Free Practice Questions for Adult Gastroenterology Fellowship

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Key Facts: Adult Gastroenterology Fellowship Exam

80-120

Official written MCQ range

SCFHS Adult Gastroenterology Blueprint

70%

Standard passing score (min 65%)

SCFHS Fellowship Written Exam Regulations

28%

Largest blueprint domain: Liver

SCFHS Adult Gastroenterology Blueprint

Not published

Official exam fee

SCFHS Examination Regulations

Saudi Fellowship Final Examination - Adult Gastroenterology (SCFHS). One paper of 80–120 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint. The standard pass mark is 70%; when the initial pass rate is below 70%, SCFHS lowers the score one mark at a time toward a 70% pass rate or a 65% score, whichever comes first. A separate final clinical examination follows the written examination.

Sample Adult Gastroenterology Fellowship Practice Questions

Try these sample questions to review concepts for the Adult Gastroenterology Fellowship exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 42-year-old man is evaluated during a routine health maintenance examination. He is asymptomatic. Laboratory testing reveals: HBsAg positive, HBeAg negative, anti-HBe positive, HBV DNA 45,000 IU/mL, serum ALT 98 U/L (reference: up to 35 U/L), and serum AST 76 U/L. Transient elastography demonstrates a liver stiffness measurement of 9.2 kPa (consistent with F2-F3 fibrosis). Abdominal ultrasound shows a normal-appearing liver without focal lesions. Which of the following is the most appropriate next step in management?

A.Repeat ALT and HBV DNA in 6 months before deciding on treatment

B.Initiate antiviral therapy with tenofovir disoproxil fumarate or entecavir

C.Initiate pegylated interferon alfa-2a for a finite 48-week course

D.Perform a percutaneous liver biopsy before initiating any pharmacological therapy

Explanation: According to AASLD and EASL clinical practice guidelines for hepatitis B, patients with HBeAg-negative chronic hepatitis B who have elevated serum ALT (> 2 times the upper limit of normal) and HBV DNA > 2,000 IU/mL, especially with non-invasive evidence of significant fibrosis (F2 or greater, liver stiffness > 8 kPa), meet clear criteria for immediate antiviral therapy. First-line oral nucleos(t)ide analogs with a high genetic barrier to resistance include entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF).

2A 56-year-old man with compensated cirrhosis secondary to metabolic dysfunction-associated steatohepatitis (MASH) is evaluated in the clinic. He has never experienced ascites, variceal hemorrhage, or hepatic encephalopathy. Vibration-controlled transient elastography (VCTE) reveals a liver stiffness measurement of 16.4 kPa. Complete blood count shows a platelet count of 185,000/uL. According to the Baveno VII consensus guidelines, which of the following is the most appropriate recommendation regarding screening for gastroesophageal varices?

A.Perform an immediate screening esophagogastroduodenoscopy (EGD) within 4 weeks

B.Screening endoscopy can be avoided; monitor platelets and elastography annually

C.Initiate non-selective beta-blocker therapy with carvedilol without endoscopic evaluation

D.Perform capsule endoscopy of the esophagus to avoid invasive screening

Explanation: Under the Baveno VII consensus criteria, patients with compensated advanced chronic liver disease (cACLD) who have a liver stiffness measurement < 20 kPa AND a platelet count > 150,000/uL have a very low risk (< 5%) of clinically significant portal hypertension and high-risk varices. In these patients, screening esophagogastroduodenoscopy (EGD) can be safely spared. They should be followed longitudinally with annual platelet counts and transient elastography.

3A 51-year-old woman with alcohol-related cirrhosis is admitted to the emergency department with hematemesis and melena. Her blood pressure is 94/58 mmHg, heart rate is 112 bpm, and hemoglobin is 7.2 g/dL. Peripheral IV access is established, and intravenous crystalloid resuscitation is initiated. Which of the following sets of pharmacological and supportive interventions should be initiated immediately prior to urgent endoscopy?

A.Intravenous vasopressin infusion, oral ciprofloxacin, and liberal transfusion targeting hemoglobin > 10 g/dL

B.Intravenous octreotide infusion, prophylactic intravenous ceftriaxone, and restrictive red blood cell transfusion targeting hemoglobin 7 to 8 g/dL

C.Intravenous pantoprazole infusion, prophylactic platelet transfusion to > 100,000/uL, and aggressive volume expansion to MAP > 85 mmHg

D.Intravenous tranexamic acid, broad-spectrum carbapenem, and fresh frozen plasma transfusion to normalize the INR

Explanation: Standard initial management of suspected acute variceal hemorrhage includes: (1) immediate initiation of a vasoactive agent (octreotide, somatostatin, or terlipressin) to decrease portal inflow; (2) short-term antibiotic prophylaxis (intravenous ceftriaxone 1 g daily for up to 7 days), which significantly reduces bacterial infections, rebleeding, and all-cause mortality; and (3) a restrictive transfusion strategy targeting a hemoglobin of 7 to 8 g/dL, which avoids rebound portal hypertension and improves survival compared to liberal transfusion.

4A 48-year-old man with decompensated cirrhosis secondary to chronic hepatitis C presents with acute esophageal variceal bleeding. Emergency endoscopy within 6 hours successfully controls the bleeding using endoscopic band ligation. Laboratory evaluation shows: total bilirubin 3.8 mg/dL, serum albumin 2.4 g/dL, INR 1.8, and serum creatinine 1.1 mg/dL. He has moderate ascites on examination, calculating to a Child-Pugh score of 11 (Class C). According to international guidelines, which of the following is the most appropriate next step in management?

A.Initiate carvedilol monotherapy immediately and defer any procedural intervention

B.Maintain endoscopic band ligation every 2 to 4 weeks until eradication without considering TIPS

C.Proceed with early (preemptive) transjugular intrahepatic portosystemic shunt (TIPS) within 24 to 72 hours

D.Place a Sengstaken-Blakemore balloon tamponade tube for 48 hours as secondary prevention

Explanation: Early (preemptive) transjugular intrahepatic portosystemic shunt (TIPS), placed within 24 to 72 hours of index endoscopy, is strongly recommended by Baveno VII, AASLD, and EASL guidelines for patients at high risk of treatment failure or death after acute variceal bleeding. High-risk patients are defined as Child-Pugh class C (score 10-13) or Child-Pugh class B (score 7-9) with active bleeding seen at diagnostic endoscopy. Preemptive TIPS reduces treatment failure, rebleeding, and 1-year mortality.

5A 54-year-old woman with cirrhosis survives an episode of acute esophageal variceal hemorrhage treated with endoscopic band ligation. She is hemodynamically stable and tolerating oral intake on day 5 of hospitalization. Which of the following regimens represents the gold standard for secondary prophylaxis against recurrent variceal hemorrhage?

A.A non-selective beta-blocker plus serial band ligation until eradication

B.Serial endoscopic variceal ligation monotherapy every 2 to 4 weeks until obliteration

C.Non-selective beta-blocker monotherapy titrated to a resting heart rate of 55 to 60 bpm

D.Long-term oral isosorbide mononitrate monotherapy combined with spironolactone

Explanation: The established standard of care for secondary prophylaxis of variceal hemorrhage is the combination of non-selective beta-blockers (NSBB: propranolol or nadolol titrated to resting heart rate 55-60 bpm, or carvedilol) AND serial endoscopic variceal ligation (EVL) performed every 2 to 4 weeks until variceal eradication. Meta-analyses demonstrate that combination therapy achieves significantly lower rebleeding rates and lower mortality than either modality alone.

6A 52-year-old woman with primary biliary cholangitis (PBC) has been compliant with ursodeoxycholic acid (UDCA) at 14 mg/kg/day for 14 months. Her current laboratory results show: alkaline phosphatase (ALP) 340 U/L (2.8 times the upper limit of normal), total bilirubin 1.1 mg/dL, and AST 48 U/L. She reports mild generalized pruritus but no jaundice or ascites. Transient elastography reveals liver stiffness of 9.8 kPa. Which of the following is the most appropriate next step in pharmacological management?

A.Add obeticholic acid, elafibranor or bezafibrate to the UDCA

B.Discontinue UDCA and switch her to oral prednisone 40 mg daily

C.Double the daily dose of UDCA to 30 mg/kg/day

D.Refer immediately for deceased-donor liver transplantation evaluation

Explanation: Approximately 40% of patients with PBC have an inadequate biochemical response to standard-dose UDCA (13-15 mg/kg/day) after 1 year of therapy, defined by persistent elevation of ALP > 1.67 times ULN or elevated bilirubin (e.g., Paris II or Toronto criteria). These patients are at high risk of disease progression and require second-line therapy added to UDCA. Approved options include obeticholic acid (a farnesoid X receptor agonist, in patients without decompensated cirrhosis) or newly approved PPAR agonists (such as elafibranor) or off-label fibrates (bezafibrate/fenofibrate).

7A 36-year-old man with a 10-year history of extensive ulcerative colitis in clinical remission presents with painless jaundice, dark urine, and pruritus. Total bilirubin is 6.8 mg/dL, direct bilirubin 4.9 mg/dL, and ALP 620 U/L. Magnetic resonance cholangiopancreatography (MRCP) reveals diffuse beading of intrahepatic ducts and a focal 1.5-cm high-grade narrowing in the proximal common hepatic duct with marked proximal biliary dilatation. What is the most appropriate next step in evaluating this dominant stricture?

A.ERCP with brush cytology and FISH

B.Initiate high-dose ursodeoxycholic acid (28 to 30 mg/kg/day) and repeat MRCP in 6 months

C.Perform immediate percutaneous fine-needle aspiration of the common hepatic duct lesion

D.Refer for immediate radical bile duct resection without prior tissue sampling

Explanation: In patients with primary sclerosing cholangitis (PSC), a new dominant stricture (defined as a stenosis < 1.5 mm diameter in the common bile duct or < 1.0 mm in the hepatic ducts) carries a high risk (up to 20-30%) of harboring occult cholangiocarcinoma (CCA). The recommended evaluation is ERCP with biliary brush cytology combined with fluorescence in situ hybridization (FISH) for polysomy, which substantially increases diagnostic sensitivity for CCA over cytology alone.

8A 28-year-old previously healthy woman presents with fatigue, arthralgias, and jaundice. Serum AST is 820 U/L, ALT is 910 U/L, total bilirubin is 4.6 mg/dL, and serum IgG is 2,400 mg/dL (upper limit 1,600 mg/dL). Antinuclear antibody (ANA) is positive at 1:640 (speckled pattern) and anti-smooth muscle antibody (ASMA) is positive at 1:320. Viral hepatitis panel, acetaminophen level, and ceruloplasmin are normal. Liver biopsy confirms interface hepatitis with dense plasma-cell lymphocytic infiltrates without cirrhosis. Which of the following is the most appropriate initial management?

A.Administer a 3-month trial of ursodeoxycholic acid before immunosuppression

B.Initiate oral budesonide combined with mycophenolate mofetil as first-line therapy

C.Initiate high-dose intravenous N-acetylcysteine infusion for 72 hours

D.Prednisone with azathioprine after checking TPMT activity

Explanation: This patient presents with classic Type 1 Autoimmune Hepatitis (elevated transaminases, markedly elevated IgG, high-titer ANA/ASMA, interface hepatitis with plasma cells on biopsy). According to AASLD/EASL guidelines, standard induction therapy consists of oral prednisone (30-60 mg/day tapered over weeks) combined with azathioprine (1-2 mg/kg/day) to achieve biochemical remission while minimizing steroid toxicity. Checking TPMT activity (or genotype) prior to azathioprine initiation prevents life-threatening myelosuppression.

9A 45-year-old man undergoes screening because his brother was diagnosed with genetic hemochromatosis. The patient is asymptomatic. Laboratory evaluation reveals: serum ferritin 1,350 ng/mL (reference: 20-250 ng/mL) and transferrin saturation 78% (reference: 20-50%). Genetic testing confirms homozygosity for the HFE C282Y mutation. Serum ALT is 58 U/L and AST is 44 U/L. Which of the following is the most appropriate management plan?

A.Stage fibrosis, then weekly phlebotomy to a ferritin of 50 to 100 ng/mL

B.Initiate iron chelation therapy with oral deferasirox as first-line treatment

C.Recommend dietary iron restriction alone and monitor ferritin every 6 months

D.Begin therapeutic phlebotomy with an end-target serum ferritin of < 10 ng/mL

Explanation: In HFE-related hemochromatosis, patients with C282Y homozygosity and serum ferritin > 1,000 ng/mL or elevated transaminases have an increased risk of advanced fibrosis or cirrhosis. Non-invasive elastography or liver biopsy is indicated to stage fibrosis and determine the need for HCC surveillance. The treatment of choice is therapeutic phlebotomy (initially 500 mL weekly or biweekly) with the goal of depleting iron stores until serum ferritin reaches 50 to 100 ng/mL, followed by maintenance phlebotomies.

10A 21-year-old college student is referred for evaluation of progressive resting tremor, dysarthria, and elevated serum transaminases (ALT 112 U/L, AST 138 U/L). Slit-lamp biomicroscopy reveals golden-brown copper deposits in Descemet's membrane (Kayser-Fleischer rings). Serum ceruloplasmin is 9 mg/dL (reference: 20-40 mg/dL), and 24-hour urinary copper excretion is 185 ug/day (reference: < 40 ug/day). Which of the following is the first-line initial pharmacological therapy?

A.Intravenous deferoxamine infusion

B.Oral zinc acetate monotherapy

C.Chelation with penicillamine or trientine

D.High-dose vitamin E and ursodeoxycholic acid

Explanation: This patient has classic Wilson disease with hepatic and neurological manifestations, confirmed by Kayser-Fleischer rings, low serum ceruloplasmin (< 20 mg/dL), and elevated 24-hour urinary copper (> 100 ug/day). Initial treatment for symptomatic patients requires copper chelation with penicillamine or trientine to mobilize tissue copper stores and promote urinary excretion. Trientine is often preferred due to a favorable toxicity profile compared to penicillamine.

About the Adult Gastroenterology Fellowship Exam

This resource is an independent English-language MCQ study adaptation created by OpenExamPrep for fellows preparing for the Saudi Fellowship Final Written Examination in Adult Gastroenterology. It is an advanced subspecialty fellowship certified by SCFHS following internal medicine residency. The final written exam evaluates clinical gastroenterology and hepatology across 80-120 MCQs, followed by a mandatory clinical OSCE. OpenExamPrep is an independent educational platform and is not affiliated with, approved by, or endorsed by SCFHS.

Exam sponsor: Saudi Commission for Health Specialties (SCFHS). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

One paper of 80–120 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

Time Limit

Not published by SCFHS

Passing Score

70% (lowered to minimum 65% if pass rate under 70%)

Exam / Certification Fees

Not published by SCFHS

Exam sponsor website

Reported exam pass rate: Not published by SCFHS. SCFHS publishes no candidate pass rate. The blueprint instead sets the passing score at 70% and, if fewer than 70% of candidates pass before final approval, lowers that score one mark at a time until a 70% pass rate is reached or the score reaches 65%, whichever comes first; it is never lowered below 65%. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

28%

Liver-related Diseases

Viral hepatitis, metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-associated liver disease, cirrhosis and its complications, portal hypertension, hepatocellular carcinoma, autoimmune and cholestatic liver diseases, vascular liver disorders, acute liver failure, and liver transplantation.

15%

Colon

Colorectal cancer screening and surveillance, polyp histology and endoscopic resection, ulcerative colitis, Crohn's colitis, microscopic colitis, diverticular disease, ischemic colitis, acute lower gastrointestinal bleeding, and functional colonic disorders.

15%

Stomach and Duodenum

Helicobacter pylori infection, peptic ulcer disease and bleeding management, gastric adenocarcinoma, gastric subepithelial lesions including GIST, neuroendocrine tumors, autoimmune gastritis, gastroparesis, and duodenal polyps.

14%

Pancreaticobiliary

Acute and chronic pancreatitis, autoimmune pancreatitis, cystic lesions of the pancreas, pancreatic adenocarcinoma, choledocholithiasis, acute cholangitis, benign and malignant biliary strictures, cholangiocarcinoma, and post-ERCP complications.

14%

Small Bowel

Celiac disease, Crohn's disease of the small bowel, small intestinal bacterial overgrowth (SIBO), occult and obscure gastrointestinal bleeding, capsule endoscopy, small bowel neuroendocrine tumors, mesenteric ischemia, and malabsorption disorders.

14%

Oesophageal

Gastroesophageal reflux disease (GERD), Barrett's esophagus and dysplasia, esophageal motility disorders including achalasia, eosinophilic esophagitis, infectious and pill-induced esophagitis, esophageal perforation, and esophageal carcinoma.

Preparing for the Adult Gastroenterology Fellowship Exam

What You Need to Know

Passing score: 70% (lowered to minimum 65% if pass rate under 70%)
Assessment: One paper of 80–120 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.
Time limit: Not published by SCFHS
Exam / certification fees: Not published by SCFHS Official sources

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Adult Gastroenterology Fellowship: Suggested Study Strategy

1Prioritize hepatology: with 28% blueprint weighting, master portal hypertension management (Baveno VII guidelines), DAA regimens for HCV, HBV antiviral indications, acute-on-chronic liver failure, and MELD 3.0 liver transplant allocation.

2Review luminal emergencies: practice stratifying Forrest classification ulcers, acute variceal hemorrhage protocols, acute severe ulcerative colitis rescue therapy algorithms, and acute cholangitis Tokyo Guidelines 2018.

3Master high-resolution esophageal manometry interpretation using Chicago Classification v4.0 criteria to distinguish achalasia subtypes, EGJOO, and distal esophageal spasm.

4Know pancreatic cyst management: familiarize yourself with the revised Fukuoka international consensus guidelines for mucinous cysts and IPMN worrisome features versus high-risk stigmata.

5Memorize post-polypectomy and Barrett's esophagus surveillance intervals according to the latest USMSTF and ACG guidelines.

Frequently Asked Questions

What is the official title and credential level for this gastroenterology exam?

The credential is officially titled the Saudi Fellowship Final Examination - Adult Gastroenterology, administered by the Saudi Commission for Health Specialties (SCFHS). It is a certified subspecialty fellowship undertaken following successful completion of an Internal Medicine residency.

What is the format and duration of the adult gastroenterology final written exam?

One paper of 80–120 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

What passing score is required by SCFHS for the adult gastroenterology written paper?

The standard passing score is 70%. If the overall cohort passing rate is below 70%, SCFHS regulations allow the cut score to be lowered one mark at a time to target a 70% cohort pass rate, with a firm floor at 65%.

Is there a clinical examination following the written exam?

This bank is an independent English-language MCQ study adaptation for the written examination. It does not simulate or replace the separate mandatory final clinical/practical assessment. Consult the specialty clinical blueprint for its station formats and any structured oral or OSCE components.

Which domain carries the highest weight on the Adult Gastroenterology blueprint?

Liver-related diseases is the single largest section, accounting for 28% of the examination blueprint, followed by Colon and Stomach/Duodenum at 15% each, and Pancreaticobiliary, Small Bowel, and Oesophageal at 14% each.

Is this practice question bank endorsed by or affiliated with SCFHS?

No. This practice question bank is an independent educational resource created by OpenExamPrep for self-study and examination preparation. It is neither affiliated with nor endorsed by the Saudi Commission for Health Specialties.

Free Practice Questions for Adult Gastroenterology Fellowship

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