-
Question 1
Incorrect
-
A 50-year-old woman with a history of alcoholic liver disease presents to the clinic with advanced cirrhosis and ascites. A recent ascitic tap revealed a protein concentration of 12 g/L and no evidence of organisms. What is the best course of action to manage the risk of spontaneous bacterial peritonitis?
Your Answer:
Correct Answer: Oral ciprofloxacin
Explanation:To prevent spontaneous bacterial peritonitis, it is recommended to administer oral ciprofloxacin or norfloxacin as prophylaxis to patients with ascites and protein concentration of 15 g/L or less.
Understanding Spontaneous Bacterial Peritonitis
Spontaneous bacterial peritonitis (SBP) is a type of peritonitis that typically affects individuals with ascites caused by liver cirrhosis. The condition is characterized by symptoms such as abdominal pain, fever, and ascites. Diagnosis is usually made through paracentesis, which involves analyzing the ascitic fluid for a neutrophil count of over 250 cells/ul. The most common organism found on ascitic fluid culture is E. coli.
Management of SBP typically involves the administration of intravenous cefotaxime. Antibiotic prophylaxis is also recommended for patients with ascites who have previously experienced an episode of SBP or have a fluid protein level of less than 15 g/l and a Child-Pugh score of at least 9 or hepatorenal syndrome. NICE recommends prophylactic oral ciprofloxacin or norfloxacin until the ascites has resolved.
Alcoholic liver disease is a significant predictor of poor prognosis in SBP. Understanding the symptoms, diagnosis, and management of SBP is crucial for healthcare professionals to provide appropriate care and improve patient outcomes.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 2
Incorrect
-
An 80-year-old man presents to the Emergency Department with a history of vomiting blood earlier in the day. What is the most significant factor indicating an upper gastrointestinal bleed?
Your Answer:
Correct Answer: Urea = 15.4 mmol/l on a background of normal renal function
Explanation:A temporary and disproportionate increase in blood urea can be caused by an upper gastrointestinal bleed, which can function as a source of protein.
Acute upper gastrointestinal bleeding is a common and significant medical issue that can be caused by various conditions, with oesophageal varices and peptic ulcer disease being the most common. The clinical features of this condition include haematemesis, melena, and a raised urea level due to the protein meal of the blood. The differential diagnosis for acute upper gastrointestinal bleeding includes oesophageal, gastric, and duodenal causes.
The management of acute upper gastrointestinal bleeding involves risk assessment using the Glasgow-Blatchford score, which helps clinicians decide whether patients can be managed as outpatients or not. Resuscitation is also necessary, including ABC, wide-bore intravenous access, and platelet transfusion if actively bleeding platelet count is less than 50 x 10*9/litre. Endoscopy should be offered immediately after resuscitation in patients with a severe bleed, and all patients should have endoscopy within 24 hours.
For non-variceal bleeding, proton pump inhibitors (PPIs) should not be given before endoscopy to patients with suspected non-variceal upper gastrointestinal bleeding. However, PPIs should be given to patients with non-variceal upper gastrointestinal bleeding and stigmata of recent haemorrhage shown at endoscopy. If further bleeding occurs, options include repeat endoscopy, interventional radiology, and surgery. For variceal bleeding, terlipressin and prophylactic antibiotics should be given to patients at presentation, and band ligation should be used for oesophageal varices and injections of N-butyl-2-cyanoacrylate for patients with gastric varices. Transjugular intrahepatic portosystemic shunts (TIPS) should be offered if bleeding from varices is not controlled with the above measures.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 3
Incorrect
-
A 32-year-old female with a history of alcoholic liver disease presents with frank haematemesis. She had been discharged just two months ago after receiving treatment for bleeding oesophageal varices. What is the most suitable course of action to take while waiting for endoscopy after resuscitation?
Your Answer:
Correct Answer: Terlipressin
Explanation:Variceal haemorrhage is a serious condition that requires prompt management. The initial treatment involves resuscitation of the patient before endoscopy. Correcting clotting with FFP and vitamin K is important, as is the use of vasoactive agents such as terlipressin or octreotide. Prophylactic IV antibiotics are also recommended to reduce mortality in patients with liver cirrhosis. Endoscopic variceal band ligation is the preferred method of treatment, and the use of a Sengstaken-Blakemore tube or Transjugular Intrahepatic Portosystemic Shunt (TIPSS) may be necessary if bleeding cannot be controlled. Propranolol and EVL are effective in preventing rebleeding and mortality, and are recommended by NICE guidelines. Proton pump inhibitor cover is given to prevent EVL-induced ulceration.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 4
Incorrect
-
Which of the following is most commonly linked to elevated levels of CA 19-9?
Your Answer:
Correct Answer: Pancreatic cancer
Explanation:CA 19-9 and Pancreatic Cancer
Understanding Tumour Markers
Tumour markers are substances that can be found in the blood, urine, or tissues of people with cancer. They are often used to help diagnose and monitor cancer, as well as to determine the effectiveness of treatment. Tumour markers can be divided into different categories, including monoclonal antibodies against carbohydrate or glycoprotein tumour antigens, tumour antigens, enzymes, and hormones.
Monoclonal antibodies are used to target specific tumour antigens, which are proteins or other molecules that are found on the surface of cancer cells. Some common tumour markers include CA 125 for ovarian cancer, CA 19-9 for pancreatic cancer, and CA 15-3 for breast cancer. However, it is important to note that tumour markers usually have a low specificity, meaning that they can also be found in people without cancer.
Tumour antigens are proteins that are produced by cancer cells and can be detected in the blood or tissues of people with cancer. Some examples of tumour antigens include prostate specific antigen (PSA) for prostatic carcinoma, alpha-feto protein (AFP) for hepatocellular carcinoma and teratoma, and carcinoembryonic antigen (CEA) for colorectal cancer.
Enzymes and hormones can also be used as tumour markers. For example, alkaline phosphatase and neurone specific enolase are enzymes that can be elevated in people with cancer, while hormones such as calcitonin and ADH can be used to detect certain types of cancer.
In summary, tumour markers are an important tool in the diagnosis and monitoring of cancer. However, they should be used in conjunction with other diagnostic tests and imaging studies, as they are not always specific to cancer and can also be elevated in people without cancer.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 5
Incorrect
-
A 23-year-old man presents to his general practitioner (GP) with a nodular rash over his shins, which was dusky blue in appearance at first but has now faded to a bruise-like appearance. His past history of note includes intermittent diarrhoea, occasionally with blood. There is no other past history of note. On examination, there is minor tenderness on the left side of his abdomen, and proctoscopy reveals moderate inflammation of the rectum. Blood testing reveals a raised C-reactive protein (CRP) level and normochromic/normocytic anaemia.
Which diagnosis best fits this clinical picture?Your Answer:
Correct Answer: Ulcerative colitis (UC)
Explanation:Erythema Nodosum and its Association with Various Diseases
Erythema nodosum is a skin condition characterized by painful, red nodules on the legs. It can be associated with various underlying diseases. In patients with ulcerative colitis, erythema nodosum is a common extraintestinal manifestation, along with uveitis, primary sclerosing cholangitis, ankylosing spondylitis, and pyoderma gangrenosum. However, sarcoidosis, tuberculosis, and mycoplasma infection can also cause erythema nodosum. It is important to consider the patient’s clinical presentation and other symptoms to determine the underlying cause. In this case, the patient’s gastrointestinal symptoms suggest inflammatory bowel disease, specifically ulcerative colitis.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 6
Incorrect
-
Which of the following extra-intestinal symptoms of inflammatory bowel disease is more prevalent in ulcerative colitis than in Crohn's disease, with a slight variation in age and maintaining paragraph breaks?
Your Answer:
Correct Answer: Primary sclerosing cholangitis
Explanation:Primary sclerosing cholangitis is often associated with ulcerative colitis.
Crohn’s disease and ulcerative colitis are the two main types of inflammatory bowel disease with many similarities in symptoms and management options. However, there are key differences such as non-bloody diarrhea and upper gastrointestinal symptoms being more common in Crohn’s disease, while bloody diarrhea and abdominal pain in the left lower quadrant are more common in ulcerative colitis. Complications and pathology also differ between the two diseases.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 7
Incorrect
-
A 55-year-old man visits the clinic with concerns about his worsening haemorrhoids. He reports having to manually push them back in after bowel movements.
Which class of haemorrhoids is most likely present?Your Answer:
Correct Answer: Grade III
Explanation:Understanding the Grading System for Hemorrhoids
Hemorrhoids are a common condition that affects many people. To help diagnose and treat this condition, clinicians use a grading system to classify the severity of the hemorrhoids. The grading system proposed by Banov et al. in 1985 is the most commonly used system.
Grade I hemorrhoids are the mildest form and only project into the anal canal. They often bleed but do not prolapse. Grade II hemorrhoids may protrude beyond the anal verge with straining or defecating, but reduce spontaneously when straining ceases. Grade III hemorrhoids protrude spontaneously or with straining and require manual reduction. Grade IV hemorrhoids are the most severe and chronically prolapse. They cannot be reduced and may present with acute thrombosis or strangulation. These lesions usually contain both internal and external components.
The grading system helps clinicians correlate symptoms with therapeutic approaches. For example, grade I and II hemorrhoids may be treated with conservative measures such as dietary changes and topical medications. Grade III and IV hemorrhoids may require more invasive treatments such as rubber band ligation or surgery.
In conclusion, understanding the grading system for hemorrhoids is important for both patients and clinicians. It helps guide treatment decisions and ensures the best possible outcome for those affected by this condition.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 8
Incorrect
-
A 50-year-old man presents to his primary care physician with complaints of abdominal pain, bloating, and loose stools. He recently started a new medication after being hospitalized for an upper gastrointestinal bleed and spontaneous bacterial peritonitis. Despite not reporting any blood loss, he has noticed a gradual worsening of his symptoms since his hospital discharge. The patient has a medical history of gout, type-2 diabetes, hypertension, alcoholism, and ischaemic heart disease. He quit smoking 10 years ago. Which medication is the most likely culprit for his symptoms?
Your Answer:
Correct Answer: Omeprazole
Explanation:Taking Omeprazole may heighten the possibility of experiencing severe diarrhoea, specifically Clostridium difficile infections. Omeprazole is a type of proton pump inhibitor that can lead to side effects like abdominal pain, flatulence, nausea/vomiting, and diarrhoea. The risk of contracting severe infections like clostridium difficile is higher, especially if the patient has received antibiotics, particularly broad-spectrum agents, for their spontaneous bacterial peritonitis.
Propranolol, a beta-blocker, can cause side effects such as a slow heart rate, dry eyes, tiredness, and nausea, but it may also result in abdominal discomfort with altered bowel habit.
Allopurinol is known to cause a rash or nausea and vomiting.Understanding Proton Pump Inhibitors and Their Adverse Effects
Proton pump inhibitors (PPIs) are medications that block the H+/K+ ATPase of the gastric parietal cell, leading to irreversible effects. Common examples of PPIs include omeprazole and lansoprazole. While these medications are effective in treating conditions such as gastroesophageal reflux disease (GERD) and peptic ulcers, they can also have adverse effects on the body.
One of the potential adverse effects of PPIs is hyponatremia, which is a condition characterized by low levels of sodium in the blood. PPIs can also lead to hypomagnesemia, which is a deficiency of magnesium in the blood. Additionally, long-term use of PPIs has been linked to an increased risk of osteoporosis and fractures. Another potential adverse effect is microscopic colitis, which is inflammation of the colon that can cause diarrhea and abdominal pain. Finally, PPIs have been associated with an increased risk of C. difficile infections, which can cause severe diarrhea and other gastrointestinal symptoms.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 9
Incorrect
-
A 56-year-old woman presents with dyspepsia and an endoscopy reveals a gastric ulcer. A CLO test confirms H. pylori infection and she is treated with eradication therapy. However, at her follow-up appointment six weeks later, her symptoms persist. What is the best test to confirm H. pylori eradication?
Your Answer:
Correct Answer: Urea breath test
Explanation:The sole recommended test for H. pylori after eradication therapy is the urea breath test. It should be noted that H. pylori serology will still show positive results even after eradication. In such cases, a stool antigen test, rather than culture, may be a suitable alternative.
Tests for Helicobacter pylori
There are several tests available to diagnose Helicobacter pylori infection. One of the most common tests is the urea breath test, where patients consume a drink containing carbon isotope 13 (13C) enriched urea. The urea is broken down by H. pylori urease, and after 30 minutes, the patient exhales into a glass tube. Mass spectrometry analysis calculates the amount of 13C CO2, which indicates the presence of H. pylori. However, this test should not be performed within four weeks of treatment with an antibacterial or within two weeks of an antisecretory drug.
Another test is the rapid urease test, also known as the CLO test. This involves mixing a biopsy sample with urea and a pH indicator. If there is a color change, it indicates the presence of H. pylori urease activity. Serum antibody tests can also be used, but they remain positive even after eradication. Culture of gastric biopsy can provide information on antibiotic sensitivity, while histological evaluation alone can be done through gastric biopsy. Lastly, the stool antigen test has a sensitivity of 90% and specificity of 95%.
Overall, these tests have varying levels of sensitivity and specificity, and the choice of test depends on the patient’s clinical presentation and the availability of resources.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 10
Incorrect
-
A 42-year-old-woman, who rarely visits the clinic, complains of heartburn and acid reflux for the past 3 weeks. She comes back after taking a PPI for 1 week with some relief. Her BMI is 27 kg/m2. What is the most suitable next step in her treatment?
Your Answer:
Correct Answer: Continue the PPI and review in 2 weeks
Explanation:Management of New-Onset Dyspepsia in a Middle-Aged Patient
When a middle-aged patient presents with new-onset dyspepsia, it is important to take a thorough clinical history to rule out more serious conditions such as malignancy. A 4-week course of full-dose PPI is typically recommended, although there is no clear evidence on whether this or Helicobacter pylori testing should be done first. If PPIs are used, a 2-week washout period is necessary before testing for H. pylori to avoid false-negative results.
While alginate preparations like Gaviscon® can be used to inhibit gastric acid reflux, it may be more appropriate to increase the PPI dose if the patient has already experienced some improvement with this medication. However, if the patient exhibits ‘red flag’ symptoms like gastrointestinal bleeding, anorexia, weight loss, dysphagia, or the presence of an epigastric mass, urgent endoscopy is necessary. Endoscopy is also recommended for patients over 55 with persistent, unexplained dyspepsia that has not responded well to PPIs.
Finally, while this patient’s BMI is on the higher end of the healthy range, referral to a dietician is unlikely to be necessary unless there are specific concerns about weight loss measures. Overall, a comprehensive approach to managing new-onset dyspepsia in middle-aged patients involves careful consideration of symptoms, medication options, and potential underlying conditions.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 11
Incorrect
-
As a foundation year two doctor on the surgical admissions unit, you encounter a thirty-year-old patient complaining of right upper abdominal pain and anorexia. Upon examination, you find an overweight Caucasian female with a soft abdomen that is tender in the right upper quadrant. Her observations indicate fever and mild tachycardia. Blood tests reveal a significantly elevated bilirubin level (87 umol/L). What is the probable diagnosis?
Your Answer:
Correct Answer: Ascending cholangitis
Explanation:The presence of fever, jaundice and right upper quadrant pain is known as Charcot’s cholangitis triad, which indicates an infection of the bile ducts. This patient is likely suffering from ascending cholangitis. Cholecystitis, which is inflammation of the gallbladder, can also cause right upper quadrant pain and may precede ascending cholangitis. While gallstones are a common cause of cholangitis, they can be asymptomatic and are not a diagnosis on their own. Pregnancy is not a likely cause of right upper quadrant pain. Gilbert’s syndrome typically causes mild jaundice only during times of stress and is usually asymptomatic.
Understanding Ascending Cholangitis
Ascending cholangitis is a bacterial infection that affects the biliary tree, with E. coli being the most common culprit. This condition is often associated with gallstones, which can predispose individuals to the infection. Patients with ascending cholangitis may present with Charcot’s triad, which includes fever, right upper quadrant pain, and jaundice. However, this triad is only present in 20-50% of cases. Other common symptoms include hypotension and confusion. In severe cases, Reynolds’ pentad may be observed, which includes the additional symptoms of hypotension and confusion.
To diagnose ascending cholangitis, ultrasound is typically used as a first-line investigation to look for bile duct dilation and stones. Raised inflammatory markers may also be observed. Treatment involves intravenous antibiotics and endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction.
Overall, ascending cholangitis is a serious condition that requires prompt diagnosis and treatment. Understanding the symptoms and risk factors associated with this condition can help individuals seek medical attention early and improve their chances of a successful recovery.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 12
Incorrect
-
A 29-year-old woman presents to the Emergency Department with a history of chlamydia, low-grade fever, and worsening abdominal pain over the past 6 hours. She reports that the pain is most severe on the right side and radiates into her shoulder. The patient is a smoker with no known medical conditions and is currently taking Microgynon for contraception. Her vital signs are within normal limits, and on palpation of the abdomen, she experiences tenderness in the right upper quadrant. An abdominal ultrasound scan, urine dip, and beta-hCG test all come back normal. What is the most likely cause of this patient's symptoms?
Your Answer:
Correct Answer: Fitz-Hugh-Curtis syndrome
Explanation:Fitz-Hugh-Curtis syndrome is a condition that arises as a result of pelvic inflammatory disease. It causes inflammation of the liver capsule, leading to pain in the upper right quadrant of the abdomen. Scar tissue formation and peri-hepatic adhesions may also occur. This condition is more common in women who have contracted chlamydia or gonorrhoea. Treatment involves eliminating the responsible organism, and in some cases, laparoscopy may be necessary to remove adhesions that have formed.
Chlamydia is a common sexually transmitted infection caused by Chlamydia trachomatis. It is prevalent in the UK, with approximately 1 in 10 young women affected. The incubation period is around 7-21 days, but many cases are asymptomatic. Symptoms in women include cervicitis, discharge, and bleeding, while men may experience urethral discharge and dysuria. Complications can include epididymitis, pelvic inflammatory disease, and infertility.
Traditional cell culture is no longer widely used for diagnosis, with nuclear acid amplification tests (NAATs) being the preferred method. Testing can be done using urine, vulvovaginal swab, or cervical swab. Screening is recommended for sexually active individuals aged 15-24 years, and opportunistic testing is common.
Doxycycline is the first-line treatment for Chlamydia, with azithromycin as an alternative if doxycycline is contraindicated or not tolerated. Pregnant women may be treated with azithromycin, erythromycin, or amoxicillin. Patients diagnosed with Chlamydia should be offered partner notification services, with all contacts since the onset of symptoms or within the last six months being notified and offered treatment.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 13
Incorrect
-
You are asked to review an 80-year-old woman in the clinic who has been referred by her GP due to weight loss, early satiety and increasing anorexia. On examination, the GP notes a palpable left supraclavicular node and an epigastric mass, but no jaundice. There is microcytic anaemia, with normal liver enzymes. Her past history includes excess consumption of alcohol and a 30-pack-year smoking history.
Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Gastric carcinoma
Explanation:Gastric carcinoma is the most common type of gastric malignancy, with adenocarcinoma accounting for 90-95% of cases. Risk factors include smoking and excessive alcohol consumption. Early gastric cancer may not present with any symptoms, while advanced disease may cause indigestion, anorexia, weight loss, early postprandial fullness, and a palpable enlarged stomach with succussion splash. Troisier’s sign, the presence of a hard and enlarged left-sided supraclavicular lymph node, suggests metastatic abdominal malignancy.
Abdominal aortic aneurysm (AAA) presents with a pulsatile epigastric mass, but not an enlarged supraclavicular node. Patients are usually asymptomatic unless there is an aneurysm leak, which causes abdominal and/or back pain and rapid deterioration.
Cholangiocarcinoma, a malignant tumor of the bile duct, typically presents with jaundice, weight loss, and abdominal pain. Normal liver function tests make this diagnosis unlikely.
Benign gastric ulcers cause epigastric pain, usually a burning sensation postprandially. This patient’s symptoms, including weight loss, anorexia, and lymphadenopathy, suggest malignant pathology.
Crohn’s disease, a chronic inflammatory bowel disease, can affect any part of the gastrointestinal tract. Gastroduodenal Crohn’s disease presents with vague symptoms such as weight loss, anorexia, dyspepsia, nausea, and vomiting. However, the examination findings in this patient make a malignant diagnosis more likely.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 14
Incorrect
-
You are evaluating a patient with Crohn's disease. Which of the following non-intestinal symptoms of Crohn's disease is associated with disease activity?
Your Answer:
Correct Answer: Erythema nodosum
Explanation:Understanding Crohn’s Disease
Crohn’s disease is a type of inflammatory bowel disease that affects various parts of the digestive tract, from the mouth to the anus. Although the exact cause of Crohn’s disease is unknown, there is a strong genetic susceptibility. The disease is characterized by inflammation in all layers of the digestive tract, which can lead to complications such as strictures, fistulas, and adhesions. Symptoms of Crohn’s disease typically appear in late adolescence or early adulthood and may include non-specific symptoms such as weight loss and lethargy, diarrhea, abdominal pain, and perianal disease. Extra-intestinal features, such as arthritis, erythema nodosum, and osteoporosis, are also common in patients with Crohn’s disease.
To diagnose Crohn’s disease, doctors may look for raised inflammatory markers, increased faecal calprotectin, anemia, and low levels of vitamin B12 and vitamin D. It is important to note that Crohn’s disease shares some extra-intestinal features with ulcerative colitis, another type of inflammatory bowel disease. Arthritis is the most common extra-intestinal feature in both Crohn’s disease and ulcerative colitis, while primary sclerosing cholangitis is much more common in ulcerative colitis. Understanding the symptoms and features of Crohn’s disease can help with early diagnosis and management of the disease.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 15
Incorrect
-
A 28-year-old pregnant woman presents to the GP with jaundice and itchy skin for the past 2 weeks. She claims that is a lot worse during this pregnancy compared to her last one. History reveals that she is currently 30 weeks pregnant with no complications up until presentation.
On examination, the only notable findings are mild jaundice seen in the sclerae, as well as excoriations around the umbilicus and flanks. She denies any tenderness in her abdomen during the examination. Blood tests show the following:
ALT 206 U/L
AST 159 U/L
ALP 796 umol/l
GGT 397 U/L
Bilirubin (direct) 56 umol/L
Bile salts 34 umol/L
Bile salts reference range 0 - 14 umol/L
What is the most likely diagnosis?Your Answer:
Correct Answer: Obstetric cholestasis
Explanation:Obstetric cholestasis, also known as intrahepatic cholestasis of pregnancy, is a condition that occurs when the flow of bile is impaired, resulting in a buildup of bile salts in the skin and placenta. The cause of this condition is believed to be a combination of hormonal, genetic, and environmental factors. While the pruritic symptoms can be distressing for the mother, the buildup of bile salts can also harm the fetus. The fetus’s immature liver may struggle to break down the excessive levels of bile salts, and the vasoconstricting effect of bile salts on human placental chorionic veins may lead to sudden asphyxial events in the fetus, resulting in anoxia and death.
Intrahepatic Cholestasis of Pregnancy: Symptoms and Management
Intrahepatic cholestasis of pregnancy, also known as obstetric cholestasis, is a condition that affects approximately 1% of pregnancies in the UK. It is characterized by intense itching, particularly on the palms, soles, and abdomen, and may also result in clinically detectable jaundice in around 20% of patients. Raised bilirubin levels are seen in over 90% of cases.
The management of intrahepatic cholestasis of pregnancy typically involves induction of labor at 37-38 weeks, although this practice may not be evidence-based. Ursodeoxycholic acid is also widely used, although the evidence base for its effectiveness is not clear. Additionally, vitamin K supplementation may be recommended.
It is important to note that the recurrence rate of intrahepatic cholestasis of pregnancy in subsequent pregnancies is high, ranging from 45-90%. Therefore, close monitoring and management are necessary for women who have experienced this condition in the past.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 16
Incorrect
-
A 45-year-old man visits his GP with a 7-month history of abdominal bloating, pain and urgency to defecate in the morning. He has no history of nausea/vomiting, per rectum bleeding, mucus on stools or weight loss. He says that his symptoms become much worse, with worsening constipation, when he is stressed. Physical examination is unremarkable.
Which of the following is the best initial treatment for his symptoms?
Your Answer:
Correct Answer: Mebeverine
Explanation:Understanding and Managing Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects 10-20% of the population, with women being more likely to develop it than men. It is characterized by abdominal pain, bloating, and altered bowel habits without any specific organic pathology.
Diagnosis of IBS is based on the presence of symptoms such as abdominal pain or discomfort, bloating, and change in bowel habit for at least 6 months. Physical examination and further investigations are necessary to exclude other differential diagnoses.
Management of IBS primarily involves psychological support and dietary measures such as fiber supplementation, low FODMAP diets, increased water intake, and avoiding trigger foods. Pharmacological treatment is adjunctive and should be directed at symptoms. Anti-spasmodics, anti-diarrheals, and antidepressants may have a positive effect on symptoms.
It is important to note that symptoms not consistent with IBS, such as rectal bleeding, anorexia/weight loss, nocturnal symptoms, or fecal incontinence, should alert the clinician to the possibility of an organic pathology. Referral for psychological therapies should be considered for patients who do not respond to pharmacological treatments after 12 months and who develop a continuing symptom profile.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 17
Incorrect
-
A 58-year-old man is recuperating on the ward after an emergency laparotomy and ileocolic resection for Crohn's disease. The nursing staff has raised concerns about his abdominal wound on the fifth day post-operation. Upon review, you observe a clear wound dehiscence in the central area of his laparotomy incision, with a small portion of the bowel visible.
What are the initial steps that should be taken in this situation?Your Answer:
Correct Answer: Cover the wound with sterile saline-soaked gauze and administer antibiotics while awaiting a senior review
Explanation:When an abdominal wound reopens after surgery, it is called wound dehiscence. This can happen for various reasons, including infection, poor surgical technique, and malnutrition. As a junior doctor, it is important to know how to manage this emergency situation. The initial steps involve administering broad-spectrum antibiotics intravenously, covering the wound with sterile gauze soaked in sterile saline to prevent the abdominal contents from drying out, and arranging for the patient to undergo wound repair in the operating theatre. It is not advisable to attempt to close the wound on the ward, as this can be unsafe and increase the risk of infection or bowel injury. A nasogastric tube is not necessary, and simply redressing the wound without moist gauze can lead to fluid loss from the abdominal contents. It is also not necessary to arrange a CT scan, as the problem is evident and requires immediate management. While antibiotics and surgery are necessary, leaving the wound open and uncovered can lead to fluid loss and infection.
Abdominal wound dehiscence is a serious issue that surgeons who perform abdominal surgery frequently encounter. It occurs when all layers of an abdominal mass closure fail, resulting in the protrusion of the viscera externally. This condition is associated with a 30% mortality rate and can be classified as either superficial or complete, depending on the extent of the wound failure.
Several factors increase the risk of abdominal wound dehiscence, including malnutrition, vitamin deficiencies, jaundice, steroid use, major wound contamination (such as faecal peritonitis), and poor surgical technique. To prevent this condition, the preferred method is the mass closure technique, also known as the Jenkins Rule.
When sudden full dehiscence occurs, the wound should be covered with saline impregnated gauze, and the patient should receive IV broad-spectrum antibiotics, analgesia, and IV fluids. Arrangements should also be made for a return to the operating theatre.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 18
Incorrect
-
Which one of the following can be utilized for monitoring patients with colorectal cancer?
Your Answer:
Correct Answer: Carcinoembryonic antigen
Explanation:Carcinoembryonic antigen can be utilized for post-operative recurrence monitoring in patients or evaluating the effectiveness of treatment in those with metastatic disease.
Colorectal Cancer Screening: Faecal Immunochemical Test (FIT)
Colorectal cancer is often developed from adenomatous polyps. Screening for this type of cancer has been proven to reduce mortality by 16%. The NHS offers a home-based screening programme called Faecal Immunochemical Test (FIT) to older adults. A one-off flexible sigmoidoscopy was trialled in England for people aged 55 years, but it was abandoned in 2021 due to the inability to recruit enough clinical endoscopists, which was exacerbated by the COVID-19 pandemic. The trial, partly funded by Cancer Research UK, showed promising early results, and it remains to be seen whether flexible sigmoidoscopy will be used as part of a future bowel screening programme.
Faecal Immunochemical Test (FIT) Screening:
The NHS now has a national screening programme that offers screening every two years to all men and women aged 60 to 74 years in England and 50 to 74 years in Scotland. Patients aged over 74 years may request screening. Eligible patients are sent FIT tests through the post. FIT is a type of faecal occult blood (FOB) test that uses antibodies that specifically recognise human haemoglobin (Hb). It is used to detect and quantify the amount of human blood in a single stool sample. FIT has advantages over conventional FOB tests because it only detects human haemoglobin, as opposed to animal haemoglobin ingested through diet. Only one faecal sample is needed compared to the 2-3 for conventional FOB tests. While a numerical value is generated, this is not reported to the patient or GP. Instead, they will be informed if the test is normal or abnormal. Patients with abnormal results are offered a colonoscopy. At colonoscopy, approximately 5 out of 10 patients will have a normal exam, 4 out of 10 patients will be found to have polyps that may be removed due to their premalignant potential, and 1 out of 10 patients will be found to have cancer. -
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 19
Incorrect
-
A 50-year-old obese man with a history of type 2 diabetes mellitus presents at the clinic for a review. He is currently asymptomatic but his recent annual blood tests have shown slightly abnormal liver function tests. The results are as follows:
- Bilirubin: 20 µmol/L (3 - 17)
- ALP: 104 u/L (30 - 100)
- ALT: 53 u/L (3 - 40)
- γGT: 58 u/L (8 - 60)
- Albumin: 38 g/L (35 - 50)
A liver ultrasound was conducted and reported fatty changes. All other standard liver screen bloods, including viral serology, are normal. The patient's alcoholic intake is within recommended limits. What is the most appropriate next test to perform?Your Answer:
Correct Answer: Enhanced liver fibrosis blood test
Explanation:For patients with non-alcoholic fatty liver disease who exhibit characteristics such as obesity and type 2 diabetes mellitus, it is recommended to conduct an enhanced liver fibrosis (ELF) test to aid in the diagnosis of liver fibrosis. According to NICE guidelines, if NAFLD is discovered incidentally, an ELF blood test should be conducted to evaluate for the presence of more advanced liver disease.
Non-Alcoholic Fatty Liver Disease: Causes, Features, and Management
Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disease in developed countries, primarily caused by obesity. It encompasses a range of conditions, from simple steatosis (fat accumulation in the liver) to steatohepatitis (fat with inflammation) and may progress to fibrosis and liver cirrhosis. Insulin resistance is believed to be the primary mechanism leading to steatosis, making NAFLD a hepatic manifestation of metabolic syndrome. Non-alcoholic steatohepatitis (NASH) is a type of liver damage similar to alcoholic hepatitis but occurs in the absence of alcohol abuse. It affects around 3-4% of the general population and may be responsible for some cases of cryptogenic cirrhosis.
NAFLD is usually asymptomatic, but hepatomegaly, increased echogenicity on ultrasound, and elevated ALT levels are common features. The enhanced liver fibrosis (ELF) blood test is recommended by NICE to check for advanced fibrosis in patients with incidental NAFLD. If the ELF blood test is not available, non-invasive tests such as the FIB4 score or NAFLD fibrosis score, in combination with a FibroScan, may be used to assess the severity of fibrosis. Patients with advanced fibrosis should be referred to a liver specialist for further evaluation, which may include a liver biopsy to stage the disease more accurately.
The mainstay of NAFLD treatment is lifestyle changes, particularly weight loss, and monitoring. Research is ongoing into the role of gastric banding and insulin-sensitizing drugs such as metformin and pioglitazone. While there is no evidence to support screening for NAFLD in adults, NICE guidelines recommend the management of incidental NAFLD findings.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 20
Incorrect
-
You assess a 19-year-old female patient in the outpatient medical assessment unit. Over the course of the last four months, she has been experiencing repeated episodes of severe vomiting lasting a few hours, preceded by intense sweating and nausea. She has also noticed a decrease in appetite and a slight loosening of her clothes. She was hospitalized once in the past four months due to dehydration. Her medical history includes migraines, but no psychiatric history. Routine blood tests with her GP and during her previous admission were unremarkable. What is the most probable diagnosis?
Your Answer:
Correct Answer: Cyclical vomiting syndrome
Explanation:Cyclical Vomiting Syndrome is characterized by severe nausea and vomiting that occurs in distinct episodes lasting from a few hours to a few days. This condition is often associated with migraine and may also result in reduced appetite and weight loss. Unlike Crohn’s disease, which typically presents with diarrhea, abdominal pain, and weight loss, Cyclical Vomiting Syndrome does not involve these symptoms. While nausea and weight loss may be present in Pheochromocytoma, this condition does not typically involve discrete episodes of vomiting. Symptoms such as headaches, tremors, palpitations, and anxiety may also be present in Pheochromocytoma. The episodes of vomiting in Cyclical Vomiting Syndrome are not related to food consumption, making bulimia an unlikely diagnosis.
Understanding Cyclical Vomiting Syndrome
Cyclical vomiting syndrome is a rare condition that is more commonly seen in children than adults. It affects females slightly more than males, and its cause is unknown. However, 80% of children and 25% of adults who develop CVS also have migraines. The condition is characterized by severe nausea and sudden vomiting that can last for hours to days. Patients may experience intense sweating and nausea before an episode, but they are typically well in between episodes. Other symptoms that may be present include weight loss, reduced appetite, abdominal pain, diarrhea, dizziness, photophobia, and headache.
To diagnose CVS, doctors typically perform routine blood tests to exclude any underlying conditions. A pregnancy test may also be considered in women. Treatment for CVS involves avoiding triggers and using prophylactic medications such as amitriptyline, propranolol, and topiramate. During acute episodes, ondansetron, prochlorperazine, and triptans may be used.
Overall, understanding cyclical vomiting syndrome is important for patients and healthcare providers alike. By recognizing the symptoms and seeking appropriate treatment, patients can manage their condition and improve their quality of life.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 21
Incorrect
-
Which of the following causes of diarrhea has the briefest incubation period?
Your Answer:
Correct Answer: Bacillus cereus
Explanation:Gastroenteritis can occur either at home or while traveling, known as travelers’ diarrhea. This condition is characterized by at least three loose to watery stools in 24 hours, accompanied by abdominal cramps, fever, nausea, vomiting, or blood in the stool. The most common cause of travelers’ diarrhea is Escherichia coli. Acute food poisoning is another pattern of illness that results in sudden onset of nausea, vomiting, and diarrhea after ingesting a toxin. Staphylococcus aureus, Bacillus cereus, or Clostridium perfringens are typically responsible for acute food poisoning.
There are several types of infections that can cause gastroenteritis, each with its own typical presentation. Escherichia coli is common among travelers and causes watery stools, abdominal cramps, and nausea. Giardiasis results in prolonged, non-bloody diarrhea, while cholera causes profuse, watery diarrhea and severe dehydration leading to weight loss. Shigella causes bloody diarrhea, vomiting, and abdominal pain, while Staphylococcus aureus results in severe vomiting with a short incubation period. Campylobacter typically starts with a flu-like prodrome and progresses to crampy abdominal pains, fever, and diarrhea, which may be bloody and mimic appendicitis. Bacillus cereus can cause two types of illness, vomiting within six hours, typically due to rice, or diarrheal illness occurring after six hours. Amoebiasis has a gradual onset of bloody diarrhea, abdominal pain, and tenderness that may last for several weeks.
The incubation period for gastroenteritis varies depending on the type of infection. Staphylococcus aureus and Bacillus cereus have an incubation period of 1-6 hours, while Salmonella and Escherichia coli have an incubation period of 12-48 hours. Shigella and Campylobacter have an incubation period of 48-72 hours, while Giardiasis and Amoebiasis have an incubation period of more than seven days.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 22
Incorrect
-
A 42-year-old woman presents with a persistent history of acid reflux. She has visited her primary care physician multiple times. A trial of low-dose proton pump inhibitor (PPI) and lifestyle changes has not improved her symptoms. She has been tested for Helicobacter pylori, and the results were negative. Her screening blood tests are normal.
What is the best course of action for management?Your Answer:
Correct Answer: Do an upper gastrointestinal (GI) endoscopy
Explanation:Approaches to Managing Dyspepsia in Patients with Gastro-Oesophageal Reflux Disease
Patients with chronic gastro-oesophageal reflux disease (GORD) are at risk of developing Barrett’s oesophagus and oesophageal cancer. Therefore, patients aged 50 years or older with a history of chronic GORD should undergo at least one upper gastrointestinal (GI) endoscopy to screen for these conditions. In younger patients, long-term low-dose proton pump inhibitor (PPI) therapy may be considered, with dose adjustment if necessary. However, ongoing dyspepsia in a patient over 50 years old warrants further investigation to exclude serious pathology. Intermittent high-dose PPI therapy is currently only used in hospital for specific indications. Counselling with false reassurance should be avoided in patients with concerning symptoms.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 23
Incorrect
-
A 68-year-old man presents with persistent dyspepsia that is alleviated by omeprazole. He has been taking omeprazole 20 mg daily for the past 2 years. What is a drawback of using a proton-pump inhibitor (PPI) for an extended period of time?
Your Answer:
Correct Answer: Increased risk of fractures
Explanation:According to the BNF, PPIs should be taken in the lowest effective dose for the shortest possible time, and their long-term use should be regularly evaluated. Prolonged use of PPIs can conceal the signs of stomach cancer and heighten the likelihood of osteoporosis and fractures by hindering the absorption of calcium and magnesium.
Understanding Proton Pump Inhibitors and Their Adverse Effects
Proton pump inhibitors (PPIs) are medications that block the H+/K+ ATPase of the gastric parietal cell, leading to irreversible effects. Common examples of PPIs include omeprazole and lansoprazole. While these medications are effective in treating conditions such as gastroesophageal reflux disease (GERD) and peptic ulcers, they can also have adverse effects on the body.
One of the potential adverse effects of PPIs is hyponatremia, which is a condition characterized by low levels of sodium in the blood. PPIs can also lead to hypomagnesemia, which is a deficiency of magnesium in the blood. Additionally, long-term use of PPIs has been linked to an increased risk of osteoporosis and fractures. Another potential adverse effect is microscopic colitis, which is inflammation of the colon that can cause diarrhea and abdominal pain. Finally, PPIs have been associated with an increased risk of C. difficile infections, which can cause severe diarrhea and other gastrointestinal symptoms.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 24
Incorrect
-
A 54 year old woman presents to the General Practice clinic with complaints of increasing dyspepsia, dysphagia, and fatigue. She reports a prolonged history of dark brown stools, but denies any recent episodes of fresh blood. She has not experienced any unexplained weight loss and underwent surgery for a peptic ulcer a decade ago. Upon investigation, she is found to have H. pylori. What should be the subsequent course of action?
Your Answer:
Correct Answer: 2 week referral to endoscopy
Explanation:Management of Dyspepsia and Referral for Possible Cancer
Dyspepsia is a common symptom that can be caused by various factors, including medication and lifestyle choices. However, it can also be a sign of underlying conditions such as stomach or oesophageal cancer. The 2015 NICE guidelines provide updated advice on when urgent referral for endoscopy is necessary. Patients with dysphagia or an upper abdominal mass consistent with stomach cancer should be referred urgently. Patients aged 55 years or older with weight loss and upper abdominal pain, reflux, or dyspepsia should also be referred urgently. Non-urgent referrals include patients with haematemesis or those with treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin levels, or raised platelet count with other symptoms.
For patients with undiagnosed dyspepsia, a step-wise approach is recommended. First, medications should be reviewed for possible causes. Lifestyle advice should also be given. If symptoms persist, a trial of full-dose proton pump inhibitor for one month or a ‘test and treat’ approach for H. pylori can be tried. If symptoms persist after either approach, the alternative should be attempted. Testing for H. pylori infection can be done using a carbon-13 urea breath test, stool antigen test, or laboratory-based serology. If symptoms resolve following test and treat, there is no need to check for H. pylori eradication. However, if repeat testing is required, a carbon-13 urea breath test should be used.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 25
Incorrect
-
A 70-year-old man presents with unexplained weight loss and episodes of passing blood in his stool for the past 3 months. Upon investigation, a CT scan reveals a T2N0M0 tumour just below the rectosigmoid junction. The patient has no significant medical history and is considered fit for surgery. What is the best course of action for management?
Your Answer:
Correct Answer: Anterior resection
Explanation:Anterior resection is the most suitable surgical option for rectal tumors, except for those located in the lower rectum. When determining the appropriate surgery for colorectal cancer, it is crucial to consider the location of the tumor, its grade, and the feasibility of the operation. In the case of a tumor located just below the rectosigmoid junction, an anterior resection or abdominoperineal excision of the rectum are the two possible options. However, since the tumor is not invading the pelvic floor, anal canal, or anal sphincter, an anterior resection is the more appropriate choice. This procedure involves resection followed by anastomosis, with the creation of a temporary defunctioning ileostomy that can later be reversed to allow the bowel to heal. Abdominoperineal excision of the rectum is not suitable in this case, as it would require a lifelong stoma. Hartmann’s procedure is also not appropriate, as it is typically performed in emergency situations such as bowel perforation or obstruction. Similarly, left hemicolectomy is not suitable for this tumor, as it is located in the upper rectum.
Colorectal cancer is typically diagnosed through CT scans and colonoscopies or CT colonography. Patients with tumors below the peritoneal reflection should also undergo MRI to evaluate their mesorectum. Once staging is complete, a treatment plan is formulated by a dedicated colorectal MDT meeting.
For colon cancer, surgery is the primary treatment option, with resectional surgery being the only cure. The procedure is tailored to the patient and tumor location, with lymphatic chains being resected based on arterial supply. Anastomosis is the preferred method of restoring continuity, but in some cases, an end stoma may be necessary. Chemotherapy is often offered to patients with risk factors for disease recurrence.
Rectal cancer management differs from colon cancer due to the rectum’s anatomical location. Tumors can be surgically resected with either an anterior resection or an abdomino-perineal excision of rectum (APER). A meticulous dissection of the mesorectal fat and lymph nodes is integral to the procedure. Neoadjuvant radiotherapy is often offered to patients prior to resectional surgery, and those with obstructing rectal cancer should have a defunctioning loop colostomy.
Segmental resections based on blood supply and lymphatic drainage are the primary operations for cancer. The type of resection and anastomosis depend on the site of cancer. In emergency situations where the bowel has perforated, an end colostomy is often safer. Left-sided resections are more risky, but ileo-colic anastomoses are relatively safe even in the emergency setting and do not need to be defunctioned.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 26
Incorrect
-
A 54-year-old man presents to your clinic after a routine blood test showed abnormal liver function tests. He denies any alcohol consumption and his hepatitis screen is negative. His cholesterol level is 4.2 and his HBA1c is 38ml/mol. He has a body mass index of 31 kg/m² and an ultrasound reveals non-alcoholic fatty liver disease. What is the most suitable approach to manage this condition?
Your Answer:
Correct Answer: Diet and exercise
Explanation:The primary management approach for NAFLD is weight loss, achieved through diet and exercise. Medications have not shown to be effective in improving the condition’s outcome.
Non-Alcoholic Fatty Liver Disease: Causes, Features, and Management
Non-alcoholic fatty liver disease (NAFLD) is a prevalent liver disease in developed countries, primarily caused by obesity. It encompasses a range of conditions, from simple steatosis (fat accumulation in the liver) to steatohepatitis (fat with inflammation) and may progress to fibrosis and liver cirrhosis. Insulin resistance is believed to be the primary mechanism leading to steatosis, making NAFLD a hepatic manifestation of metabolic syndrome. Non-alcoholic steatohepatitis (NASH) is a type of liver damage similar to alcoholic hepatitis but occurs in the absence of alcohol abuse. It affects around 3-4% of the general population and may be responsible for some cases of cryptogenic cirrhosis.
NAFLD is usually asymptomatic, but hepatomegaly, increased echogenicity on ultrasound, and elevated ALT levels are common features. The enhanced liver fibrosis (ELF) blood test is recommended by NICE to check for advanced fibrosis in patients with incidental NAFLD. If the ELF blood test is not available, non-invasive tests such as the FIB4 score or NAFLD fibrosis score, in combination with a FibroScan, may be used to assess the severity of fibrosis. Patients with advanced fibrosis should be referred to a liver specialist for further evaluation, which may include a liver biopsy to stage the disease more accurately.
The mainstay of NAFLD treatment is lifestyle changes, particularly weight loss, and monitoring. Research is ongoing into the role of gastric banding and insulin-sensitizing drugs such as metformin and pioglitazone. While there is no evidence to support screening for NAFLD in adults, NICE guidelines recommend the management of incidental NAFLD findings.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 27
Incorrect
-
A 28-year-old female patient complains of symptoms that suggest coeliac disease. What is the primary test that should be employed for screening individuals with coeliac disease?
Your Answer:
Correct Answer: Tissue transglutaminase antibodies
Explanation:According to NICE, the initial serological test for coeliac disease should be tissue transglutaminase antibodies.
Investigating Coeliac Disease
Coeliac disease is a condition caused by sensitivity to gluten, which can lead to villous atrophy and malabsorption. It is often associated with other conditions such as dermatitis herpetiformis and autoimmune disorders. Diagnosis of coeliac disease is made through a combination of serology and endoscopic intestinal biopsy. The gold standard for diagnosis is the biopsy, which should be performed in all patients with suspected coeliac disease to confirm or exclude the diagnosis. The biopsy traditionally takes place in the duodenum, but jejunal biopsies are also sometimes performed. Findings supportive of coeliac disease include villous atrophy, crypt hyperplasia, an increase in intraepithelial lymphocytes, and lamina propria infiltration with lymphocytes. Serology tests for coeliac disease include tissue transglutaminase antibodies and endomyseal antibodies, while anti-gliadin antibodies are not recommended. Patients who are already on a gluten-free diet should reintroduce gluten for at least six weeks prior to testing. Rectal gluten challenge is not widely used. A gluten-free diet can reverse villous atrophy and immunology in patients with coeliac disease.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 28
Incorrect
-
A 57-year-old patient visits the GP clinic complaining of painful burning sensations in her chest for the past week, particularly after eating. She also mentions feeling bloated, which is a new experience for her. During the examination, the GP observes some abdominal tenderness and decides to order an upper GI endoscopy. The patient is currently taking aspirin, metformin, and omeprazole. What guidance should the GP offer her regarding the procedure?
Your Answer:
Correct Answer: Stop the omeprazole two weeks before the procedure
Explanation:To ensure proper identification of any pathology during the upper GI endoscopy, it is recommended that the patient discontinues the use of proton pump inhibitors, such as omeprazole, at least two weeks prior to the procedure.
Investigating Gastro-Oesophageal Reflux Disease
Gastro-oesophageal reflux disease (GORD) can be difficult to diagnose as there is often a poor correlation between symptoms and the appearance of the oesophagus during endoscopy. However, there are certain indications for upper GI endoscopy, including age over 55 years, symptoms lasting more than four weeks or persistent symptoms despite treatment, dysphagia, relapsing symptoms, and weight loss. If endoscopy is negative, further investigation may be necessary. The gold standard test for diagnosis is 24-hour oesophageal pH monitoring. It is important to consider these investigations in order to accurately diagnose and treat GORD.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 29
Incorrect
-
A 45-year-old woman presents to the Emergency Department with a 2-month history of dull abdominal pain. It is central and occasionally radiates to her back. However, this is not always present and it seems to get worse half an hour after a meal. She denies any vomiting or diarrhoea but confirms that painful episodes are accompanied by nausea.
The patient does not have any past medical history but admits that she has been drinking a glass of wine every night for the past 15 years. An abdominal X-ray is done.
Given the likely diagnosis, which of the following findings are most likely to be seen on the abdominal X-ray?
Select the SINGLE most likely finding from the list below.
Your Answer:
Correct Answer: Pancreatic calcifications
Explanation:The patient’s symptoms of dull, central abdominal pain that worsens after meals and radiates to the back, along with a history of regular alcohol consumption, suggest a diagnosis of chronic pancreatitis. Imaging studies, such as an abdominal X-ray or CT scan, may reveal pancreatic calcifications, which are a common finding in chronic pancreatitis. If imaging is inconclusive, a faecal elastase test may be used to assess pancreatic exocrine function. The presence of the football sign, air under the diaphragm, dilated loops of small bowel, or the Rigler sign on an abdominal X-ray would suggest other conditions such as gastrointestinal perforation or bowel obstruction, which do not fit the patient’s presentation.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
-
Question 30
Incorrect
-
A 25-year-old man presents with worries about the appearance of his tongue. He reports that it has been like this for a few months but is not causing any discomfort or issues. On examination, the tongue appears mildly erythematous with a few patches surrounded by a white-ish border, and there is no exudate that can be scraped off. What is the MOST probable diagnosis?
Your Answer:
Correct Answer: Geographic tongue
Explanation:Understanding Geographic Tongue: Symptoms, Causes, and Management
Geographic tongue is a common and benign condition that affects the tongue. It is characterized by irregular, smooth, red patches with a white border that resemble a map. While some individuals may experience pain or discomfort, others may not have any symptoms at all. The cause of geographic tongue is unknown, and there is currently no cure. However, symptomatic pain relief and avoidance of certain triggers may help manage the condition.
It is important to differentiate geographic tongue from other oral conditions such as oral candidiasis, oral leukoplakia, and vitamin deficiencies. Oral candidiasis can present with white/yellow plaques that can be easily removed, while oral leukoplakia presents with painless white plaques that cannot be easily scraped away and may be pre-malignant. Vitamin deficiencies such as B12 and C can also cause oral symptoms.
Overall, geographic tongue is a harmless condition that primarily affects females. While it may cause discomfort for some individuals, it does not pose any serious health risks. If you are experiencing symptoms of geographic tongue, it is recommended to seek advice from a healthcare professional for proper diagnosis and management.
-
This question is part of the following fields:
- Gastroenterology/Nutrition
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)