Prometric Exam Questions for Gastroenterology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the GES5171 Paper

The gastroenterology specialist paper (GES5171) is written for the GI registrar: the bleed on the acute take, the cirrhotic with ascites, the young patient with bloody diarrhoea, the endoscopy list decisions and the screening programme. Viral hepatitis and fatty liver disease are major regional burdens, and the paper reflects that. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale.

For titles and the route, read the gastroenterologist guide. For timed papers use the Gastroenterology specialist bank; the Internal Medicine bank covers the overlapping general medicine.

GI bleeding

Question 1

A 55-year-old on aspirin presents with melaena, a pulse of 110 and a blood pressure of 95/60 mmHg. After resuscitation, the correct sequence is:

1. High-dose intravenous proton pump inhibitor and discharge
2. Risk assessment with a Glasgow-Blatchford score, endoscopy within 24 hours (sooner if unstable after resuscitation), endoscopic therapy for high-risk ulcer stigmata, then high-dose PPI, H. pylori testing and review of antiplatelet need
3. Surgery first
4. Barium meal

Answer: B. Transfusion is restrictive (haemoglobin threshold about 70 g/L unless cardiac disease). Pre-endoscopy PPI does not replace endoscopy.

Question 2

A patient with known cirrhosis has haematemesis. Besides resuscitation and endoscopy, which measures reduce mortality?

1. High-dose aspirin
2. Vasoactive therapy with terlipressin or octreotide, prophylactic antibiotics such as ceftriaxone, endoscopic band ligation within 12 hours, and TIPS for refractory or high-risk bleeding
3. Propranolol during the acute bleed
4. Vitamin K alone

Answer: B. Antibiotics reduce infection, rebleeding and death in cirrhotic bleeding. Non-selective beta blockers are secondary prophylaxis after recovery.

Question 3

A 70-year-old has painless large-volume fresh rectal bleeding that has stopped. Colonoscopy after preparation shows multiple diverticula with no active bleeding. The most likely source and advice are:

1. Colorectal cancer; urgent surgery
2. Diverticular bleeding, which stops spontaneously in most cases; manage expectantly, review antiplatelets and NSAIDs, and consider CT angiography and embolisation if bleeding recurs with instability
3. Haemorrhoids; banding
4. Ulcerative colitis; steroids

Answer: B. Diverticular bleeding and angiodysplasia are the commonest causes of major lower GI bleeding in the elderly.

Peptic disease and the oesophagus

Question 4

A patient has a duodenal ulcer and a positive H. pylori stool antigen in a region with high clarithromycin resistance. The recommended first-line eradication regimen is:

1. Clarithromycin triple therapy for 7 days
2. Bismuth quadruple therapy (PPI, bismuth, tetracycline, metronidazole) for 14 days, or a non-bismuth concomitant regimen where bismuth is unavailable, with confirmation of eradication by stool antigen or urea breath test at least 4 weeks after treatment
3. PPI alone for 8 weeks
4. Antacids

Answer: B. Clarithromycin resistance exceeds 15% in much of the Gulf and South Asia, so bismuth quadruple therapy is first line. Test of cure is required after treating a complicated ulcer.

Question 5

Endoscopy for long-standing reflux shows a 4 cm segment of salmon-coloured mucosa above the gastro-oesophageal junction; biopsies show intestinal metaplasia without dysplasia. The management is:

1. Oesophagectomy
2. Long-term PPI, lifestyle advice and surveillance endoscopy at an interval set by segment length (about every 3 to 5 years for non-dysplastic Barrett's), with endoscopic eradication therapy if dysplasia develops
3. No follow-up
4. Radiofrequency ablation now

Answer: B. Barrett's oesophagus carries a small annual cancer risk; dysplasia is treated endoscopically.

Question 6

A 45-year-old has progressive dysphagia to solids then liquids, regurgitation and weight loss, with a bird-beak appearance on barium swallow and failed lower oesophageal sphincter relaxation on manometry. The diagnosis and treatment options are:

1. Oesophageal cancer; chemotherapy
2. Achalasia; pneumatic dilatation, laparoscopic Heller myotomy or per-oral endoscopic myotomy, after endoscopy to exclude pseudoachalasia from a tumour at the cardia
3. GORD; PPI
4. Eosinophilic oesophagitis; diet

Answer: B. Achalasia is diagnosed by manometry; endoscopy excludes malignancy, especially in older patients with rapid onset.

Inflammatory bowel disease and coeliac disease

Question 7

A 25-year-old with ulcerative colitis presents with more than six bloody stools a day, a temperature of 38 °C, a pulse of 100 and a CRP of 60. The management is:

1. Oral mesalazine and outpatient review
2. Admission for acute severe colitis: intravenous hydrocortisone, stool cultures and C. difficile testing, VTE prophylaxis, daily review with surgical involvement, and rescue therapy with infliximab or ciclosporin if there is no response by day 3, with colectomy for failure or complications
3. Loperamide and opioids
4. Immediate colectomy without medical therapy

Answer: B. Truelove and Witts criteria define acute severe colitis; antimotility drugs and opioids risk toxic megacolon.

Question 8

A patient with ileocolonic Crohn's disease has frequent relapses despite steroids and has a perianal fistula. The appropriate maintenance strategy is:

1. Repeated courses of prednisolone
2. Early anti-TNF therapy (for example infliximab or adalimumab), often with a thiopurine, after screening for TB and hepatitis B, plus surgical assessment of the fistula with seton placement where needed
3. Mesalazine alone
4. Antibiotics only

Answer: B. Steroids are not maintenance therapy. TB screening before biologics is essential given regional prevalence.

Question 9

A 30-year-old has iron deficiency anaemia, bloating and a strongly positive tissue transglutaminase IgA. The next step is:

1. Start a gluten-free diet immediately and never biopsy
2. Duodenal biopsies at endoscopy while still eating gluten to confirm coeliac disease, then a lifelong gluten-free diet with dietitian support and screening for nutritional deficiencies and bone health
3. Iron tablets alone
4. Colonoscopy only

Answer: B. Starting the diet before biopsy produces false-negative histology; some guidelines allow a no-biopsy diagnosis in children with very high titres.

Liver

Question 10

A patient with cirrhosis and new ascites has a diagnostic paracentesis showing a neutrophil count of 400 cells/mm³. The management is:

1. Diuretics alone
2. Treat spontaneous bacterial peritonitis with intravenous antibiotics such as cefotaxime or ceftriaxone, give albumin to reduce renal failure, and start long-term secondary antibiotic prophylaxis after recovery
3. Large-volume paracentesis without antibiotics
4. Steroids

Answer: B. A neutrophil count of 250 or more defines SBP. Albumin on days 1 and 3 reduces hepatorenal syndrome and mortality.

Question 11

A 40-year-old has HBsAg positive for over a year, HBeAg negative, HBV DNA of 50,000 IU/mL, persistently raised ALT and moderate fibrosis on elastography. The management is:

1. No treatment; monitor only
2. Antiviral therapy with a high-barrier nucleos(t)ide analogue such as entecavir or tenofovir, with surveillance for hepatocellular carcinoma by six-monthly ultrasound in those with cirrhosis or other risk factors
3. Interferon only
4. Liver transplant

Answer: B. Treatment is indicated for active disease with significant fibrosis; household contacts are vaccinated. Hepatitis B serology is part of every Gulf licence medical.

Question 12

A patient with chronic hepatitis C genotype 3 and compensated cirrhosis asks about treatment. The current approach is:

1. Interferon and ribavirin for a year
2. Pan-genotypic direct-acting antivirals (such as sofosbuvir/velpatasvir) for 12 weeks, with cure rates above 95%, and continued HCC surveillance after cure because cirrhosis persists
3. No treatment is available
4. Steroids

Answer: B. Direct-acting antivirals have transformed hepatitis C care; drug interactions and renal function guide the regimen.

Pancreas, screening and endoscopy safety

Question 13

A patient with acute gallstone pancreatitis has a CRP of 250 at 48 hours and organ failure persisting beyond 48 hours. Which statement about management is correct?

1. Early surgical necrosectomy improves survival
2. This is severe acute pancreatitis: intensive supportive care, early enteral nutrition, no prophylactic antibiotics, urgent ERCP only for cholangitis or persistent biliary obstruction, and cholecystectomy during the same admission for mild disease or after recovery for severe disease
3. Nil by mouth for two weeks
4. Routine prophylactic antibiotics

Answer: B. Persistent organ failure defines severe disease. Necrosis is managed with a delayed step-up approach only if infected.

Question 14

A 55-year-old average-risk adult asks about colorectal cancer screening. Appropriate options include:

1. No screening until symptoms
2. Colonoscopy every 10 years, or a faecal immunochemical test every 1 to 2 years with colonoscopy if positive, starting at 45 to 50 depending on the national programme, and earlier with a family history
3. Annual CT
4. Barium enema

Answer: B. Gulf programmes have adopted FIT-based screening; adenoma detection and bowel preparation quality are audited.

Question 15

Which patient most needs a planned bridging strategy before a polypectomy during colonoscopy?

1. A patient on aspirin 75 mg for primary prevention
2. A patient on warfarin for a mechanical mitral valve, who needs anticoagulation interruption with heparin bridging and INR check, because polypectomy is a high-bleeding-risk procedure in a high-thrombotic-risk patient
3. A patient on no medication
4. A patient on a statin

Answer: B. Endoscopy antithrombotic guidelines classify procedures by bleeding risk and patients by thrombotic risk; low-dose aspirin usually continues.

How to use these questions

• Learn the bleeding pathways for variceal and non-variceal, upper and lower bleeding, with the drugs and timings.
• Know cirrhosis complications: ascites, SBP, encephalopathy, hepatorenal syndrome, HCC surveillance.
• Cover hepatitis B and C management, which are common in the candidate and patient populations.
• Practise under time in the Gastroenterology bank with the error-log method.

Internal medicine content overlaps heavily (internal medicine sample questions), and general surgeons share the acute abdomen (general surgery sample questions). Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool.

Frequently asked questions

How many questions are in the gastroenterology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 65% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper include hepatology and endoscopy?

Yes. Liver disease is a large share, and endoscopy questions cover indications, findings and safety rather than technique.

Can a DM or MRCP gastroenterology holder skip the exam?

Often, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.