken-Blakemore tube E) Transjugular intrahepatic portosystemic shunt (TIPS) Answer & Explanation Answer: B – Band ligation Endoscopic band ligation is the definitive treatment for actively bleeding oesophageal varices. Terlipressin is a bridge, not definitive. Sclerotherapy is second-line. Balloon tamponade is a temporary salvage measure. TIPS is for refractory bleeding after failed endoscopy. A 30-year-old woman presents with chronic diarrhoea, bloating, and weight loss. IgA-tissue transglutaminase antibodies are strongly positive. Duodenal biopsies show villous atrophy. She is started on a gluten-free diet but symptoms persist after 6 months. What is the most appropriate next investigation? A) Methotrexate B) Colchicine C) Obeticholic acid D)
