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  • Question 1 - A 25-year-old man presents with bloody diarrhoea associated with systemic upset. Blood tests...

    Incorrect

    • A 25-year-old man presents with bloody diarrhoea associated with systemic upset. Blood tests show the following:


      Hb 13.4 g/dL,
      Platelets 467 * 109/L,
      WBC 8.2 * 109/L,
      CRP 89 mg/l

      A diagnosis of ulcerative colitis is suspected. Which part of the bowel is most likely to be affected?

      Your Answer:

      Correct Answer: Rectum

      Explanation:

      The most COMMON site of inflammation from ulcerative colitis is the rectum, making this the correct answer. This is simply a fact you need to memorize. In general, ulcerative colitis only occurs in colorectal regions– nothing in the small bowel (unless there is backwash into the terminal ileum) and nothing further up the GI tract. In Crohn’s it can affect the entire GI tract from mouth to anus.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 2 - 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:

      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
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  • Question 3 - A 24 year old presents with diarrhoea. She has had a previous ileal...

    Incorrect

    • A 24 year old presents with diarrhoea. She has had a previous ileal resection for Crohn's Disease. She has also had two recent episodes of loin to groin pain. Her bloods are normal including her inflammatory markers

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Short bowel syndrome

      Explanation:

      Given her history of bowel resections, the most likely answer in this case is short bowel syndrome. IBS is a diagnosis of exclusion and less likely. Bacterial overgrowth does not relate to resection history, so unlikely. Celiac disease or a flare of IBD are also less likely than short bowel syndrome in this case, simply given the history. Also her labs are normal making these unlikely. History, history, history!

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 4 - 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
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  • Question 5 - A 37-year-old social worker is referred to you with a long history of...

    Incorrect

    • A 37-year-old social worker is referred to you with a long history of diarrhoea and abdominal discomfort. She was diagnosed with irritable bowel syndrome 10 years ago and takes mebeverine, peppermint tablets and Gaviscon. She is a vegetarian and rarely drinks or smokes.

      Examination of all systems is normal. Her blood tests show macrocytic anaemia. An upper gastrointestinal endoscopy reveals oesophagitis, hypertrophy of the gastric body and multiple duodenal ulcers.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Zollinger–Ellison syndrome

      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
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  • Question 6 - Which of the following statements is true concerning gastrin? ...

    Incorrect

    • Which of the following statements is true concerning gastrin?

      Your Answer:

      Correct Answer: Release is triggered by GI luminal peptides

      Explanation:

      Gastrin is released by G cells in the antrum of the stomach. It stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and also aids in gastric motility. It is released in response to the following stimuli: vagal stimulation, antrum distention, hypercalcemia. It is inhibited by the following: presence of acid in stomach, SST, secretion, GIP, VIP, glucagon, calcitonin.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 7 - A 16-year-old female presents with a two day history of right iliac fossa...

    Incorrect

    • A 16-year-old female presents with a two day history of right iliac fossa pain, nausea and loss of appetite. You suspect that she has acute appendicitis. Which scoring system could you use to lend support to your diagnosis?

      Your Answer:

      Correct Answer: Alvarado score

      Explanation:

      The prompt is suggestive of acute appendicitis. The Alvarado score is a clinical scoring system used to determine the likelihood of appendicitis, so this is the correct answer. A score greater than 6 is generally considered at risk for having acute appendicitis. It has 8 different criteria included (symptoms, signs, and lab results) and divides patients into appendicitis unlikely, possible, probable, and definite. The Center Score is a score to access the likelihood that pharyngitis is due to Strep. The Child-Pugh score predicts prognosis in liver cirrhosis. The Glasgow score is two different scores– the Glasgow coma score in trauma, which estimates level of consciousness, essentially, and The Glasgow Imrie Criteria which determines the severity of acute pancreatitis based on 8 lab values. The MELD score predicts the severity of end-stage liver disease.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 8 - 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
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  • Question 9 - A 55-year-old obese woman presents to casualty. She has rigors and reports a...

    Incorrect

    • A 55-year-old obese woman presents to casualty. She has rigors and reports a fever. On examination there is jaundice and tenderness over the right upper quadrant of her abdomen.

      She has an elevated white blood cell count and a markedly raised alkaline phosphatase level; transaminases and bilirubin are also abnormal.

      Which of these diagnoses best fits the clinical picture?

      Your Answer:

      Correct Answer: Ascending cholangitis

      Explanation:

      This question describes Charcot’s triad– fever, RUQ pain, and jaundice, which is seen in ascending cholangitis. Reynold’s pentad is a worsened version of this, where you have RUQ pain, fever, jaundice, hypotension, and altered mental status. Risk factors for gallstones are the 4F’s- female, fat, forty, and fertile. You would not have the elevated bilirubin, ALP, transaminases with a kidney stone or in peptic ulcer disease. Hepatitis would not cause elevation of bilirubin.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 10 - A 45-year-old man who had a liver transplant just over 3 months ago,...

    Incorrect

    • A 45-year-old man who had a liver transplant just over 3 months ago, now has primary sclerosing cholangitis. He complains of fever, abdominal pain and diarrhoea, which has come on over the last week. He has a platelet count of 60 x 109/L and alanine transaminase (ALT) of 300 U/L with a normal bilirubin.

      He is taking tacrolimus and prednisolone for immunosuppression, and tells you that he recently stopped taking valganciclovir.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Donor-acquired cytomegalovirus

      Explanation:

      The fact that he has recently stopped taking his valganciclovir, anti-viral, is key to the answer to this question. This makes the answer quite plainly donor-acquired CMV infection over all of the other answer choices. He needs to stay on prophylaxis against this, particularly in the first 3 months after transplant. Symptoms and presentations of CMV infection can include fever, abdominal pain, diarrhoea, pneumonitis, hepatitis, hematologic abnormalities, retinitis, and esophagitis.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 11 - 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:

      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
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  • Question 12 - A 54-year-old plumber presents with general deterioration. He drinks approximately 25 units of...

    Incorrect

    • A 54-year-old plumber presents with general deterioration. He drinks approximately 25 units of alcohol each week and is a smoker of five cigarettes daily. Examination reveals that he is jaundiced, has numerous spider naevi on his chest and he has a temperature of 37.2°C. Abdominal examination reveals hepato-splenomegaly.

      Investigations reveal:
      Bilirubin 100 micromol/L (1-22),
      Alkaline phosphatase 310 iu/l (45 – 105),
      ALT 198 iu/l (5 – 35),
      AST 158 iu/l (1 – 31),
      Albumin 25 g/L (37 – 49),

      Hepatitis B virus surface antigen positive,
      Hepatitis B virus e antigen negative,
      Hepatitis B virus DNA awaited.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Chronic hepatitis B infection

      Explanation:

      The clinical scenario describes a man in liver failure. Given the serological results, he is most likely to have a chronic hepatitis B infection. In chronic hepatitis B infection, you have +HBsAg, +anti-HBc, (-)IgM antiHBc, and (-) anti-HBs. In acute hepatitis B infection, you have +HBsAg, +anti-HBc, +IgM anti-HBc, and negative anti-HBs. in immunity due to natural infection, you have negative HBsAg, +anti-HBc, and + anti-HBs. In immunity due to vaccination, you have negative HBsAg, negative anti-HBc, and positive anti-HBs. While he could have a superimposed hepatitis D infection on top of hepatitis B, there is no mention of hepatitis D serology, make this an incorrect answer. The other choices do not involve hepatitis serologies.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 13 - 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:

      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
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  • Question 14 - 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
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  • Question 15 - 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
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  • Question 16 - A 20-year-old student presents to the university health service complaining of flu-like symptoms,...

    Incorrect

    • A 20-year-old student presents to the university health service complaining of flu-like symptoms, lethargy and jaundiced sclerae and an inability to eat due to a sore throat. He remembered that his father may have suffered from a liver condition. On further questioning a history of intravenous drug use on two occasions is identified.

      Investigations reveal:
      Alanine transaminase (ALT) 23 U/l,
      Aspartate transaminase (AST) 28 U/l,
      Bilirubin 78 μmol/L,
      Albumin 41g/l.

      Which of the following diagnoses fits best with this clinical picture?

      Your Answer:

      Correct Answer: Gilbert’s syndrome

      Explanation:

      When a patient presents with an illness (unrelated to the liver) or a stressful event on the body, and develops asymptomatic jaundice, think Gilbert’s syndrome. It is autosomal dominant. It is an unconjugated hyperbilirubinemia from impaired glucuronyl transferase. Classically, Crigler-Najjar would be in infants, and it would be symptomatic. It is also an unconjugated hyperbilirubinemia.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 17 - Which of the following forms of acute viral hepatitis has a much higher...

    Incorrect

    • Which of the following forms of acute viral hepatitis has a much higher mortality in pregnant than non-pregnant females?

      Your Answer:

      Correct Answer: Hepatitis E

      Explanation:

      Pregnant patient in a third world country with hepatitis: The answer is most likely Hepatitis E. The mortality for Hepatitis E in pregnant women is very high. It is transmitted faecal-orally. There is no hepatitis G. Hepatitis C, B, A are less likely to be the correct answer than E given it’s classic association with pregnancy and poor living conditions.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 18 - A 74-year-old woman referred by her GP because of increasing weight loss, early...

    Incorrect

    • A 74-year-old woman referred by her GP because of increasing weight loss, early satiety and increasing anorexia. She admits to 2 or 3 episodes of vomiting blood. The GP feels an epigastric mass.

      There is both a microcytic anaemia and abnormal liver enzymes. Her past history, which may be of importance, includes excess consumption of sherry and spirits, and a 30 pack-year smoking history.

      Which diagnosis fits best with this clinical picture?

      Your Answer:

      Correct Answer: Gastric carcinoma

      Explanation:

      With a clinical history of weight loss, smoking, drinking alcohol, and hematemesis, the most likely answer is gastric carcinoma (also a mass). Based on symptomatology alone this is more likely than gastric lymphoma, as she has many risk factors for adenocarcinoma and/or squamous cell carcinoma. Helicobacter gastritis would not likely present with the severity of symptoms, neither would benign gastric ulcers.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 19 - A 26-year-old office worker presents with a 3 year history of epigastric pain,...

    Incorrect

    • A 26-year-old office worker presents with a 3 year history of epigastric pain, especially 30 minutes after eating. This is associated with nausea and belching. She also describes constipation with occasional explosive diarrhoea. The stools are normally hard with mucus and she needs to strain with every motion. Abdominal pain is relieved after defecation but abdominal bloating persists. She wakes up an hour earlier each morning to finish her breakfast in order to prevent vomiting. She has missed work on a few occasions and feels that her weight has fluctuated. Past medical history includes scarlet fever. She is not on any regular medications except intermittent laxatives over the counter. Abdominal examination is normal. Rectal examination reveals an anal fissure.

      Investigation results:
      Haemoglobin (Hb 13.1 g/dL,
      White blood count (WBC) 6.0 × 109/L,
      Platelets 180× 109/L,
      Mean cell volume (MCV) 87 fL,
      International normalised ratio (INR) 1.0,
      Na+ 136 mmol/L,
      K+ 3.9 mmol/L,
      Urea 3.7 mmol/L,
      Creatinine 70 μmol/L,
      Albumin 39 glL.
      Liver function test normal.
      Anti-endomysial antibody negative.
      Thyroid function test normal.
      Gastroscopy normal.
      Flexible sigmoidoscopy and biopsy normal.
      Abdominal and pelvic ultrasound scans are normal.

      What is the most likely diagnosis to account for her symptoms?

      Your Answer:

      Correct Answer: Overlap irritable bowel syndrome and functional dyspepsia

      Explanation:

      This is most likely describing irritable bowel syndrome (IBS). Symptoms are either diarrhoea, constipation, or both, abdominal pain, bloating, of varying duration. It is a functional, not an organic problem, as far as research shows at this point. It is essentially a diagnosis of exclusion. Treatment is a high fibre diet with fluids. Caffeine should be avoided as this can worsen symptoms.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 20 - A 74-year-old man presents with left-sided lower abdominal pain. He is obese and...

    Incorrect

    • A 74-year-old man presents with left-sided lower abdominal pain. He is obese and admits to a dislike of high fibre foods. The pain has been grumbling for the past couple of weeks and is partially relieved by defecation. He has suffered intermittent diarrhoea.
       
      Blood testing reveals a neutrophilia, and there is also a microcytic anaemia. Barium enema shows multiple diverticula, more marked on the left-hand side of the colon.
       
      Which diagnosis fits best with this clinical picture?

      Your Answer:

      Correct Answer: Diverticular disease

      Explanation:

      Given that he has diverticula in the clinical scenario combined with his presenting symptoms, it is likely that he has diverticular disease. A low fibre diet would support this diagnosis. Acute diverticulitis would require treatment with antibiotics. Depending on the severity (Hinchey classification) would determine if he needs oral or IV antibiotics, hospital admission or outpatient treatment. Sometimes abscesses or micro perforations occur, which typical require drainage and possibly surgical intervention. Diverticular disease is clearly a better answer than other possible answer choices, simply based on the symptoms presented in the prompt (and mention of low fibre).

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 21 - 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
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  • Question 22 - 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:

      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
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  • Question 23 - A 29-year-old woman presents to clinic complaining of intermittent diarrhoea and constipation. Full...

    Incorrect

    • A 29-year-old woman presents to clinic complaining of intermittent diarrhoea and constipation. Full blood count and viscosity were normal. Flexible sigmoidoscopy was unremarkable.

      What is the next most appropriate management step?

      Your Answer:

      Correct Answer: High-fibre diet

      Explanation:

      This is most likely describing irritable bowel syndrome (IBS). Symptoms are either diarrhoea, constipation, or both, abdominal pain, bloating, with various durations. It is a functional, not organic, problem, as far as research shows at this point. It is essentially a diagnosis of exclusion. Treatment is a high fibre diet with fluids. Caffeine should be avoided as this can worsen symptoms. Full colonoscopy is not warranted at this time, neither is a barium enema. A wheat-free diet is not likely to help as there is no evidence they have an allergy to this.

    • This question is part of the following fields:

      • Gastroenterology
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  • 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.

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      • Gastroenterology
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  • Question 25 - A 24-year-old woman who is known to have type 1 diabetes mellitus, presents...

    Incorrect

    • A 24-year-old woman who is known to have type 1 diabetes mellitus, presents with a three month history of diarrhoea, fatigue and weight loss. She has tried excluding gluten from her diet for the past 4 weeks and feels much better. She requests to be tested so that a diagnosis of coeliac disease can be confirmed. What is the most appropriate next step?

      Your Answer:

      Correct Answer: Ask her to reintroduce gluten for the next 6 weeks before further testing

      Explanation:

      The patient likely has celiac’s disease, but if she has been avoiding gluten, a biopsy may be negative. Even though a biopsy is the gold standard for diagnosis, she will need to re-introduce gluten into her diet prior to undergoing the biopsy.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 26 - A 17-year-old Caucasian woman presents with lethargy and chronic nausea. Her mother is...

    Incorrect

    • A 17-year-old Caucasian woman presents with lethargy and chronic nausea. Her mother is worried she may be depressed.

      On examination, there are signs of chronic liver disease and a gold-yellow ring at the periphery of the iris in both eyes. Her serum copper level is low.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Wilson’s disease

      Explanation:

      This patient has Wilson’s disease. They Kayser-Fleischer ring (ring that encircles the iris) is diagnostic of this. Low serum copper is seen in Wilson’s disease. With the Kayser-Fleischer ring, this makes all of the other answer choices incorrect.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 27 - A 27 year old woman presents with diarrhoea. She has had a previous...

    Incorrect

    • A 27 year old woman presents with diarrhoea. She has had a previous ileal resection for Crohn's Disease. Her inflammatory markers are normal. What is the most likely cause of her diarrhoea?

      Your Answer:

      Correct Answer: Bile Acid Malabsorption

      Explanation:

      The question describes a patient who has had an ileal resection. Bile acids are reabsorbed in the distal ileum. Since this has been resected in this patient, one would expect her to have malabsorption of bile acids, causing her diarrhoea. This is a more likely correct answer than a Crohn’s flare, bacterial overgrowth, gastroenteritis, or tropical sprue, given the details included in the question prompt.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 28 - A 33-year-old lady who is known hepatitis C positive comes to your clinic....

    Incorrect

    • A 33-year-old lady who is known hepatitis C positive comes to your clinic. She is 28 weeks pregnant and her obstetrician wants you to assess her and provide medical advice for the mother and child.

      Which of the following statements concerning hepatitis C are most accurate in her case?

      Your Answer:

      Correct Answer: Breast-feeding does not increase the risk of transmission

      Explanation:

      Breast feeding has not been shown to increase the risk of transmission of HCV from mother to baby. This is simply a fact to memorize. The other answer choices are not the most accurate as there is no evidence-proven way to decrease the chance that baby will get HCV from the mother during the birth. About 5 out of every 100 infants born to HCV infected mothers become infected.

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      • Gastroenterology
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  • Question 29 - 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
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  • Question 30 - 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
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