00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
Retry this test Dashboard

  • Question 1 - A 25-year-old woman is reviewed in clinic. She was previously treated with omeprazole,...

    Incorrect

    • A 25-year-old woman is reviewed in clinic. She was previously treated with omeprazole, amoxicillin and clarithromycin for Helicobacter pylori (H. pylori). She remains on PPI therapy but continues to have epigastric discomfort. You suspect she has ongoing H. pylori infection and request a urea breath test to investigate this. How long would the patient need to stop her PPI therapy before the urea breath test?

      Your Answer: Not at all

      Correct Answer: 14 days

      Explanation:

      PPI will affect the accuracy of the test. In general, most recommend discontinuing PPI therapy for 2 weeks prior to a urea breath test. PPI’s have an anti-H. pylori effect.

    • This question is part of the following fields:

      • Gastroenterology
      34.5
      Seconds

  • Question 2 - A 36-year-old man is being investigated for recurrent gastric and duodenal ulceration diagnosed...

    Correct

    • A 36-year-old man is being investigated for recurrent gastric and duodenal ulceration diagnosed at endoscopy. He has suffered from bouts of abdominal pain and intermittent diarrhoea although his weight is stable. Some of his investigations results are: Basal acid secretion 20 mEq/h (1–5), Fasting gastrin 200 pg/ml (<100), Secretin test: Basal gastrin 200pg/ml, Post-secretin 500pg/ml. Which of the following are responsible for the elevated gastrin levels?

      Your Answer: Gastrinoma

      Explanation:

      This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. The secretin test is a test that can differentiate gastrinoma from other causes of high gastrin levels. Gastrin will rise after secretin injection if the patient has a gastrinoma.

    • This question is part of the following fields:

      • Gastroenterology
      42.1
      Seconds

  • Question 3 - A 34-year-old HIV positive man is referred to gastroenterology due to jaundiced sclera....

    Incorrect

    • A 34-year-old HIV positive man is referred to gastroenterology due to jaundiced sclera. Liver function tests are as follows: Albumin 34 g/l ALP 540 iu/l Bilirubin 67 µmol/L, ALT 45 iu/l What is the most likely diagnosis?

      Your Answer: Primary biliary cirrhosis

      Correct Answer: Sclerosing cholangitis

      Explanation:

      HIV can cause strictures in the biliary tract (see source for details of the disease). This makes the diagnosis of primary sclerosing cholangitis most likely given the clinical presentation and lab values. Due to its association with HIV this is more likely than all of the other answer choices. Know this association.

    • This question is part of the following fields:

      • Gastroenterology
      24.8
      Seconds

  • Question 4 - Which of the following is most commonly associated with the development of pseudomembranous...

    Incorrect

    • Which of the following is most commonly associated with the development of pseudomembranous colitis?

      Your Answer: Flucloxacillin

      Correct Answer: Cefuroxime

      Explanation:

      Pseudomembranous colitis is caused by a C. difficile infection that causes membranes to form on the colon wall. It is caused most commonly by broad-spectrum antibiotics. This would include cephalosporins, broad-spectrum penicillin, and clindamycin. Macrolides and quinolones have also been reported as potential aetiologies, but much less commonly.

    • This question is part of the following fields:

      • Gastroenterology
      10.7
      Seconds

  • Question 5 - A 72-year-old woman presents with a 3 month history of colicky abdominal pain...

    Incorrect

    • A 72-year-old woman presents with a 3 month history of colicky abdominal pain after eating, and diarrhoea. She has lost 7 kg in weight over the last few months. A recent gastroscopy and colonoscopy were normal. Her past medical history includes angina and a right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan. right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan. Blood tests revealed: Haemoglobin (Hb) 118 g/l, Mean corpuscular volume (MCV) 80 fl, White cell count (WCC) 12.3 x 109/L, Platelets 210 x 109/L, Na+ 133 mmol/L, K+ 5.2 mmol/L, Urea 8.1 mmol/L, Creatinine 134 mmol/L. Select the most appropriate further investigations.

      Your Answer: Magnetic resonance imaging (MRI) of the abdomen

      Correct Answer: Contrast-enhanced computed tomography (CT) of the abdomen

      Explanation:

      The patient is 74 years old. She has had a recent gastroscopy and colonoscopy. She has a history of angina and a right CEA. She is having colicky abdominal pain after meals and weight loss, which points to a possible diagnosis of chronic mesenteric ischemia. Thus, you would want to do a contrast-enhanced CT scan of the abdomen to look for this. A 24 hour cardiac monitor would also be helpful to look for any abnormal rhythm that could be a potential aetiology of her disease.

    • This question is part of the following fields:

      • Gastroenterology
      70.7
      Seconds

  • Question 6 - Hepatitis C is what kind of virus? ...

    Correct

    • Hepatitis C is what kind of virus?

      Your Answer: A variable RNA virus

      Explanation:

      Hepatitis C is a single-stranded positive sense RNA virus. It is variable because of the high rate of error of RNA-dependent RNA polymerase and the pressure from the host immune system has caused HCV to evolve and develop seven genetic lineages.

    • This question is part of the following fields:

      • Gastroenterology
      9.2
      Seconds

  • Question 7 - A 53-year-old woman presents with upper GI haemorrhage. She has a history of...

    Incorrect

    • A 53-year-old woman presents with upper GI haemorrhage. She has a history of rheumatoid arthritis for which she is managed with low dose prednisolone, diclofenac and codeine phosphate. On examination in the Emergency ward her BP is 90/60 mmHg, pulse 100/min. You fluid resuscitate her and her BP improves to 115/80 mmHg, with a pulse of 80/min. Investigations; Hb 10.4 g/dL, WCC 6.1 x109/L, PLT 145 x109/L, Na+ 139 mmol/L, K+ 4.9 mmol/L, Creatinine 180 μmol/L, ECG – Lateral ST depression , Upper GI endoscopy reveals a large bleeding ulcer on the posterior aspect of the duodenum. It cannot be easily reached with the endoscope, and you decide to attempt embolization. Which of the following is the artery that should be targeted?

      Your Answer: Gastroduodenal artery

      Correct Answer: Posterior superior Pancreaticoduodenal artery

      Explanation:

      The most common location for a duodenal ulcer bleed is the posterior duodenum (remember: posterior bleeds, anterior perforates). The perfusion to this area is most specifically from the posterior superior pancreaticoduodenal artery.

      The anterior superior pancreaticoduodenal artery supplies the anterior region. The gastroepiploic artery supplies mostly the stomach. The splenic artery goes, obviously, toward the spleen, in the other direction. The gastroduodenal artery is a branch of the celiac artery, and it’s branches are the anterior superior pancreaticoduodenal artery and posterior superior pancreaticoduodenal artery.

    • This question is part of the following fields:

      • Gastroenterology
      40
      Seconds

  • Question 8 - A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and...

    Correct

    • A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and flatulence. Clinical examination is unremarkable. Faecal occult bloods are negative and haematological and biochemical investigations are unremarkable. Which of the following is the next most appropriate management step?

      Your Answer: Trial of dairy-free diet

      Explanation:

      The best next step is to try a dairy-free diet, many patients may develop this in their lifetime. IBS is a diagnosis of exclusion, and one would need to rule lactose intolerance out as a potential aetiology first. She is only 28, and without overt bleeding or signs/sxs/labs suggestive of obstruction or inflammation; colonoscopy, flex sig and a barium enema are not indicated.

    • This question is part of the following fields:

      • Gastroenterology
      23.3
      Seconds

  • Question 9 - A 56-year-old woman has a family history of haemochromatosis and is homozygous for...

    Incorrect

    • A 56-year-old woman has a family history of haemochromatosis and is homozygous for the C282Y mutation. Her ferritin is 927 mg/L (normal range 15-150), haemoglobin 12.5 g/dL (normal range 11.5-16) and aspartate aminotransferase 87 U/L (normal range <40). Which is the best course of action?

      Your Answer: Intravenous desferrioxamine

      Correct Answer: Weekly venesection to drop her ferritin into the low-normal range

      Explanation:

      Venesection should be done (essentially blood-letting) to decrease the too-high ferratin level. IV Desterrioxamine would have the opposite effect. ASA does not have to do with ferritin. You do not just watch this and recheck. And you do not want to make the patient anaemic.

    • This question is part of the following fields:

      • Gastroenterology
      21.7
      Seconds

  • Question 10 - A 32-year-old lady, known with a history of Type 1 diabetes presents to...

    Correct

    • A 32-year-old lady, known with a history of Type 1 diabetes presents to the clinic with increasing tiredness, mild upper abdominal discomfort and itching. The GP has arranged some investigations prior to her clinic visit. Investigations; Hb 13.2 g/dL, WCC 5.0 x109/L, PLT 240 x109/L, Na+ 140 mmol/L, K+ 4.9 mmol/L, Creatinine 90 μmol/L, HbA1c 8.3%, Anti-Smooth muscle antibody: positive, Immunoglobulins increased. Which of the following would be the next appropriate investigation?

      Your Answer: Liver function testing

      Explanation:

      The key to this question is anti-smooth muscle antibodies. This is a finding of autoimmune hepatitis, which can be seen in type I diabetics. This also fits with her clinical picture. If you know these two facts, you should get every question correct regarding autoimmune hepatitis. Liver function testing is the best answer, then and should be elevated to indicate inflammation of the liver. Hepatic US, CK, thyroid function testing, short synacthen test are not helpful in the diagnosis of autoimmune hepatitis.

    • This question is part of the following fields:

      • Gastroenterology
      27.7
      Seconds

  • Question 11 - A 36-year-old lady presents to the emergency department with right upper quadrant pain....

    Incorrect

    • A 36-year-old lady presents to the emergency department with right upper quadrant pain. She has also noticed that her skin seems slightly yellower over the last week or so and you notice a yellow tinge to her sclera. On further questioning, she complains of itching of her arms. Her only past medical history of note includes ulcerative colitis for which she takes mesalazine. Given her presentation, what is the best investigation to diagnose the most likely underlying condition?

      Your Answer: ANCA antibody testing

      Correct Answer: ERCP (endoscopic retrograde cholangiopancreatography)

      Explanation:

      With biliary obstructive symptoms in a patient with ulcerative colitis, one should immediately think of primary sclerosing cholangitis (PSC). PSC is characterized by inflammation and fibrosis of the intrahepatic and extrahepatic ducts. The best diagnostic test for PSC is ERCP. ANCA antibiotics may be positive, but not the best test to DIAGNOSE THE CONDITION. The same can be said of serum transaminase levels– they will be abnormal but nonspecific. While a liver ultrasound may be helpful, it is not the best test. Liver biopsy would be used to stage the PSC later.

    • This question is part of the following fields:

      • Gastroenterology
      22.4
      Seconds

  • Question 12 - A 45-year-old female develops profuse watery diarrhoea with lower abdominal pain seven days...

    Incorrect

    • A 45-year-old female develops profuse watery diarrhoea with lower abdominal pain seven days after undergoing laparoscopic cholecystectomy. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Pseudomembranous colitis

      Explanation:

      Pseudomembranous colitis is caused by a C. difficile infection that causes membranes to form on the colon wall. It is caused most commonly by broad-spectrum antibiotics. This would include cephalosporins, broad-spectrum penicillin, and clindamycin. Macrolides and quinolones have also been reported as potential aetiologies, but much less commonly. This woman would have received antibiotics prophylactically before her surgery, predisposing her to a possible c difficile infection. This is a much better answer choice than pseudo obstruction, abdominal sepsis, bile acid diarrhoea, and campylobacter gastroenteritis simply based on history of present illness.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 13 - A 25-year-old lady with a history of ulcerative colitis presents to clinic. She...

    Incorrect

    • A 25-year-old lady with a history of ulcerative colitis presents to clinic. She had extensive colitis 10 years ago, which has improved with medical treatment. Last year she had been diagnosed with primary sclerosing cholangitis. Her last colonoscopy was 6 months ago, which detected no active disease, and random biopsies were normal. She is remaining well and asymptomatic. When should colonic screening be performed on this patient?

      Your Answer:

      Correct Answer: Colonoscopy should be performed annually

      Explanation:

      Colonoscopy screening should begin 10 years after the first diagnosis in ulcerative colitis, given the increased risk for colon cancer. Given that she has developed primary sclerosing cholangitis, her risk of colon cancer is even higher. Colonoscopy screening should occur at 3 year intervals in the second decade, 2 year intervals in the third decade, and 1 year intervals by the first decade, making A the correct answer choice.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 14 - A 69-year-old man on the cardiology ward who is hypotensive, and tachycardic is...

    Incorrect

    • A 69-year-old man on the cardiology ward who is hypotensive, and tachycardic is having profuse melaena. He was commenced on dabigatran 150mg bd by the cardiologists 48 hours earlier for non-valvular atrial fibrillation. Following appropriate resuscitation which of the following treatments is most likely to improve his bleeding?

      Your Answer:

      Correct Answer: Idarucizumab (Praxbind)

      Explanation:

      Idarucizumab (Praxbind) is a newer antidote for dabigatran, the first of its kind. It is a monoclonal antibody fragment that binds dabigatrin with a higher affinity than thrombin. It is very expensive.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 15 - A 17-year-old boy presents with a 2 day history of colicky abdominal pain,...

    Incorrect

    • A 17-year-old boy presents with a 2 day history of colicky abdominal pain, vomiting and diarrhoea. He has been passing blood mixed with diarrhoea. He has no significant past medical history and takes no regular medication. On examination he is pyrexial and clinically dehydrated. Cardiorespiratory and abdominal examinations are normal. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Campylobacter infection

      Explanation:

      The patient has bloody diarrhoea that sounds like a food poisoning in the clinical scenario. Campylobacter is the most common cause of this in the United Kingdom. This is then followed by Salmonella and Shigella. The symptoms are usually self limiting. This is more likely to be bacterial from the food than a viral gastroenteritis.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 16 - A 43-year-old man is reviewed in the gastroenterology clinic. He has had troublesome...

    Incorrect

    • A 43-year-old man is reviewed in the gastroenterology clinic. He has had troublesome dyspepsia for the past six months which has not settled with proton pump inhibitor (PPI) therapy. During the review of his systems he also reports passing 6-7 watery stools per day. An OGD 3 weeks ago showed gastric erosions and ulcers. Which one of the following investigations is most likely to be diagnostic?

      Your Answer:

      Correct Answer: Fasting gastrin

      Explanation:

      This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from the hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. None of the other answer choices are a better answer than this. CT abdomen may potentially show a tumour, but this is not diagnostic for type.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 17 - Which of the following is consistent with a diagnosis of insulinoma? ...

    Incorrect

    • Which of the following is consistent with a diagnosis of insulinoma?

      Your Answer:

      Correct Answer: Low fasting glucose, high insulin, high C peptide

      Explanation:

      Insulinoma is associated with LOW fasting glucose, HIGH insulin level, and HIGH C peptide. Insulin-abuse or overdose will cause HGH insulin levels and a LOW C peptide. If the C peptide is low, be suspicious.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 18 - With respect to liver cirrhosis, which of the following statements is correct? ...

    Incorrect

    • With respect to liver cirrhosis, which of the following statements is correct?

      Your Answer:

      Correct Answer: The final common pathway of hepatic fibrosis is mediated by the hepatic stellate cell

      Explanation:

      The development of hepatic fibrosis reflects an alteration in the normally balanced processes of extracellular matrix production and degradation. [6] The extracellular matrix, the normal scaffolding for hepatocytes, is composed of collagens (especially types I, III, and V), glycoproteins, and proteoglycans. Increased collagen in the space of Disse (space b/w sinusoids and hepatocytes) leads to capillarization of sinusoids, and stellate cells also have contractile properties when activated. This is fibrosis processes. This can lead to the development of portal hypertension.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 19 - A 33-year-old man with a known history of alcoholic liver disease is reviewed...

    Incorrect

    • A 33-year-old man with a known history of alcoholic liver disease is reviewed following a suspected oesophageal variceal haemorrhage. He has been resuscitated and intravenous terlipressin has been given. His blood pressure is now 104/60 mmHg and his pulse is 84/min. What is the most appropriate intervention?

      Your Answer:

      Correct Answer: Endoscopic variceal band ligation

      Explanation:

      The correct course of action after giving terlipressin and resuscitating with IV fluids is to perform an EGD with endoscopic variceal band ligation. According to NICE: ‘Offer endoscopic variceal band ligation for the primary prevention of bleeding for people with cirrhosis who have medium to large oesophageal varices. There are serious complications of a TIPS procedure and it is not the first line treatment.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 20 - A 42-year-old man presented with bloody diarrhoea and weight loss. Which one of...

    Incorrect

    • A 42-year-old man presented with bloody diarrhoea and weight loss. Which one of the following would favour the diagnosis of Crohn’s disease on rectal biopsy?

      Your Answer:

      Correct Answer: Patchy inflammation

      Explanation:

      The correct answer is patchy inflammation. Superficial ulceration as well as non-patchy inflammation are seen in ulcerative colitis (UC) in the colon and rectum; you would expect to see transmural inflammation in Crohn’s disease and it can be patchy and located anywhere from mouth to anus. Crypt distortion and crypt abscesses are seen in both UC and Crohn’s, however they are more common in ulcerative colitis.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 21 - A 32-year-old woman was referred for endoscopy and found to have a duodenal...

    Incorrect

    • A 32-year-old woman was referred for endoscopy and found to have a duodenal ulcer and a positive urease test. She was given lansoprazole, amoxicillin and clarithromycin for 7 days. Which of the following is the most appropriate way of determining the successful eradication of H. pylori?

      Your Answer:

      Correct Answer: Urea breath test

      Explanation:

      Urea breath test is the most sensitive test to determine if there has been RESOLUTION/ERADICATION of the infection with H. pylori. The best test for initial diagnosis would be EGD with biopsy.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 22 - If a patient has HIV what is the most likely cause of persistent...

    Incorrect

    • If a patient has HIV what is the most likely cause of persistent watery diarrhoea?

      Your Answer:

      Correct Answer: Cryptosporidium

      Explanation:

      When you have a patient with HIV and diarrhoea on the exam, think Cryptosporidium. In those who are immunocompetent this organism doesn’t usually cause symptoms, but in immunocompromised people like those with HIV, it causes infection and diarrhoea. Typically those with CD4 counts of <100 cells/µL1 have the greatest risk for prolonged, severe, or extraintestinal cryptosporidiosis.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 23 - Which one of the following is not associated with non-alcoholic steatohepatitis? ...

    Incorrect

    • Which one of the following is not associated with non-alcoholic steatohepatitis?

      Your Answer:

      Correct Answer: Type 1 diabetes mellitus

      Explanation:

      There are two types of Non-alcoholic fatty liver disease (NAFLD); simple fatty liver and non-alcoholic steatohepatitis (NASH). Simple fatty liver and NASH are two separate conditions.
      Simple fatty liver, also called non-alcoholic fatty liver (NAFL), is a form of NAFLD in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not progress to cause liver damage or complications.
      Non-alcoholic steatohepatitis (NASH)
      NASH is a form of NAFLD in which you have hepatitis and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer. Type I diabetes is not associated with NASH (non-alcoholic steatohepatitis), but type II diabetes is. Hyperlipidaemia, obesity, sudden weight loss/starvation and jejunoileal bypass are all associated with NASH. This is the most common cause of liver disease in the developed world.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 24 - A 62-year-old lady is referred with painless jaundice and weight loss. Bilirubin is...

    Incorrect

    • A 62-year-old lady is referred with painless jaundice and weight loss. Bilirubin is 214 mmol/L, alanine transaminase (ALT) 62 U/L, alkaline phosphatase (ALP) 605 U/L, albumin 34 g/L and prothrombin time 17 seconds. Ultrasound of the abdomen shows a grossly dilated biliary tree and a dilated pancreatic duct, but no mass is seen. What is the next most appropriate step in her management?

      Your Answer:

      Correct Answer: Abdominal CT scan

      Explanation:

      This scenario is suggestive of a pancreatic head mass with obstructive jaundice and US showing a ‘double duct’ sign. A CT Scan would be recommended to evaluate for a pancreatic head mass. If a mass was found, the next step would then be to do an ERCP with EUS to obtain a biopsy of the mass for tissue diagnosis. Laparoscopy would not be recommended. CA19-9 would not be diagnostic.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 25 - A 47-year-old man is seen in clinic with a 3 month history of...

    Incorrect

    • A 47-year-old man is seen in clinic with a 3 month history of chronic epigastric discomfort. The pain comes and goes and radiates to his back and his right shoulder tip at times. It is worse after meals but there is no relieving factor. He feels nauseous most of the time and has foul-smelling stools. He has lost 2 stones in weight. He also complains of intermittent light-headedness. He drinks a bottle of wine on most nights and smokes 20 cigarettes /day. On examination, he is thin and looks neglected. His abdomen is soft, but tender on deep palpation in the epigastric area. He has a 2 cm non-tender liver edge. He also has decreased sensation to light touch on both feet. Bloods: sodium 131 mmol/L, potassium 4.2 mmol/L, creatine 64 μmol/L, amylase 35 U/l, alanine aminotransferase (ALT) 104 U/l, alkaline phosphatase (ALP) 121 U/l, bilirubin 24 μmol/L, calcium 2.01 mmol/L, whole cell count (WCC) 12.1 × 109/L, haemoglobin (Hb) 10.2 g/dL, platelets 462 × 109/L. Abdominal X-ray (AXR) was normal and oesophago-gastro duodenoscopy (OGD) showed mild gastritis. Campylobacter-like organism (CLO) test negative. Ultrasound abdomen showed a mildly enlarged liver with fatty change, spleen and kidneys normal, pancreas partially obscured by overlying bowel gas. 72-h stool fat was 22 g in 72 h. He is referred for a secretin test: volume collected 110 ml, bicarbonate 52 mEq/l. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Chronic pancreatitis

      Explanation:

      The question describes an alcohol abusing man with chronic epigastric discomfort, radiating into his back, worse with meals, and foul-smelling stools, weight loss, as well as chronic nausea. This is likely, thus chronic pancreatitis due to alcohol abuse. Hepatomegaly and peripheral neuropathy secondary to anaemia support the diagnosis of long term alcohol abuse. Bacterial overgrowth may present with diarrhoea and is a less likely diagnosis than pancreatitis. Celiac disease is a less likely diagnosis than pancreatitis, and you would also expect mention of diarrhoea. VIPoma would also likely present with diarrhoea. Cecal carcinoma would more than likely present with blood in the stool.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 26 - A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling...

    Incorrect

    • A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling in her feet and hands. She has recently developed an ulcer on her left heel, after having burnt her foot in a hot bath. A number of depigmented areas are readily seen over her upper limbs. She is currently taking low-dose prednisolone (7.5 mg daily), alendronic acid, lansoprazole, paracetamol, indomethacin, methotrexate and rituximab. Her blood tests demonstrate: Haemoglobin 9.9 g/l, MCV 102 fl, Platelets 410 x 109/L, White blood cells 12.3 x 109/L, Vitamin B12 97 pg/ml, Folate 12.3ng/ml, Random blood glucose 9.9 mmol/L, Thyroid-stimulating hormone 4.7 mU/ml, Thyroxine 12.8 pmol/L. Which autoantibody would be most diagnostic for the underlying disease?

      Your Answer:

      Correct Answer: Anti-intrinsic factor (IF)

      Explanation:

      This clinical scenario describes pernicious anaemia. Anti-intrinsic factor (IF) antibodies are most specific for pernicious anaemia. Antigastric parietal cell antibodies have a higher sensitivity but are less specific for pernicious anaemia. The other antibodies listed are not related to pernicious anaemia. Anti-TTG is seen with Celiac’s disease, anti-TPO is seen with thyroid disease, GAD is seen with type I diabetes, but this does not explain her anaemia.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 27 - A 35-year-old gentleman with a history of alcohol excess presents to hospital with...

    Incorrect

    • A 35-year-old gentleman with a history of alcohol excess presents to hospital with progressive abdominal distension. He now complains of early satiety and abdominal discomfort as a result of the distension. Examination reveals a significantly distended abdomen with shifting dullness. A diagnostic ascitic tap is performed and the fluid sent for analysis. What is the most appropriate first line treatment for his ascites?

      Your Answer:

      Correct Answer: Paracentesis

      Explanation:

      The first line treatment for ascites that is symptomatic is paracentesis. If it is not symptomatic, treatment could be with salt and fluid restriction as well as spironolactone. If spironolactone maximum dosage is reached, you can use furosemide additionally. Amiloride is not a diuretic that is recommended in this case.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 28 - A 27-year-old man with a long history of heavy alcohol intake is admitted...

    Incorrect

    • A 27-year-old man with a long history of heavy alcohol intake is admitted with nausea and frequent vomiting four hours after a meal in a restaurant. During review in the Emergency department he vomits a cupful of blood. What is the cause of his haematemesis?

      Your Answer:

      Correct Answer: Mallory-Weiss tear

      Explanation:

      This is a classic clinical presentation, with alcohol intake and nausea/vomiting that leads to hematemesis, of a Mallory-Weiss tear. Because of the history, that makes this more likely than haemorrhagic gastritis, duodenal ulceration, or oesophagitis (also oesophagitis would not bleed a cupful). Oesophageal varices would present with copious amounts of hematemesis and most likely hemodynamic instability as a result of the amount of blood loss. In Mallory-Weiss tear they are typically presented as a hemodynamically stable patient.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 29 - A 32-year-old man, originally from Pakistan, was admitted with ascites and weight loss....

    Incorrect

    • A 32-year-old man, originally from Pakistan, was admitted with ascites and weight loss. The protein level on ascitic tap was 9 g/l. Which of the following is the most likely cause of this presentation?

      Your Answer:

      Correct Answer: Hepatic cirrhosis

      Explanation:

      This is a low protein level, indicating the fluid is transudative. The only answer choice that is a transudative fluid is in hepatic cirrhosis. Exudative fluid would be seen in tuberculous peritonitis, peritoneal lymphoma, with liver mets, and with intra-abdominal malignancy.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 30 - Which one of the following is most associated with the development of acute...

    Incorrect

    • Which one of the following is most associated with the development of acute pancreatitis?

      Your Answer:

      Correct Answer: Hyperchylomicronaemia

      Explanation:

      Hyperchylomicronaemia is an increase (markedly) in chylomicrons, and this can cause acute pancreatitis, as well as xanthomas. It can be seen in familial lipoprotein lipase (LPL) deficiency, primary type V hyperlipoproteinemia, idiopathic hyperchylomicronaemia, and familial apolipoprotein CII deficiency. Treatment is dietary fat restriction in order to avoid pancreatitis attacks.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastroenterology (4/11) 36%
Passmed
Retry this test Dashboard