1High-yield associations
| Finding or trigger | Classic association | The exam point |
|---|---|---|
| Iron deficiency in a man or a postmenopausal woman | Gastrointestinal blood loss | Ferritin under 30 microgram/L; coeliac serology and upper and lower endoscopy (GESA 2022). |
| Transferrin saturation over 45% | HFE haemochromatosis (C282Y homozygote) | Venesect to ferritin 50 to 100 microgram/L; test first-degree relatives (GESA 2021). |
| Dermatitis herpetiformis | Coeliac disease | Skin biopsy with direct immunofluorescence confirms it; then coeliac serology and duodenal biopsy on gluten. HLA-DQ2/DQ8 only excludes (MJA 2017). |
| Ulcerative colitis with cholestatic liver tests | Primary sclerosing cholangitis | Yearly colonoscopy from PSC diagnosis (Cancer Council Australia 2018). |
| Acute severe colitis failing IV corticosteroids | Steroid-refractory acute severe UC | Rescue infliximab or ciclosporin, or colectomy. PBS lists infliximab for acute severe UC. |
| HBsAg negative, anti-HBc positive, before rituximab | Hepatitis B reactivation | Entecavir or tenofovir prophylaxis, not monitoring (GESA 2022). |
| Raised ALP, antimitochondrial antibody | Primary biliary cholangitis | Ursodeoxycholic acid first; PPAR agonists now preferred second line (Aust Prescr 2026). |
| Fatty liver, FIB-4 1.3 to 2.7 | Indeterminate fibrosis risk | Elastography or a serum fibrosis test; over 2.7, refer; use 2.0 instead of 1.3 over 65 (GESA MAFLD 2024). |
| Ascitic neutrophils over 250 × 106/L | Spontaneous bacterial peritonitis | IV ceftriaxone plus 20% albumin 1.5 g/kg within 6 hours (GESA 2022). |
| Haematemesis in cirrhosis | Variceal haemorrhage | Terlipressin, IV ceftriaxone, transfuse below Hb 70 g/L, endoscopy within 12 hours (GESA 2022). |
| Heavy drinker, new jaundice, Maddrey over 32 | Severe alcoholic hepatitis | Corticosteroids; Lille non-response at a first decompensation: transplant assessment (TSANZ 2026). |
2Australia-only high-yield (won't be in UK or US banks)
Bowel cancer screening (Cancer Council Australia 2023; NBCSP). Two-yearly iFOBT from 45 to 74. The NBCSP mails kits from 50 to 74; since July 2024, people aged 45 to 49 can request one.
Surveillance (Cancer Council Australia 2018 and 2014). One or two small tubular adenomas: colonoscopy at 10 years; three or four: 5 years. After cancer resection: 1 year, then 5. Left-sided or wider colitis: from 8 years after symptom onset. Barrett oesophagus without dysplasia: 3 to 5 years if under 3 cm, 2 to 3 years if longer.
Viral hepatitis (PBS, October 2026; GESA 2022). PBS lists glecaprevir-pibrentasvir, sofosbuvir-velpatasvir and sofosbuvir-velpatasvir-voxilaprevir for hepatitis C; any doctor or nurse practitioner experienced in hepatitis C, or consulting a specialist, may prescribe. Entecavir and tenofovir are listed for hepatitis B (Section 100 community access; GPs need S100 prescriber training, GESA 2022). Pregnancy with HBV DNA over 200,000 IU/mL: tenofovir from week 28.
HCC surveillance (GESA consensus, revised 2026). 6-monthly ultrasound with AFP: any cirrhosis (if fit for treatment), even after hepatitis C cure; hepatitis B without cirrhosis in Asian or Pacific men over 40 and women over 50, sub-Saharan Africans over 20, and Aboriginal and Torres Strait Islander people from 40.
IBD (PBS, October 2026). Crohn disease and UC: infliximab, adalimumab, vedolizumab, ustekinumab, upadacitinib. UC only: golimumab, tofacitinib, ozanimod, etrasimod. Phases: Initial 1, 2 or 3 (new patient, change, recommencement), then continuing. Risankizumab and guselkumab: psoriasis and psoriatic arthritis only; mirikizumab was not found in the PBS medicine index.
PBC (PBS and TGA, October 2026). PBS lists ursodeoxycholic acid, and obeticholic acid and elafibranor (initial and continuing phases). Seladelpar, registered in January 2026 (Aust Prescr 2026), was not found in the PBS medicine index; bezafibrate is not marketed here.
Transplant referral (TSANZ guidelines v1.18, 2026). MELD over 15, diuretic-resistant ascites, recurrent encephalopathy, recurrent SBP, recurrent or persistent bleeding, or HCC within UCSF criteria (up to 3 lesions, none over 4.5 cm, total 8 cm; or one up to 6.5 cm); AFP over 1000 ng/mL excludes. Alcohol: usually six months' abstinence.
3Sample questions (Physify format)
1. A 56 year old man has a positive bowel screening test. A complete, well-prepared colonoscopy removes two tubular adenomas of 5 and 7 mm with low-grade dysplasia. He has no family history of colorectal cancer. Under the Australian surveillance colonoscopy guideline, when should his next colonoscopy be?
- A. In 1 year
- B. In 3 years
- C. In 5 years
- D. In 10 years
- E. Never; discharge him from surveillance
Answer: D
D. Correct. One or two small (under 10 mm) tubular adenomas without high-grade dysplasia are low risk: first surveillance at 10 years (Cancer Council Australia 2018).
A. One year is the interval after curative resection of colorectal cancer.
B. Three years is for higher-risk findings, such as three or four adenomas with one 10 mm or larger.
C. Five years is for three or four small tubular adenomas, or one or two small adenomas with villous change or high-grade dysplasia.
E. The Australian guideline sets a first interval of 10 years, or return to the screening program, for this low-risk finding.
2. A 67 year old woman with diffuse large B-cell lymphoma is to start R-CHOP. She is HBsAg negative and anti-HBc positive, with anti-HBs 40 IU/L, undetectable HBV DNA and normal liver tests. Under the Australian hepatitis B consensus, what is the most appropriate approach?
- A. No action, as her anti-HBs is protective
- B. A hepatitis B vaccine booster before chemotherapy
- C. Entecavir or tenofovir prophylaxis with chemotherapy
- D. ALT 3-monthly and HBV DNA 6-monthly, treating if they rise
- E. Hepatitis B immunoglobulin before each rituximab dose
Answer: C
C. Correct. Anti-CD20 therapy carries over 10% reactivation risk with past HBV exposure, so treat with entecavir or tenofovir (GESA 2022).
A. Anti-HBs does not stop reactivation of virus persisting in hepatocytes during B-cell depletion.
B. Vaccination does not address infection that is already latent.
D. Monitoring is the consensus approach for HBsAg-positive people on low-risk immunosuppression, not for rituximab.
E. Hepatitis B immunoglobulin is for newborns and after exposure; it does not prevent reactivation.
3. Five adults have chronic hepatitis B without cirrhosis, normal liver tests and no family history of hepatocellular carcinoma. Under the GESA 2026 HCC consensus statement, which one should start 6-monthly HCC surveillance now?
- A. A 34 year old man born in Vietnam
- B. A 44 year old Aboriginal man
- C. A 46 year old woman born in China
- D. A 38 year old woman born in Samoa
- E. A 52 year old Italian-born man with a low PAGE-B score
Answer: B
B. Correct. GESA 2026 recommends surveillance from age 40 in Aboriginal and Torres Strait Islander people with hepatitis B without cirrhosis: ultrasound with AFP every 6 months. The NHMRC-endorsed national guideline (MJA 2025) starts at 50, or earlier with a family history of HCC or, from 40, a high-risk HBV genotype; the question asks for the GESA position.
A. Asian men without cirrhosis qualify from over 40.
C. Asian women without cirrhosis qualify from over 50.
D. Pacific women also qualify from over 50.
E. Other groups are selected by risk score, and a low PAGE-B score means very low risk.