HKCP Intermediate Examination (Hong Kong)

A 56-year-old man presents to the emergency department with severe, crushing substernal chest pain of 2 hours' duration. The ECG shows ST-segment elevation of 3 mm in leads V1 to V4. The hospital's cardiac catheterization laboratory is currently occupied, and the estimated time to transfer the patient to a nearby tertiary hospital for primary PCI is 140 minutes. What is the most appropriate next step in management?

• AImmediate intravenous fibrinolytic therapy
• BImmediate transfer for primary percutaneous coronary intervention (PCI)
• CIntravenous infusion of glycoprotein IIb/IIIa inhibitor and wait for the catheterization…
• DCoronary artery bypass grafting (CABG)

A 62-year-old man presents with sudden-onset, severe, tearing chest pain radiating to his back. His blood pressure is 185/110 mmHg and heart rate is 105 bpm. A CT angiogram confirms a Stanford Type B aortic dissection. Which of the following is the initial drug treatment of choice?

• AIntravenous nitroprusside alone
• BIntravenous labetalol
• CIntravenous hydralazine
• DIntravenous diltiazem

A 65-year-old woman with a history of hypertension and ischemic heart disease presents with progressive dyspnea on exertion. An echocardiogram reveals a left ventricular ejection fraction (LVEF) of 32%. She is currently taking enalapril 10 mg twice daily and carvedilol 25 mg twice daily. Her blood pressure is 125/75 mmHg, heart rate is 68 bpm, and eGFR is 45 mL/min/1.73m2. What is the most appropriate medication to add next to optimize her guideline-directed medical therapy?

• ASpironolactone
• BDapagliflozin
• CDigoxin
• DAmlodipine

A 24-year-old asymptomatic male is referred for evaluation after his older brother suffered sudden cardiac death at age 28. Echocardiography reveals asymmetric septal hypertrophy with a maximum wall thickness of 32 mm. No left ventricular outflow tract gradient is detected at rest. Which of the following is the most appropriate next step in his management?

• AReassure the patient and schedule a repeat echocardiogram in 5 years
• BPropose insertion of an implantable cardioverter-defibrillator (ICD)
• CInitiate therapy with high-dose beta-blockers
• DRefer for surgical septal myectomy

A 45-year-old active intravenous drug user presents with fever, chills, and a new murmur. Blood cultures grow Staphylococcus aureus in 3 out of 3 bottles. Echocardiography demonstrates a 12-mm mobile vegetation on the aortic valve with moderate aortic regurgitation. While hospitalized, he develops acute pulmonary edema. What is the most appropriate next step?

• AAdd rifampicin to the current antibiotic regimen
• BIncrease the dose of intravenous penicillin
• CUrgent surgical valve replacement
• DPerform repeat blood cultures and await results

A 78-year-old woman with severe symptomatic aortic stenosis presents for management. She has severe dyspnea (NYHA Class III). Echocardiography shows an aortic valve area of 0.7 cm2 and a mean pressure gradient of 48 mmHg. Her Society of Thoracic Surgeons (STS) score is calculated at 9%, indicating high surgical risk. What is the preferred intervention?

• ASurgical aortic valve replacement (SAVR)
• BTranscatheter aortic valve implantation (TAVI)
• CBalloon aortic valvuloplasty as definitive therapy
• DMedical management with high-dose loop diuretics only

A 58-year-old man presents with progressive shortness of breath. Transthoracic echocardiography reveals severe primary mitral regurgitation (MR) due to mitral valve prolapse (P2 flail leaflet). The left ventricular ejection fraction is 55% and the left ventricular end-systolic diameter (LVESD) is 42 mm. The patient is asymptomatic and can exercise normally. What is the most appropriate recommendation?

• AConservative outpatient follow-up every 12 months
• BReferral for mitral valve repair surgery
• CInitiate treatment with an ACE inhibitor
• DTranscatheter edge-to-edge repair (TEER) with MitraClip

A 71-year-old woman with a history of hypertension and type 2 diabetes presents with palpitations. Her ECG shows atrial fibrillation with a ventricular rate of 115 bpm. She has no chest pain or dyspnea. Her blood pressure is 130/80 mmHg. What is the most appropriate long-term management strategy for stroke prevention?

• AAspirin 81 mg daily
• BAspirin 81 mg daily and clopidogrel 75 mg daily
• COral anticoagulation with a DOAC (e.g., apixaban)
• DNo antithrombotic therapy is required

A 19-year-old female presents with recurrent episodes of syncope, typically triggered by loud noises or sudden emotional stress. Her ECG reveals a QTc interval of 510 ms. Her genetic testing is positive for a KCNH2 mutation (LQT2). Which of the following medications is the first-line treatment for this condition?

• AAmiodarone
• BPropranolol
• CVerapamil
• DFlecainide

A 48-year-old man presents with progressive abdominal distension and peripheral edema. On examination, he has elevated jugular venous pressure that increases during inspiration. A pericardial knock is heard on auscultation. Which of the following hemodynamic findings is most supportive of constrictive pericarditis rather than restrictive cardiomyopathy?

• ADiscordance in ventricular pressure changes during respiration
• BEqualization of diastolic pressures in all four cardiac chambers
• CMarked elevation of brain natriuretic peptide (BNP) levels
• DA 'dip and plateau' pattern in ventricular diastolic pressures

A 68-year-old woman is admitted for a severe skin infection and is started on intravenous antibiotics. On day 3, her serum creatinine rises from a baseline of 80 umol/L to 180 umol/L. Urine output has decreased to 25 mL/hour over the last 12 hours. Urinalysis shows 1+ protein, 10-15 white blood cells per high-power field, and white blood cell casts. Eosinophiluria is detected. Which of the following is the most likely diagnosis?

• AAcute tubular necrosis (ATN)
• BAcute interstitial nephritis (AIN)
• CPrerenal azotemia
• DPostrenal obstruction

A 32-year-old Chinese woman presents with generalized edema. Urinalysis shows 4+ protein, and 24-hour urine protein is 6.8 g. Serum albumin is 21 g/L. Renal biopsy is performed and light microscopy shows normal-appearing glomeruli. Immunofluorescence is negative. Electron microscopy shows diffuse effacement of podocyte foot processes. What is the initial treatment of choice?

• AIntravenous cyclophosphamide
• BHigh-dose oral corticosteroids
• CMycophenolate mofetil
• DRituximab

A 28-year-old female with Systemic Lupus Erythematosus (SLE) presents with rising creatinine and proteinuria (3.2 g/day). A renal biopsy demonstrates Class IV (diffuse proliferative) Lupus Nephritis. She wishes to conceive in the near future. Which of the following is the most appropriate induction regimen?

• AHigh-dose corticosteroids and intravenous cyclophosphamide
• BHigh-dose corticosteroids and oral mycophenolate mofetil (MMF)
• CHigh-dose corticosteroids and oral cyclosporine
• DHigh-dose corticosteroids and rituximab

A 35-year-old man presents with recurrent episodes of gross hematuria, typically occurring 1-2 days after an upper respiratory tract infection. His serum creatinine is 95 umol/L, blood pressure is 135/85 mmHg, and 24-hour urine protein is 0.8 g. Renal biopsy confirms IgA nephropathy. What is the most appropriate initial management?

• AObservation only
• BInitiation of an ACE inhibitor or ARB
• CStart oral prednisolone
• DStart tonsillectomy referral

A 28-year-old female presents with resistant hypertension. A renal artery duplex ultrasound shows findings suspicious for fibromuscular dysplasia (FMD) of the right renal artery. What is the gold standard diagnostic method and the preferred treatment if significant stenosis is confirmed?

• ACT angiography; surgical revascularization
• BDigital subtraction angiography (DSA); percutaneous transluminal angioplasty (PTA) withou…
• CMagnetic resonance angiography (MRA); renal artery stenting
• DRenal scintigraphy; medical therapy with ACE inhibitors only

A 42-year-old man with Autosomal Dominant Polycystic Kidney Disease (ADPKD) presents for follow-up. He has a family history of end-stage kidney disease. His eGFR is 55 mL/min/1.73m2. A recent MRI shows a total kidney volume (TKV) of 1600 mL, which classifies him as Mayo Class 1D (rapidly progressive). Which of the following therapies has been shown to slow the decline of kidney function in this patient population?

• ATolvaptan
• BOctreotide
• CRapamycin (sirolimus)
• DHigh-dose loop diuretics

A 74-year-old man with CKD Stage 4 presents with severe generalized weakness. His serum potassium is found to be 6.8 mmol/L. The ECG shows peaked T waves and widening of the QRS complex. What is the most immediate life-saving intervention?

• AIntravenous administration of 10% calcium gluconate
• BIntravenous infusion of insulin and dextrose
• CNebulized salbutamol therapy
• DEmergency hemodialysis

A 52-year-old woman with small cell lung cancer presents with confusion. Her serum sodium is 112 mmol/L. Serum osmolality is 235 mOsm/kg, urine osmolality is 450 mOsm/kg, and urine sodium is 48 mmol/L. She is clinically euvolemic. What is the maximum recommended rate of sodium correction over the first 24 hours to avoid osmotic demyelination syndrome (ODS)?

• A4-6 mmol/L
• B8 mmol/L
• C12 mmol/L
• D15 mmol/L

A 45-year-old woman presents with persistent muscle weakness. Laboratory testing reveals: Serum K+ 2.8 mmol/L, HCO3- 16 mmol/L, Cl- 112 mmol/L, Serum pH 7.31. Urine pH is 6.2. Urinary anion gap is positive. Which type of Renal Tubular Acidosis (RTA) does this patient most likely have?

• AType 1 (Distal) RTA
• BType 2 (Proximal) RTA
• CType 4 (Hyperkalemic) RTA
• DFanconi Syndrome

A 55-year-old man with CKD Stage 5 on hemodialysis has persistent secondary hyperparathyroidism. His labs show: Calcium 2.65 mmol/L (elevated), Phosphate 2.1 mmol/L (elevated), Parathyroid Hormone (PTH) 85 pmol/L (markedly elevated). Which of the following is the most appropriate treatment to manage his secondary hyperparathyroidism?

• ACalcitriol
• BCinacalcet
• CCalcium carbonate
• DAlfacalcidol

A 24-year-old woman presents to the emergency department with an acute exacerbation of asthma. She is tachypneic with a respiratory rate of 28 bpm, heart rate of 115 bpm, and oxygen saturation of 93% on room air. She is unable to complete sentences in one breath. On examination, there is bilateral expiratory wheezing. Initial therapy with nebulized salbutamol and ipratropium bromide is administered. A repeat arterial blood gas on room air shows: pH 7.42, PaCO2 5.3 kPa (40 mmHg), PaO2 9.1 kPa (68 mmHg), HCO3- 24 mmol/L. How should this blood gas result be interpreted?

• AReassuring normal acid-base status and ventilation
• BAn expected hyperventilation pattern with respiratory alkalosis
• CA sign of impending respiratory failure indicating a life-threatening attack
• DA primary metabolic acidosis with respiratory compensation

A 68-year-old man with severe COPD presents with increased dyspnea, increased sputum volume, and sputum purulence. His arterial blood gas on room air shows: pH 7.28, PaCO2 7.8 kPa (58 mmHg), PaO2 6.8 kPa (51 mmHg), HCO3- 28 mmol/L. He is alert and cooperative. What is the most appropriate next step in respiratory support?

• AHigh-flow nasal cannula (HFNC) oxygen therapy
• BNon-invasive positive pressure ventilation (NIV)
• CEndotracheal intubation and mechanical ventilation
• DLow-flow oxygen via nasal cannulae at 2 L/min

An 82-year-old man presents with a 2-day history of productive cough, fever, and confusion. On examination, his respiratory rate is 32 bpm, blood pressure is 88/54 mmHg, and heart rate is 108 bpm. Chest radiograph demonstrates right lower lobe consolidation. Blood tests show a urea of 8.2 mmol/L. What is his CURB-65 score and the recommended management setting?

• AScore 2; outpatient management
• BScore 3; inpatient management (medical ward)
• CScore 5; urgent inpatient admission, consider ICU
• DScore 5; immediate intubation and ICU admission

A 62-year-old male smoker presents with progressive exertional dyspnea and dry cough over the last 9 months. On examination, he has bilateral fine end-expiratory velcro-like crackles at both lung bases and clubbing of the fingers. High-resolution CT (HRCT) of the chest shows subpleural, basal-predominant reticular abnormalities, traction bronchiectasis, and honeycombing. What is the most appropriate next step in management?

• AInitiate high-dose systemic corticosteroids
• BInitiate antifibrotic therapy with pirfenidone or nintedanib
• CRefer for urgent bronchoscopy and transbronchial biopsy
• DInitiate immunosuppressive therapy with azathioprine and prednisolone

A 34-year-old woman presents with painful red nodules on her shins, bilateral ankle swelling, and dry cough. A chest radiograph demonstrates bilateral hilar lymphadenopathy. Blood tests show an elevated serum angiotensin-converting enzyme (ACE) level. What is the diagnosis and the most appropriate initial management?

• ALofgren syndrome (sarcoidosis); oral NSAIDs and supportive care
• BPulmonary tuberculosis; quad-therapy (HRZE)
• CErythema nodosum secondary to streptococcal infection; penicillin
• DStage II sarcoidosis; high-dose oral corticosteroids

A 54-year-old man is admitted with a right-sided bacterial pneumonia. Over the next 48 hours, he develops a pleural effusion on the same side. Thoracentesis is performed and pleural fluid analysis shows: pH 7.02, glucose 1.8 mmol/L, LDH 1200 U/L, Gram stain shows Gram-positive cocci. What is the most appropriate next step in management?

• ASend fluid for culture and observe the patient on intravenous antibiotics
• BInsertion of a chest tube (tube thoracostomy)
• CRepeat thoracentesis in 48 hours to monitor fluid chemistry
• DImmediate thoracoscopy and decortication

A 45-year-old woman is admitted to the ICU after a major orthopedic surgery. She suddenly develops severe dyspnea, chest pain, and hypoxia. Her blood pressure drops to 78/50 mmHg, heart rate is 135 bpm, and oxygen saturation is 84% on high-flow oxygen. Bedside echocardiography shows acute right ventricular strain and dilation. CT pulmonary angiogram confirms a saddle pulmonary embolism. What is the most appropriate immediate treatment?

• AIntravenous unfractionated heparin bolus and infusion
• BSystemic thrombolytic therapy (e.g., alteplase)
• CImmediate surgical embolectomy
• DPlacement of an inferior vena cava (IVC) filter

A 38-year-old woman presents with progressive dyspnea on exertion and syncope. Physical examination reveals a prominent pulmonic component of the second heart rate sound (P2) and a tricuspid regurgitant murmur. Echocardiography suggests pulmonary hypertension. A right heart catheterization is performed and shows: Mean pulmonary artery pressure (mPAP) of 38 mmHg, Pulmonary artery wedge pressure (PAWP) of 12 mmHg, Pulmonary vascular resistance (PVR) of 4 Wood units. How should this be classified?

• APre-capillary pulmonary hypertension (Group 1 PAH)
• BPost-capillary pulmonary hypertension (Group 2 secondary to left heart disease)
• CHyperdynamic pulmonary hypertension (Group 5)
• DMixed pre- and post-capillary pulmonary hypertension

A 48-year-old obese man is referred for evaluation of daytime somnolence and loud snoring. Polysomnography reveals an Apnea-Hypopnea Index (AHI) of 34 events per hour. He has a history of difficult-to-control hypertension. What is the gold standard first-line treatment for his condition?

• AMandibular advancement device
• BContinuous Positive Airway Pressure (CPAP)
• CUvulopalatopharyngoplasty (UPPP)
• DWeight loss and sleep hygiene advice alone

A 52-year-old construction worker who worked in tunnel excavation in Hong Kong for 25 years presents with progressive exertional dyspnea. A chest radiograph reveals multiple small rounded opacities (1-3 mm) predominantly in the upper lobes, along with calcification of the hilar lymph nodes ('eggshell calcification'). What is the most likely diagnosis?

• AAsbestosis
• BSilicosis
• CCoal worker's pneumoconiosis
• DBerylliosis

A 45-year-old man with severe acute pancreatitis develops worsening hypoxia and tachypnea. Chest radiograph shows bilateral alveolar infiltrates sparing the costophrenic angles. Arterial blood gas on mechanical ventilation with a FiO2 of 0.60 and PEEP of 10 cmH2O shows a PaO2 of 8.0 kPa (60 mmHg). The pulmonary artery wedge pressure is 12 mmHg. What is the patient's PaO2/FiO2 ratio, and which ventilator strategy is recommended?

• AP/F ratio 100; low tidal volume ventilation (6 mL/kg predicted body weight)
• BP/F ratio 150; high tidal volume ventilation (10 mL/kg predicted body weight) to clear CO2
• CP/F ratio 200; use of low PEEP (< 5 cmH2O) to prevent barotrauma
• DP/F ratio 250; immediate extubation to non-invasive ventilation

A 64-year-old woman is admitted with urosepsis. Her blood pressure is 82/44 mmHg despite the administration of 30 mL/kg of intravenous crystalloids. Her lactate is 3.2 mmol/L. What is the most appropriate next step in management?

• AAdminister another 2 L of crystalloid fluids
• BInitiate intravenous noradrenaline (norepinephrine) infusion
• CStart intravenous dopamine infusion
• DAdminister intravenous hydrocortisone 200 mg daily

A 28-year-old man is brought to the emergency department after being stung by a bee. He is dyspneic, has widespread urticaria, and a blood pressure of 80/40 mmHg. Strident breathing is noted. What is the most appropriate first-line medication, dose, and route of administration?

• AAdrenaline 0.5 mg intramuscularly (1:1000 solution)
• BAdrenaline 0.1 mg intravenously (1:10,000 solution)
• CHydrocortisone 200 mg intravenously
• DChlorpheniramine 10 mg intravenously

A 72-year-old woman is admitted with acute cardiogenic pulmonary edema. She is severely dyspneic, tachypneic (34 bpm), and has accessory muscle use. Her oxygen saturation is 86% on a high-concentration oxygen mask. Her blood pressure is 160/95 mmHg. Which of the following is the most appropriate non-invasive respiratory intervention?

• AContinuous Positive Airway Pressure (CPAP)
• BHigh-Flow Nasal Cannula (HFNC)
• CBi-level Positive Airway Pressure (BiPAP)
• DImmediate endotracheal intubation

A 45-year-old firefighter is brought to the emergency department after being rescued from a burning building. He is confused and has a headache. His oxygen saturation is 100% on a standard pulse oximeter. Arterial blood gas shows a normal PaO2 of 13.3 kPa (100 mmHg), but a carboxyhemoglobin (COHb) level of 32%. What is the most appropriate next step in management?

• ADischarge home as the PaO2 and oxygen saturation are normal
• BAdminister 100% high-flow oxygen via a non-rebreather mask
• CInitiate non-invasive positive pressure ventilation (NIV)
• DAdminister intravenous sodium thiosulfate

A 58-year-old intubated patient in the ICU on mechanical ventilation for 5 days develops a new fever of 38.8 C, purulent endotracheal secretions, and worsening oxygenation. A chest radiograph demonstrates a new progressive infiltrate in the left lower lobe. What is the most appropriate next step to guide antimicrobial therapy?

• AStart empiric broad-spectrum antibiotics after obtaining endotracheal aspirate cultures
• BPerform a bronchoalveolar lavage (BAL) and defer antibiotics until the culture results ar…
• CChange the endotracheal tube immediately
• DInitiate systemic corticosteroids

A 21-year-old woman with Type 1 Diabetes presents to the emergency department with abdominal pain, nausea, and vomiting. On examination, she is dry and has deep, rapid breathing (Kussmaul breathing). Her labs show: Serum glucose 24 mmol/L, HCO3- 10 mmol/L, pH 7.15, urine ketones 3+. An intravenous infusion of normal saline is started. What is the correct approach to starting insulin therapy?

• AStart a subcutaneous long-acting insulin analogue immediately
• BStart an intravenous infusion of soluble insulin at 0.1 units/kg/hour once fluid resuscit…
• CGive an intravenous bolus of 50 units of soluble insulin immediately
• DDefer insulin therapy until the blood pH is corrected to > 7.30 using bicarbonate infusion

A 26-year-old woman presents to the emergency department 8 hours after ingesting a large amount of paracetamol in a suicide attempt. Her serum paracetamol level is found to be above the treatment line on the Rumack-Matthew nomogram. What is the mechanism of toxicity, and what is the specific antidote?

• ADepletion of glutathione; N-acetylcysteine
• BInhibition of cytochrome P450; activated charcoal
• CDirect mitochondrial toxicity; sodium bicarbonate
• DBinding to GABA receptors; flumazenil

A 74-year-old man in the ICU on day 3 post-abdominal surgery is noted to be fluctuating in his attention, disoriented, and pulling at his intravenous lines. He is visual hallucinating. What is the most appropriate first-line non-pharmacological strategy and, if needed, the pharmacological agent of choice?

• APhysical restraints; intravenous diazepam
• BReorientation and optimization of sleep-wake cycle; low-dose haloperidol or atypical anti…
• CMove patient to a dark, quiet room; continuous propofol infusion
• DIntravenous chlorpromazine; close observation

A 62-year-old intubated patient with severe ARDS is receiving mechanical ventilation in Volume Control mode. The ventilator screen shows a peak inspiratory pressure (PIP) of 38 cmH2O and a plateau pressure of 26 cmH2O. What is the most likely cause of this pressure pattern?

• ADecreased respiratory system compliance (e.g., worsening pulmonary edema)
• BIncreased airway resistance (e.g., bronchospasm or tube obstruction)
• CAn air leak in the ventilator circuit
• DPatient-ventilator dyssynchrony (active fighting against the ventilator)

A 54-year-old man with a 10-year history of gastroesophageal reflux disease (GERD) undergoes an upper endoscopy. Biopsies of the distal esophagus demonstrate specialized columnar epithelium with goblet cells (Barrett's esophagus) extending 2 cm above the gastroesophageal junction. No dysplasia is detected on high-definition white light endoscopy and random biopsies. What is the recommended surveillance interval?

• ARepeat endoscopy in 6 months
• BRepeat endoscopy in 1 year
• CRepeat endoscopy in 3 to 5 years
• DNo further surveillance is required if no dysplasia is found

A 48-year-old man is diagnosed with a duodenal ulcer. A biopsy of the gastric antrum is positive for Helicobacter pylori. He has no known allergies. What is the recommended first-line eradication regimen in regions with high clarithromycin resistance (such as Hong Kong), according to current consensus guidelines?

• AClarithromycin triple therapy: Proton Pump Inhibitor (PPI), Amoxicillin, Clarithromycin f…
• BBismuth quadruple therapy: PPI, Bismuth subsalicylate, Metronidazole, Tetracycline for 14…
• CSequential therapy: PPI and Amoxicillin for 5 days, followed by PPI, Clarithromycin, and…
• DLevofloxacin triple therapy: PPI, Amoxicillin, Levofloxacin for 10 days

A 28-year-old man presents with chronic diarrhea, crampy right lower quadrant abdominal pain, and weight loss. On examination, a tender mass is palpable in the right iliac fossa. Colonoscopy reveals patchy, transmural inflammation in the terminal ileum with a cobblestone appearance and deep linear ulcers. Granulomas are noted on biopsy. Which of the following is the most likely diagnosis?

• AUlcerative colitis
• BCrohn's disease
• CIntestinal tuberculosis
• DCeliac disease

A 32-year-old woman is admitted with a severe flare of ulcerative colitis. She reports 8 bloody bowel movements per day, has a heart rate of 105 bpm, temperature of 38.0 C, and hemoglobin of 92 g/L. Abdominal X-ray shows a colonic diameter of 4.5 cm with no free air. She is started on intravenous hydrocortisone 100 mg every 6 hours. On day 3, her symptoms remain unchanged. What is the most appropriate next step in management?

• AContinue intravenous steroids for another 7 days before assessing response
• BInitiate rescue therapy with intravenous infliximab or cyclosporine
• CProceed to emergency total colectomy
• DSwitch to oral prednisolone and discharge home

A 35-year-old woman presents with persistent bloating, flatulence, and iron deficiency anemia. Serological screening is positive for IgA anti-tissue transglutaminase (anti-tTG) antibodies. An upper endoscopy is performed. Which of the following histological findings in the duodenum is most consistent with the diagnosis?

• ANon-caseating granulomas and mucosal ulceration
• BIntraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy
• CFoamy macrophages accumulating in the lamina propria
• DMetaplastic gastric mucosa in the duodenum

A 26-year-old woman presents with a 6-month history of recurrent abdominal pain, typically occurring 2-3 times per week, associated with bloating. The pain is relieved by defecation and is accompanied by a change in stool frequency and form. Her weight is stable, and she has no rectal bleeding, nocturnal symptoms, or family history of inflammatory bowel disease or colorectal cancer. What is the most likely diagnosis and initial management strategy?

• AInflammatory bowel disease; refer for urgent colonoscopy
• BIrritable bowel syndrome (IBS); dietary modification (low FODMAP) and reassurance
• CCeliac disease; place on a gluten-free diet immediately
• DColon cancer; perform urgent CT abdomen and pelvis

A 45-year-old man undergoes a screening colonoscopy. Two small (5 mm and 6 mm) tubular adenomas with low-grade dysplasia are completely removed from the sigmoid colon. When should his next surveillance colonoscopy be scheduled?

• AIn 1 year
• BIn 3 years
• CIn 7 to 10 years
• DIn 5 years