# AMC MCQ Gastroenterology Questions: 10 Free Practice MCQs

> 10 free AMC MCQ gastroenterology questions with answers and explanations, from a bank of 13 gastroenterology questions. Try them now, no sign up.

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Last updated: 2026-10-29

Ten AMC MCQ-style gastroenterology questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 13 gastroenterology questions and many more across every topic.

1. 1 / 10  
A 28-year-old woman presents to her GP with chronic abdominal bloating, fatigue, and iron deficiency. She suspects she might have coeliac disease and has been on a self-imposed gluten-free diet for the last 4 weeks.  
Which of the following is the most appropriate diagnostic approach according to Coeliac Australia guidelines?  
Show answer

**Answer: B.** Advise the patient to undertake a gluten challenge (eating gluten daily for at least 4–6 weeks) followed by serology and gastroscopy with duodenal biopsy

**Why:** For diagnostic tests to be accurate, patients must be consuming gluten. Coeliac Australia recommends that patients who have started a gluten-free diet undergo a gluten challenge (e.g., eating at least 4 slices of wheat bread or equivalent daily for 4–6 weeks) before receiving serological screening (tTG IgA) and a gastroscopy with duodenal biopsies (the gold standard for diagnosis showing villous atrophy).

  * **A.** Serological markers can become false-negative if the patient has been gluten-free; a gluten challenge is required first.
  * **C.** HLA typing has a high negative predictive value but cannot confirm active disease, as many healthy individuals carry these genes.
  * **D.** Empirical dietary changes without histological confirmation are not recommended, as a lifelong gluten-free diet requires definitive diagnosis.  
Sources: Coeliac Australia Medical Advisory Committee Guidelines; RACGP Coeliac Disease Screening Guidelines
2. 2 / 10  
A 45-year-old woman presents with persistent pruritus and fatigue. Her liver function tests show a cholestatic pattern with an ALP of 420 U/L (normal < 110) and a GGT of 180 U/L (normal < 40). Her abdominal ultrasound shows normal bile ducts and liver parenchyma.  
Which of the following tests is most specific to confirm the diagnosis of Primary Biliary Cholangitis (PBC)?  
Show answer

**Answer: B.** Serum anti-mitochondrial antibodies (AMA)

**Why:** Primary Biliary Cholangitis (formerly primary biliary cirrhosis) is a chronic autoimmune liver disease targeting intrahepatic bile ducts. It typically presents in middle-aged women with fatigue, pruritus, and elevated ALP/GGT. The diagnostic hallmark is the presence of serum anti-mitochondrial antibodies (AMA), which has a specificity and sensitivity of > 95%.

  * **A.** Anti-dsDNA is specific for Systemic Lupus Erythematosus (SLE), not Primary Biliary Cholangitis.
  * **C.** AFP is a tumor marker for hepatocellular carcinoma and yolk sac tumors, not diagnostic for PBC.
  * **D.** ASMA is associated with Autoimmune Hepatitis, which typically presents with a hepatocellular pattern, not cholestatic.  
Sources: GESA Primary Biliary Cholangitis Guidelines; EASL Clinical Practice Guidelines: Management of Primary Biliary Cholangitis
3. 3 / 10  
A 54-year-old woman is found to have abnormal liver function tests during a health insurance screen. Her results show: Bilirubin 18 umol/L (normal < 20), ALP 380 U/L (normal 30–110), GGT 240 U/L (normal < 40), ALT 45 U/L (normal < 35), AST 38 U/L (normal < 35).  
What is the correct interpretation of these liver function tests and the most appropriate next investigation?  
Show answer

**Answer: C.** Cholestatic pattern; perform an abdominal ultrasound

**Why:** An elevation of alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) out of proportion to alanine aminotransferase (ALT) and aspartate aminotransferase (AST) is a classic cholestatic pattern. The first step in evaluating cholestasis is an abdominal ultrasound to look for biliary duct dilation, which indicates extrahepatic biliary obstruction (e.g., gallstones or pancreatic masses).

  * **A.** The ALT and AST are only minimally elevated, whereas ALP and GGT are significantly elevated, indicating a cholestatic pattern.
  * **B.** The bilirubin is normal, and there are significant enzyme elevations, ruling out isolated hyperbilirubinemia (e.g., Gilbert's).
  * **D.** Biliary imaging with ultrasound must precede invasive procedures like liver biopsy to exclude mechanical obstruction.  
Sources: GESA Guidelines on the Management of Abnormal Liver Function Tests; RACGP Guidelines on Liver Enzymes
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5. 4 / 10  
A 45-year-old man presents with persistent fatigue, joint pain in his hands (particularly the second and third metacarpophalangeal joints), and mild abdominal discomfort. Routine blood tests reveal: Ferritin 1250 ug/L (normal 30–300), Transferrin Saturation 68% (normal 15–45%), and mildly elevated AST and ALT.  
Which of the following is the most appropriate next step to confirm the diagnosis of Hereditary Haemochromatosis?  
Show answer

**Answer: C.** Perform genetic testing for the HFE gene mutations (C282Y and H63D)

**Why:** Hereditary haemochromatosis is an autosomal recessive disorder of iron metabolism, most commonly caused by mutations in the HFE gene (specifically C282Y homozygosity). Diagnostic criteria include biochemical evidence of iron overload (transferrin saturation > 45% and elevated ferritin) followed by confirmation with HFE gene mutation analysis.

  * **A.** Liver biopsy is invasive and is no longer the first-line diagnostic test for hereditary haemochromatosis, though it may be used to assess for cirrhosis.
  * **B.** MRI is useful for quantifying tissue iron overload and monitoring complications, but genetic testing is the standard for primary diagnosis.
  * **D.** Therapeutic venesection is the correct treatment but should not be initiated before a definitive genetic diagnosis is established.  
Sources: GESA Clinical Guidelines for Haemochromatosis; RACGP Genomics in General Practice Guidelines
6. 5 / 10  
A 38-year-old man presents to the Emergency Department with sudden-onset, severe epigastric pain radiating to his back, accompanied by vomiting. On examination, he is tachycardic (110 bpm) and has epigastric tenderness. His serum lipase level is reported as 750 U/L (upper limit of normal is 60 U/L).  
Which of the following is true regarding the diagnosis of acute pancreatitis in this patient?  
Show answer

**Answer: A.** He meets the diagnostic criteria for acute pancreatitis, and initial imaging is not necessary for confirmation

**Why:** The diagnosis of acute pancreatitis requires at least two of the following: 1) characteristic abdominal pain; 2) serum lipase or amylase activity at least three times the upper limit of normal; 3) characteristic findings on cross-sectional imaging (CT or MRI). Since this patient has typical pain and a lipase level > 12 times normal, a definite diagnosis can be made without exposing him to contrast-enhanced CT radiation at presentation.

  * **B.** Imaging is not required if the patient already meets diagnostic criteria (typical pain and lipase >= 3x normal).
  * **C.** Either lipase or amylase can be used; checking both does not improve diagnostic accuracy.
  * **D.** Etiology is important for management but is not a requirement for the initial diagnosis of acute pancreatitis.  
Sources: eTG complete — Gastroenterology; IAP/APA Evidence-Based Guidelines for the Management of Acute Pancreatitis
7. 6 / 10  
A 42-year-old patient tests positive for chronic Hepatitis C infection with detectable HCV RNA on PCR testing. Liver enzymes are mildly elevated.  
What is the current treatment status in Australia?  
Show answer

**Answer: C.** Direct Acting Antivirals (DAAs) (e.g. Epclusa, Maviret) for 8-12 weeks

**Why:** In Australia, Direct-Acting Antivirals (DAAs) such as Sofosbuvir/Velpatasvir (Epclusa) or Glecaprevir/Pibrentasvir (Maviret) provide a >95% cure rate (SVR12) with an 8-12 week oral course. They are fully funded on the PBS and can be prescribed by general practitioners.

  * **A.** Incorrect. Pegylated Interferon injections are obsolete due to severe side-effect profiles and inferior cure rates compared to DAAs.
  * **B.** Incorrect. Supportive management alone allows progression to liver cirrhosis and hepatocellular carcinoma in chronic HCV.
  * **D.** Incorrect. Liver transplantation is reserved for end-stage liver disease or decompensated cirrhosis, not uncomplicated chronic HCV.  
Sources: GESA Hepatitis C
8. 7 / 10  
A 45-year-old male with a history of alcohol dependence presents with hematemesis and melena. On examination, he is pale and tachycardic (HR 125 bpm, BP 85/50 mmHg) with abdominal stigmata of chronic liver disease.  
What is the most appropriate initial management bundle alongside aggressive fluid resuscitation?  
Show answer

**Answer: A.** Intravenous Terlipressin, prophylactic IV Ceftriaxone, and urgent gastroscopy for endoscopic band ligation

**Why:** Acute variceal bleeding secondary to portal hypertension is a medical emergency. Initial management includes aggressive fluid resuscitation, blood transfusion targets (Hb 70-80 g/L), IV vasoactive drugs (Terlipressin or Octreotide), prophylactic broad-spectrum IV antibiotics (Ceftriaxone), and urgent gastroscopy (EGDS) for band ligation within 12 hours.

  * **B.** Incorrect. Barium swallow is contraindicated in acute upper GI bleeding and oral PPIs alone are ineffective against hypertensive variceal haemorrhage.
  * **C.** Incorrect. Acute variceal haemorrhage is a life-threatening emergency with high mortality that requires immediate inpatient intervention.
  * **D.** Incorrect. Primary haemostasis for bleeding varices is achieved endoscopically (band ligation) or via TIPS, not open laparotomy.  
Sources: GESA Clinical Practice Guidelines - Acute Upper GI Bleeding; Baveno VII Consensus Guidelines
9. 8 / 10  
A 56-year-old man with decompensated alcoholic cirrhosis and tense ascites develops progressive renal impairment, with creatinine rising from 80 to 190 umol/L over 4 days. Urinalysis is normal, and there is no response to a fluid challenge with intravenous albumin. He is diagnosed with Hepatorenal Syndrome (HRS).  
Which of the following describes the primary pathophysiological mechanism driving renal failure in HRS?  
Show answer

**Answer: B.** Splanchnic vasodilation leading to severe renal vasoconstriction and hypoperfusion

**Why:** Hepatorenal syndrome is a form of functional renal failure that occurs in patients with advanced cirrhosis. Portal hypertension leads to the release of vasodilators (like nitric oxide) in the splanchnic circulation, causing arterial vasodilation. This leads to systemic hypotension, triggering compensatory activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system, resulting in severe renal arterial vasoconstriction and decreased GFR.

  * **A.** This describes cholemic nephrosis, which is distinct from the functional renal failure of hepatorenal syndrome.
  * **C.** Coagulopathy is present in cirrhosis, but capillary thrombosis is not the mechanism of HRS.
  * **D.** IgA nephropathy can occur in patients with cirrhosis, but it presents with hematuria and proteinuria, not acute functional renal failure.  
Sources: GESA Cirrhosis Guidelines; Harrison's Principles of Internal Medicine
10. 9 / 10  
A 48-year-old man presents to his GP complaining of chronic fatigue, joint pain in his hands, and mild abdominal discomfort. Routine blood tests reveal: ferritin 1200 ug/L (normal < 300) and transferrin saturation 68% (normal < 45%).  
Which of the following is the most appropriate next step to confirm the diagnosis of Hereditary Hemochromatosis?  
Show answer

**Answer: D.** Perform genetic testing for HFE gene mutations (C282Y and H63D)

**Why:** Hereditary Hemochromatosis is primarily caused by homozygosity for the C282Y mutation in the HFE gene. In patients presenting with elevated ferritin (>300 ug/L) and transferrin saturation (>45%), the diagnosis is confirmed by genetic testing for HFE mutations, avoiding the need for liver biopsy in most cases.

  * **A.** Liver biopsy is invasive and is now reserved for staging fibrosis, not for primary diagnostic confirmation.
  * **B.** Venesection is the treatment, but diagnosis should be confirmed via genetic testing first.
  * **C.** CT scan is not diagnostic for hemochromatosis and cannot replace genetic or tissue confirmation.  
Sources: Haemochromatosis Australia Guidelines; RACGP Red Book
11. 10 / 10  
A 56-year-old asymptomatic man is found to have a hemoglobin of 115 g/L (normal 130–170) and a ferritin of 12 ug/L (normal 30–300) during a routine health assessment.  
What is the most appropriate next diagnostic step?  
Show answer

**Answer: C.** Refer the patient for both a gastroscopy and a colonoscopy

**Why:** Iron deficiency anemia in adult men and postmenopausal women is commonly caused by chronic occult gastrointestinal bleeding. Common etiologies include gastrointestinal malignancies (e.g. colorectal cancer), peptic ulcer disease, or angiodysplasia. Bidirectional endoscopy (gastroscopy and colonoscopy) is the gold standard investigation to locate the site of bleeding.

  * **A.** While iron supplementation is necessary, it is critical to investigate the cause of iron deficiency in a male patient first to exclude occult malignancy.
  * **B.** FOBT is a screening tool and is not indicated for patients who already have documented iron deficiency anemia; they require diagnostic endoscopy directly.
  * **D.** Coeliac disease can cause iron malabsorption, but structural GI evaluation with endoscopy/colonoscopy is the priority to exclude malignancy.  
Sources: GESA Clinical Update: Iron Deficiency Anemia; RACGP Preventive Care Guidelines (Red Book)

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