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  • Question 1 - A 48-year-old man with a two year history of ulcerative colitis, has been...

    Correct

    • A 48-year-old man with a two year history of ulcerative colitis, has been receiving parenteral nutrition for 4 months. He has developed a dermatitis and has noticed some loss of hair. Serum biochemistry shows a marginally raised glucose concentration and a lower alkaline phosphatase activity. Which of the following is the most likely?

      Your Answer: Zinc deficiency

      Explanation:

      Zinc deficiency can present with alopecia, dermatitis, poor growth, increased susceptibility to infection, and cognitive deficiency. Magnesium deficiency can cause fatigue, cramping and an irregular EKG. Copper deficiency can present with fatigue and weakness. Chromium deficiency can present with hyperglycaemia.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 2 - A 35-year-old gentleman with a history of alcohol excess presents to hospital with...

    Incorrect

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

      Your Answer: Furosemide

      Correct Answer: Paracentesis

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 3 - 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 4 - A 33-year-old man with a known history of alcoholic liver disease is reviewed...

    Incorrect

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

      Your Answer:

      Correct Answer: Endoscopic variceal band ligation

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 5 - 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.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 6 - 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.

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      • Gastroenterology
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  • Question 7 - A 32-year-old lady, known with a history of Type 1 diabetes presents to...

    Incorrect

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

      Your Answer:

      Correct Answer: Liver function testing

      Explanation:

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

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      • Gastroenterology
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  • Question 8 - A 62-year-old lady is referred with painless jaundice and weight loss. Bilirubin is...

    Incorrect

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

      Your Answer:

      Correct Answer: Abdominal CT scan

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 9 - Which of the following stimulates the secretion of gastrin? ...

    Incorrect

    • Which of the following stimulates the secretion of gastrin?

      Your Answer:

      Correct Answer: Amino acids

      Explanation:

      Gastrin is released from G cells in the antrum of the stomach after a meal. It stimulates parietal cells to release HCl. Gastrin is stimulated by a number of things: antrum distention, vagal stimulation, peptides (especially amino acids) in the stomach, hypercalcemia. Gastrin release is inhibited by acid, SST, GIP, VIP, secretin, glucagon, and calcitonin.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 10 - A 51-year-old man was brought to the Emergency department for loose stools. He...

    Incorrect

    • A 51-year-old man was brought to the Emergency department for loose stools. He was dehydrated, weak and in shock. He had previously been complaining of large stool volumes for a one month period. Stool colour was normal. There was no history of laxative abuse and no significant past medical history. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: VIPoma

      Explanation:

      Given that the patient has had large amount, high volume watery diarrhoea in an acute period of time, from the answer choices given, this narrows the diagnosis down to VIPoma or carcinoid syndrome. You would expect with carcinoid syndrome for there to be periodic episodes of diarrhoea, though, with a description of flushing, additionally, associated with these episodes. Thus, VIPoma is the most likely answer here. VIPomas are known to cause hypokalaemia from this large amount of watery diarrhoea. Stool volume should be > 700 ml/day.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 11 - A 50 year old man undergoes a colonoscopy due to the finding of...

    Incorrect

    • A 50 year old man undergoes a colonoscopy due to the finding of blood in his stools. The colonoscopy revealed four polyps which were variable in size from one at 0.5cm, 2 at approximately 1.5cm and one at 2 cm. When should this patient have a follow up colonoscopy?

      Your Answer:

      Correct Answer: 3 years

      Explanation:

      For the question, you need knowledge of the British Society of Gastroenterology guidelines. This patient has 3-4 adenomas with 3 of them > 1 cm. This places him at medium risk and the recommendation if for a 3-year follow up period.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 12 - A 47-year-old man with a history of alcohol induced liver disease is admitted...

    Incorrect

    • A 47-year-old man with a history of alcohol induced liver disease is admitted to the gastroenterology ward. He has developed tense ascites again and a plan is made to site an ascitic drain. His renal function after 2 days is as follows: Na+ 131 mmol/L, K+ 3.8 mmol/L, Urea 12.2 mmol/L, Creatinine 205 µmol/L, Which of the following pathophysiological changes is most likely to be responsible for the declining renal function?

      Your Answer:

      Correct Answer: Splanchnic vasodilation

      Explanation:

      Hepatorenal syndrome is renal vasoconstriction that cannot overcome the effects of splanchnic vasodilation. Vasoactive mediators cause this splanchnic vasodilation, reducing SVR, which is sensed by the juxtaglomerular apparatus, activating the RAAS system, leading to renal vasoconstriction. However, the overall splanchnic vasodilation effect is greater than this renal vasoconstriction effect.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 13 - A 57-year-old school teacher is found to have abnormal liver function tests at...

    Incorrect

    • A 57-year-old school teacher is found to have abnormal liver function tests at a health screening. Other than tiredness and occasional gritty eyes that she attributes to age, she is well. She is postmenopausal and takes hormone replacement therapy (HRT) but no other medication. She smokes 12 cigarettes per day but takes no alcohol. There is nothing to find on examination. Some of her blood results are shown below: Albumin 40 g/l (37–49) Alanine aminotransferase(ALT) 14 U/l (5–35) Alkaline Phosphatase 300 U/l (45–105) AMA positive >1:40 Anti-dsDNA weakly positive Bilirubin 12 μmol/l (1–22) High-density lipoprotein (HDL) cholesterol 4.0 mmol/l (>1.55) Liver–kidney microsomal antibody (anti-LKM) negative Liver transaminase (AST) 10 U/l (1–31) Low-density lipoprotein (LDL) cholesterol 4.0 mmol/l (<3.36) Plasma thromboplastin (PT) 12 s (11.5–15.5) Smooth muscle antibody (SMA) negative Which of the following would be an appropriate next step?

      Your Answer:

      Correct Answer: Ursodeoxycholic acid

      Explanation:

      The patient is AMA+ and weakly + for anti-dsDNA, suggesting an autoimmune process. She also has gritty eyes, which makes you think Sjogren’s syndrome. She has an elevated ALP and normal AST/ ALT. All of these factors, in addition to her middle age and the fact that she is a woman, make the diagnosis of primary biliary cirrhosis (PBC) most likely. It is associated with conditions (autoimmune) such as Sjogren’s syndrome. The treatment for this disease initially is ursodeoxycholic acid. Liver transplantation is the definitive treatment for end-stage disease.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 14 - A 32-year-old woman was referred for endoscopy and found to have a duodenal...

    Incorrect

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

      Your Answer:

      Correct Answer: Urea breath test

      Explanation:

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

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      • Gastroenterology
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  • Question 15 - A 72-year-old woman presents with a 3 month history of colicky abdominal pain...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 16 - A 24-year-old woman presents as an emergency to her GP with acute vomiting...

    Incorrect

    • A 24-year-old woman presents as an emergency to her GP with acute vomiting which began some 3–4 hours after attending an afternoon meeting. Cream cakes were served during the coffee break. Which of the following organisms is the most likely cause of this acute attack of vomiting?

      Your Answer:

      Correct Answer: Staphylococcus aureus

      Explanation:

      Staph. aureus is the most likely cause. It is found in foods like dairy products, cold meats, or mayonnaise. It produces a heat-stable ENDOTOXIN (remember this) that causes nausea, vomiting, and diarrhoea 1-6 hours after ingestion of contaminated food. B. cereus is classically associated with fried rice being reheated. Salmonella is typical with raw eggs and undercooked poultry. Campylobacter which is most commonly associated with food poisoning, is seen with poultry 50% of the time. Yersinia enterocolitica is seen with raw or undercooked pork, and may be a case presenting with mesenteric adenitis.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 17 - A 53-year-old man is brought into the emergency department by the paramedics. He...

    Incorrect

    • A 53-year-old man is brought into the emergency department by the paramedics. He collapsed oat home suffering from a myocardial infarction and was subsequently resuscitated following a cardiac arrest. Blood tests show impaired liver function (ALT 1400 u/l). He is on a statin, and at his appointment last week his LFT was normal. There is nothing to note on examination and he is currently not complaining of any pain. Given this man's presentation, what is the most likely cause of his impaired liver function tests?

      Your Answer:

      Correct Answer: Ischaemic hepatitis

      Explanation:

      When you have abnormal liver function tests after a cardiac arrest, the most likely aetiology, barring history that is known or given excluding this diagnosis, would be ischemia. Chronic alcohol abuse would not see an acute elevation like this. Hepatitis B is just unlikely given the clinical picture, ischemia is much more likely. The same is for Budd-Chiari syndrome (venous thrombosis) and Wilson’s disease.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 18 - A 55-year-old man develops central abdominal pain a few hours after having an...

    Incorrect

    • A 55-year-old man develops central abdominal pain a few hours after having an Endoscopic Retrograde Cholangiopancreatography (ERCP) performed. Investigations reveal the following: Amylase: 545 u/dL, Erect chest x-ray: Normal heart and lungs and no free air noted. What is the most appropriate management?

      Your Answer:

      Correct Answer: Intravenous fluids + analgesia

      Explanation:

      A very common complication after ERCP is post-ERCP pancreatitis, which based on the clinical scenario , this man has. The treatment for this is pain control, lots of intravenous fluids, and traditionally bowel rest, although more recent evidence suggests early feeding is better.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 19 - A 24-year-old waiter applies for a job at a cafeteria. He gives a...

    Incorrect

    • A 24-year-old waiter applies for a job at a cafeteria. He gives a history of having had enteric fever 2 years ago. Which of the following investigations is most likely to indicate a chronic carrier status?

      Your Answer:

      Correct Answer: Culture of intestinal secretions

      Explanation:

      The chronic asymptomatic carrier state is thought to be why there is continued appearance of the bacterium in human populations. As shedding of the organism is intermittent and sometimes at low levels, methods to detect it have been limited. The Salmonella typhi may be cultured from intestinal secretions, faeces or urine in chronic carriers and is recommended to confirm the diagnosis. Vi agglutination test can also be high in normal people in areas with typhoid endemic. Full blood count or blood culture would not be helpful to determine carrier status. Widal antigen test is unable to differentiate carriers from people with a hx of prior infection.

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      • Gastroenterology
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  • Question 20 - A 28-year-old patient presents with inflammatory bowel disease. 5-ASA would be most appropriate...

    Incorrect

    • A 28-year-old patient presents with inflammatory bowel disease. 5-ASA would be most appropriate in treating which condition?

      Your Answer:

      Correct Answer: Maintenance therapy for ulcerative colitis

      Explanation:

      5-ASA is not an acute treatment; it is for maintenance therapy for ulcerative colitis and/or Crohn’s. The most benefit is seen in patients with ulcerative colitis.

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      • Gastroenterology
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  • Question 21 - The increased risk of oesophageal malignancy in patients with Barrett’s oesophagus is approximately:...

    Incorrect

    • The increased risk of oesophageal malignancy in patients with Barrett’s oesophagus is approximately:

      Your Answer:

      Correct Answer: 50 - 100 times risk

      Explanation:

      Barrett’s oesophagus is the transformation of the normal squamous epithelium of the oesophagus to columnar, intestinal type epithelium. It is often seen in patients with reflux and there is a 50-100 fold increased risk of oesophageal adenocarcinoma in patients with Barrett’s oesophagus.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 22 - A 32-year-old man, originally from Pakistan, was admitted with ascites and weight loss....

    Incorrect

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

      Your Answer:

      Correct Answer: Hepatic cirrhosis

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 23 - A 28-year-old man who is admitted with bright red haematemesis, which occurred after...

    Incorrect

    • A 28-year-old man who is admitted with bright red haematemesis, which occurred after a bout of vomiting. He had been out with friends on a stag party and consumed 12 pints of beer. Upper gastrointestinal (GI) endoscopy proves unremarkable and haemoglobin (Hb) is stable at 12.5 g/dl the morning after admission, there is no sign of circulatory compromise. There have been no previous similar episodes. Which of the following stems represents the best course of action for this patient?

      Your Answer:

      Correct Answer: Send home

      Explanation:

      This is a classic clinical presentation, with alcohol intake and nausea/vomiting that leads to hematemesis, of a Mallory-Weiss tear. In Mallory-Weiss tear, they typically present as a hemodynamically stable patient after a night of binge drinking and excessive resultant vomiting. Given his EGD did not show any other pathology and he is now stable, he can be discharged home.

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      • Gastroenterology
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  • Question 24 - In which part of the body is conjugated bilirubin metabolised to urobilinogen? ...

    Incorrect

    • In which part of the body is conjugated bilirubin metabolised to urobilinogen?

      Your Answer:

      Correct Answer: Large intestine

      Explanation:

      Urobiligen is produced by the action of bacteria on bilirubin in the intestine. As a reminder, unconjugated bilirubin becomes conjugated in the hepatocyte. Conjugated bilirubin goes through enterohepatic circulation. About half of the urobiligen is reabsorbed and excreted by the kidneys in the urine. The rest is converted to stercobilinogen –> stercobilin, which is excreted in stool, giving it its brown colour.

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      • Gastroenterology
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  • Question 25 - An 82-year-old woman is brought in by her carer with fluctuating consciousness. On...

    Incorrect

    • An 82-year-old woman is brought in by her carer with fluctuating consciousness. On examination she is deeply jaundiced, hypotensive with a tachycardia and has a hepatic flap. Initial blood tests reveal an ALT of 1000 U/l, INR 3.4, ALP 600 U/l and a bilirubin of 250 mmol/l. Repeat blood tests 6 hours later show an ALT of 550 U/l, INR 4.6, ALP 702 U/l and bilirubin of 245 m mol/l. The toxicology screen for paracetamol and aspirin is negative; she is positive for hepatitis B surface antibody and negative for hepatitis B surface antigen. Which of the following would best explain her clinical condition?

      Your Answer:

      Correct Answer: Acute liver failure secondary to paracetamol

      Explanation:

      Liver flap is pathognomonic for liver failure. Paracetamol (also known as acetaminophen) overdose usually presents with symptoms including liver failure, resulting in confusion, jaundice, and coagulopathy a few days after overdose. The first 24 hours, people usually have minimal symptoms. Diagnosis is based on blood levels of acetaminophen at specific times after it was taken (see reference). If she took it a few days ago, levels may indeed be undetectable. The hepatitis B serology suggests prior vaccination. Wilson’s disease is not the most likely diagnosis given her presentation. The AST:ALT ratio would be expected to be reversed in alcohol induced liver failure.

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      • Gastroenterology
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  • Question 26 - 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.

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      • Gastroenterology
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  • Question 27 - A 45-year-old man was referred for abnormal liver biochemistry. Investigations showed he had...

    Incorrect

    • A 45-year-old man was referred for abnormal liver biochemistry. Investigations showed he had an ALT of 98 U/l and was Hep B surface antigen positive. Which of the following is true of chronic active hepatitis due to the hepatitis B virus?

      Your Answer:

      Correct Answer: It carries an increased risk of subsequent hepatocellular carcinoma

      Explanation:

      Chronic hepatitis B patients have an increased risk of hepatocellular carcinoma. 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. It is important to remember these serologies, it will get you a lot of points on the test.

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      • Gastroenterology
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  • Question 28 - A 36-year-old man with diabetes is referred with abnormal liver biochemistry. Which of...

    Incorrect

    • A 36-year-old man with diabetes is referred with abnormal liver biochemistry. Which of the following is in keeping with a diagnosis of haemochromatosis?

      Your Answer:

      Correct Answer: Transferrin saturation 78% (20-50)

      Explanation:

      A high transferrin saturation is seen in hemochromatosis, as well as a high iron level (>30), a high ferritin level, and a LOW TIBC (<20). Think of it like the opposite findings of iron deficiency anaemia which is a low iron, low ferritin, high TIBC.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 29 - A 76-year-old woman is admitted with a productive cough and pyrexia. Chest x-ray...

    Incorrect

    • A 76-year-old woman is admitted with a productive cough and pyrexia. Chest x-ray shows a pneumonia and she is commenced on intravenous ceftriaxone. Following admission a stool sample is sent because of diarrhoea. This confirms the suspected diagnosis of Clostridium difficile diarrhoea and a 10-day course of oral metronidazole is started. After 10 days her diarrhoea is ongoing but she remains clinically stable. What is the most appropriate treatment?

      Your Answer:

      Correct Answer: Oral vancomycin for 14 days

      Explanation:

      When a patient fails treatment with metronidazole (Flagyl) treatment, the next course of action is to change to oral vancomycin, which is shown to be effective in the treatment of c diff colitis. Oral rifampicin is not a treatment for c diff. Oral metronidazole is not resolving her symptoms so is not the correct answer. clindamycin is a cause of c diff colitis, not a treatment. IV Vanc is not active in the gut so is not the treatment; oral is active in the gut.

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      • Gastroenterology
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  • Question 30 - A 63 year old man presents with painless jaundice and weight loss over...

    Incorrect

    • A 63 year old man presents with painless jaundice and weight loss over the last few months. He is a heavy smoker and has a past medical history of COPD. On examination his abdomen is soft and non tender and he is clearly icteric. His bloods reveal deranged LFTs with an alkaline phosphates of 240 and a bilirubin of 92, ALT and AST are both around 200. An ultrasound of his abdomen is performed and shows both intra and extrahepatic bowel duct dilatation within the liver. What`s the first line investigation of his case?

      Your Answer:

      Correct Answer: MRCP

      Explanation:

      When you hear painless jaundice and weight loss in the same sentence, the first thing you should think is cancer. Likely cholangiocarcinoma here or some other biliary tract obstructing cancer. The first line imaging for this would be MRCP because you’re looking for obstruction– the dilatation of the intra and extrahepatic ducts suggests this. This is less invasive than an ERCP or a liver biopsy. CT C/A/P will likely be needed for staging later but it is asking for the initial test.

    • This question is part of the following fields:

      • Gastroenterology
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Gastroenterology (1/2) 50%
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