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  • Question 1 - A 63-year-old woman is concerned about the possibility of having bowel cancer. She...

    Correct

    • A 63-year-old woman is concerned about the possibility of having bowel cancer. She has been experiencing bloating and abdominal discomfort for the past 6 months, as well as unintentional weight loss. Her cousin was recently diagnosed with colorectal cancer, which has prompted her to seek medical attention.
      What is a red flag symptom for colorectal cancer?

      Your Answer: Weight loss

      Explanation:

      Red Flag Symptoms for Suspected Cancer Diagnosis

      When it comes to suspected cancer diagnosis, certain symptoms should be considered as red flags. Unintentional weight loss is one such symptom, which should be taken seriously, especially in older women. Bloating, while a general symptom, may also require further investigation if it is persistent and accompanied by abdominal distension. A family history of bowel cancer is relevant in first-degree relatives, but a diagnosis in a cousin may not be significant. Abdominal pain is a non-specific symptom, but if accompanied by other signs like weight loss and altered bowel habits, it may be a red flag. Finally, persistent abdominal distension in women over 50 should be investigated further to rule out ovarian malignancy.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 2 - What is the correct statement regarding gastric acid secretion? ...

    Incorrect

    • What is the correct statement regarding gastric acid secretion?

      Your Answer: It is stimulated by somatostatin

      Correct Answer: It is potentiated by histamine

      Explanation:

      Understanding Gastric Acid Secretion: Factors that Stimulate and Inhibit its Production

      Gastric acid, also known as stomach acid, is a vital component in the process of digesting food. Composed of hydrochloric acid, potassium chloride, and sodium chloride, it is secreted in the stomach and plays a crucial role in breaking down ingested food contents. In this article, we will explore the factors that stimulate and inhibit gastric acid secretion.

      Stimulation of Gastric Acid Secretion

      There are three classic phases of gastric acid secretion. The cephalic (preparatory) phase is triggered by the sight, smell, thought, and taste of food acting via the vagus nerve. This results in the production of gastric acid before food actually enters the stomach. The gastric phase is initiated by the presence of food in the stomach, particularly protein-rich food, caused by stimulation of G cells which release gastrin. This is the most important phase. The intestinal phase is stimulated by luminal distension plus the presence of amino acids and food in the duodenum.

      Potentiation and Inhibition of Gastric Acid Secretion

      Histamine potentiates gastric acid secretion, while gastrin inhibits it. Somatostatin, secretin, and cholecystokinin also inhibit gastric acid production.

      Importance of Gastric Acid Secretion

      Gastric acid secretion reduces the risk of Zollinger–Ellison syndrome, a condition characterized by excess gastric acid production that can lead to multiple severe gastric ulcers, requiring high-dose antacid treatment. Understanding the factors that stimulate and inhibit gastric acid secretion is crucial in maintaining a healthy digestive system.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 3 - A 39-year-old male with a history of alcoholism was admitted to the hospital...

    Incorrect

    • A 39-year-old male with a history of alcoholism was admitted to the hospital with jaundice and altered consciousness. He had been previously admitted for ascites and jaundice. Upon investigation, his bilirubin levels were found to be 44 µmol/L (5.1-22), serum albumin levels were 28 g/L (40-50), and his prothrombin time was 21 seconds (13 seconds). The patient had a fluid thrill in his abdomen and exhibited asterixis. Although he was awake, he was unable to distinguish between day and night. What is the patient's Child-Pugh score (CTP)?

      Your Answer: 5

      Correct Answer: 12

      Explanation:

      The Child-Turcotte-Pugh score (CTP) is used to assess disease severity in cirrhosis of liver. It consists of five clinical measures, each scored from 1 to 3 according to severity. The minimum score is 5 and maximum score is 15. Once a score has been calculated, the patient is graded A, B, or C for severity. The CTP score is primarily used to decide the need for liver transplantation. However, some criticisms of this scoring system highlight the fact that each of the five categories is given equal weighting, which is not always appropriate. Additionally, in two specific diseases, primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), the bilirubin cut-off levels in the table are markedly different.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 4 - A 67-year-old malnourished patient needs to have a nasogastric (NG) tube inserted for...

    Incorrect

    • A 67-year-old malnourished patient needs to have a nasogastric (NG) tube inserted for enteral feeding. What is the primary method to verify the NG tube's secure placement before starting feeding?

      Your Answer: Abdominal X-ray

      Correct Answer: Aspirate 10 ml and check the pH

      Explanation:

      Methods for Confirming Correct Placement of Nasogastric Tubes

      Nasogastric (NG) tubes are commonly used in medical settings to administer medication, nutrition, or to remove stomach contents. However, incorrect placement of an NG tube can lead to serious complications. Therefore, it is important to confirm correct placement before using the tube. Here are some methods for confirming correct placement:

      1. Aspirate and check pH: Aspirate 10 ml of fluid from the NG tube and test the pH. If the pH is less than 5.5, the tube is correctly placed in the stomach.

      2. Visual inspection: Do not rely on visual inspection of the aspirate to confirm correct placement, as bronchial secretions can be similar in appearance to stomach contents.

      3. Insert air and auscultate: Injecting 10-20 ml of air can help obtain a gastric aspirate, but auscultation to confirm placement is an outdated and unreliable technique.

      4. Chest X-ray: If no aspirate can be obtained or the pH level is higher than 5.5, a chest X-ray can be used to confirm correct placement. However, this should not be the first-line investigation.

      5. Abdominal X-ray: An abdominal X-ray is not helpful in determining correct placement of an NG tube, as it does not show the lungs.

      By using these methods, healthcare professionals can ensure that NG tubes are correctly placed and reduce the risk of complications.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 5 - A 32-year-old, malnourished patient needs to have a nasogastric tube (NGT) inserted for...

    Incorrect

    • A 32-year-old, malnourished patient needs to have a nasogastric tube (NGT) inserted for enteral feeding. What is the most important measure to take before beginning the feeding plan?

      Your Answer: Aspirate 10 ml from the tube and observe the appearance of the tube aspirate

      Correct Answer: Chest radiograph

      Explanation:

      Confirming Nasogastric Tube Placement: The Role of Chest Radiograph

      Confirming the placement of a nasogastric tube (NGT) is crucial to prevent potential harm to the patient. While pH testing was previously used, chest radiograph has become the preferred method due to its increasing availability and negligible radiation exposure. The NGT has two main indications: enteral feeding/medication administration and stomach decompression. A chest radiograph should confirm that the NGT is passed down the midline, past the carina, past the level of the diaphragm, deviates to the left, and the tip is seen in the stomach. Respiratory distress absence is a reliable indicator of correct placement, while aspirating or auscultating the tube is unreliable. Abdominal radiographs are not recommended due to their inability to visualize the entire length of the NGT and the unnecessary radiation risk to the patient.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 6 - A 25-year-old male patient reports experiencing mild jaundice following periods of fasting or...

    Correct

    • A 25-year-old male patient reports experiencing mild jaundice following periods of fasting or exercise. Upon examination, his complete blood count and liver function tests appear normal. What is the recommended course of treatment for this individual?

      Your Answer: No treatment required

      Explanation:

      Gilbert Syndrome

      Gilbert syndrome is a common genetic condition that causes mild unconjugated hyperbilirubinemia, resulting in intermittent jaundice without any underlying liver disease or hemolysis. The bilirubin levels are usually less than 6 mg/dL, but most patients exhibit levels of less than 3 mg/dL. The condition is characterized by daily and seasonal variations, and occasionally, bilirubin levels may be normal in some patients. Gilbert syndrome can be triggered by dehydration, fasting, menstrual periods, or stress, such as an intercurrent illness or vigorous exercise. Patients may experience vague abdominal discomfort and fatigue, but these episodes resolve spontaneously, and no treatment is required except supportive care.

      In recent years, Gilbert syndrome is believed to be inherited in an autosomal recessive manner, although there are reports of autosomal dominant inheritance. Despite the mild symptoms, it is essential to understand the condition’s triggers and symptoms to avoid unnecessary medical interventions. Patients with Gilbert syndrome can lead a normal life with proper care and management.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 7 - A 25-year-old man presents with mild jaundice following a flu-like illness. During a...

    Incorrect

    • A 25-year-old man presents with mild jaundice following a flu-like illness. During a review by a gastroenterologist, he has been told that a diagnosis of Gilbert’s syndrome is probable.
      Which of the following test results most suggests this diagnosis?

      Your Answer:

      Correct Answer: Absence of bilirubin in the urine

      Explanation:

      Understanding Gilbert’s Syndrome: Absence of Bilirubin in Urine and Other Characteristics

      Gilbert’s syndrome is a genetic condition that affects 5-10% of the population in Western Europe. It is characterized by intermittent raised unconjugated bilirubin levels due to a defective enzyme involved in bilirubin conjugation. Despite this, patients with Gilbert’s syndrome have normal liver function, no evidence of liver disease, and no haemolysis. Attacks are usually triggered by various insults to the body.

      One notable characteristic of Gilbert’s syndrome is the absence of bilirubin in the urine. This is because unconjugated bilirubin is non-water-soluble and cannot be excreted in the urine. In unaffected individuals, conjugated bilirubin is released into the bile and excreted in the faeces or reabsorbed in the circulation and excreted in the urine as urobilinogen.

      Other characteristics that are not expected in Gilbert’s syndrome include decreased serum haptoglobin concentration, elevated aspartate aminotransferase (AST) activity, and increased reticulocyte count. Haptoglobin is an acute phase protein that is decreased in haemolysis, which is not associated with Gilbert’s syndrome. AST activity is associated with normal liver function, which is also a characteristic of Gilbert’s syndrome. A raised reticulocyte count is observed in haemolytic anaemia, which is not present in Gilbert’s syndrome.

      Increased urinary urobilinogen excretion is also not expected in Gilbert’s syndrome as it is associated with haemolytic anaemia. Understanding the characteristics of Gilbert’s syndrome can aid in its diagnosis and management, which typically does not require treatment.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 8 - A 40-year-old woman presents with sudden onset of abdominal pain for the past...

    Incorrect

    • A 40-year-old woman presents with sudden onset of abdominal pain for the past 6 hours. The pain is rapidly worsening and is more severe in the right upper quadrant. She has no significant medical history and denies any recent illnesses or similar episodes in the past. She is sexually active and takes an oral contraceptive pill. Upon examination, her blood pressure is 120/80 mmHg, pulse rate 85 bpm, respiratory rate 16/min, and body temperature 37.5 ºC. The sclera is icteric. Tender hepatomegaly and shifting abdominal dullness are noted. Blood tests reveal elevated total and direct bilirubin, alanine aminotransferase, and aspartate aminotransferase. Partial thromboplastin time and prothrombin time are within normal limits. Mild to moderate abdominal ascites is found on an ultrasound study.
      What is the most likely cause of her condition?

      Your Answer:

      Correct Answer: Occlusion of the hepatic vein

      Explanation:

      Differential diagnosis of a patient with abdominal pain, hepatomegaly, and ascites

      Budd-Chiari syndrome and other potential causes

      When a patient presents with abdominal pain, tender hepatomegaly, and ascites, one possible diagnosis is Budd-Chiari syndrome, which can have an acute or chronic course and is more common in pregnant women or those taking oral contraceptives. In the acute form, liver function tests show elevated bilirubin and liver enzymes. However, other conditions should also be considered.

      Ruptured hepatic adenoma can cause intraperitoneal bleeding and shock, but it does not explain the liver function abnormalities. Occlusion of the portal vein may be asymptomatic or cause mild symptoms, and liver function tests are usually normal. Fulminant viral hepatitis typically has a prodromal phase and signs of liver failure, such as coagulopathy. Drug-induced hepatic necrosis, such as from paracetamol overdose or halothane exposure, can also lead to fulminant liver failure, but the patient’s history does not suggest this possibility.

      Therefore, while Budd-Chiari syndrome is a plausible diagnosis, the clinician should also consider other potential causes and obtain more information from the patient, including any medication use or exposure to hepatotoxic agents.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 9 - A 38-year-old woman is brought to the Emergency Department by her partner due...

    Incorrect

    • A 38-year-old woman is brought to the Emergency Department by her partner due to increasing confusion and abdominal distension. Collateral history indicates increasing forgetfulness over the last 12 months and that other members of the family have had similar symptoms although further details are not available. Examination identifies hepatomegaly and ascites. The patient is noted to have a shuffling gait and tremor. Ultrasound of the liver confirms the presence of cirrhosis.
      Which one of the following tests would most likely confirm the suspected diagnosis?

      Your Answer:

      Correct Answer: Serum ceruloplasmin

      Explanation:

      Understanding Wilson’s Disease: Symptoms, Diagnosis, and Treatment

      Wilson’s disease is a rare genetic disorder that causes copper to accumulate in the liver and brain, leading to a range of symptoms including neuropsychiatric issues, liver disease, and parkinsonism. Diagnosis is typically based on low serum ceruloplasmin and low serum copper, as well as the presence of Kayser-Fleischer rings in the cornea. Treatment involves a low copper diet and the use of copper chelators like penicillamine, with liver transplant as a potential option for severe cases. Other conditions, such as α-1-antitrypsin deficiency and autoimmune hepatitis, can cause liver disease but do not typically present with parkinsonian symptoms. Understanding the unique features of Wilson’s disease is crucial for accurate diagnosis and effective treatment.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 10 - A 36-year-old man complained of abdominal pain and weight loss. Upon investigation, he...

    Incorrect

    • A 36-year-old man complained of abdominal pain and weight loss. Upon investigation, he was diagnosed with coeliac disease. The biopsy of his small intestine revealed blunting of villi with crypt hyperplasia and intraepithelial lymphocytes ++. What is the stage of his disease?

      Your Answer:

      Correct Answer: III

      Explanation:

      The Marsh Criteria: A Morphological Classification of Coeliac Disease Biopsy

      Coeliac disease is a condition that affects the small intestine, causing damage to the lining and leading to malabsorption of nutrients. The Marsh criteria is a morphological classification system used to diagnose coeliac disease through intestinal biopsy.

      The classification system consists of four stages, with stage 0 indicating a normal biopsy and stage IV indicating total villous atrophy. In between, stages I-III show varying degrees of damage to the duodenal villi, intraepithelial lymphocytes, and crypts.

      Recently, the Marsh-Oberhuber classification was introduced, which subdivides stage III into three classes based on the degree of villous atrophy. Stage IV has been eliminated from this modified version.

      In coeliac disease and other inflammatory conditions, such as milk protein allergy, the pattern of intraepithelial lymphocytes may be reversed. In stage I disease, only increased intraepithelial lymphocytes would be seen on biopsy, while stage 0 would appear normal. Class II disease would show normal duodenal villi, and stage IV would be associated with crypt atrophy.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 11 - An 82-year-old man presents to his General Practitioner (GP) with a 4-month history...

    Incorrect

    • An 82-year-old man presents to his General Practitioner (GP) with a 4-month history of progressively worsening jaundice. His wife says that she noticed it a while ago, but her husband has been reluctant to come to see the GP. The man does not complain of any abdominal pain and on examination no masses are felt. He agrees when asked by the GP that he has lost quite some weight recently. The patient has a strong alcohol history and has been smoking 20 cigarettes daily since he was in his twenties. The GP refers the patient to secondary care.
      Which one of the following is the most likely diagnosis for this patient?

      Your Answer:

      Correct Answer: Pancreatic cancer

      Explanation:

      Differential Diagnosis of Painless Jaundice in a Patient with Risk Factors for Pancreatic Cancer

      This patient presents with painless jaundice, which is most suggestive of obstructive jaundice due to a tumour in the head of the pancreas. The patient also has strong risk factors for pancreatic cancer, such as smoking and alcohol. However, other conditions should be considered in the differential diagnosis, such as chronic cholecystitis, chronic pancreatitis, cholangiocarcinoma, and chronic liver disease.

      Chronic cholecystitis is unlikely to be the cause of painless jaundice, as it typically presents with colicky abdominal pain and gallstones on ultrasound. Chronic pancreatitis is a possible diagnosis, given the patient’s risk factors, but it usually involves abdominal pain and fatty diarrhoea. Cholangiocarcinoma is a rare cancer that develops in the bile ducts and can cause jaundice, abdominal pain, and itching. Primary sclerosing cholangitis is a risk factor for cholangiocarcinoma. Chronic liver disease is also a possible consequence of alcohol abuse, but it usually involves other signs such as nail clubbing, palmar erythema, and spider naevi.

      Therefore, a thorough evaluation of the patient’s medical history, physical examination, laboratory tests, and imaging studies is necessary to confirm the diagnosis of pancreatic cancer and rule out other potential causes of painless jaundice. Early detection and treatment of pancreatic cancer are crucial for improving the patient’s prognosis and quality of life.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 12 - A 31-year-old woman complains of abdominal pain, nausea, and vomiting. An ultrasound scan...

    Incorrect

    • A 31-year-old woman complains of abdominal pain, nausea, and vomiting. An ultrasound scan reveals the presence of gallstones and an abnormal dilation of the common bile duct measuring 7 mm. The patient is currently taking morphine for pain relief. After four hours, the pain subsides, and she is discharged without any symptoms. Two weeks later, she returns for a follow-up visit and reports being symptom-free. What is the most appropriate next step in managing her condition?

      Your Answer:

      Correct Answer: Laparoscopic cholecystectomy

      Explanation:

      The patient had symptoms of biliary colic, including nausea, vomiting, and right upper quadrant pain, and an ultrasound scan revealed gallstones and a dilated common bile duct. While the patient’s pain has subsided, there is a risk of complications from gallstone disease. Magnetic resonance cholangiopancreatography is a non-invasive diagnostic procedure that visualizes the biliary and pancreatic ducts, but it does not offer a management option. Endoscopic retrograde cholangiopancreatography can diagnose and treat obstruction caused by gallstones, but it is only a symptomatic treatment and not a definitive management. Repeat ultrasound has no added value in management. The only definitive management for gallstones is cholecystectomy, or removal of the gallbladder. Doing nothing puts the patient at risk of complications.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 13 - A 55-year-old man presents to the clinic with abnormal liver function tests (LFTs)....

    Incorrect

    • A 55-year-old man presents to the clinic with abnormal liver function tests (LFTs). He reports drinking no more than 3 units of alcohol per week and has no significant medical history. The patient was prescribed amoxicillin by his primary care physician for a sinus infection two weeks ago.

      During the physical examination, the patient's BMI is found to be 40 kg/m2, indicating obesity. The LFTs reveal:

      - ALT 120 U/L (5-40)
      - AST 130 U/L (10-40)
      - Alkaline phosphatase 200 U/L (45-105)

      What is the most likely cause of this liver function test derangement?

      Your Answer:

      Correct Answer: Non-alcoholic fatty liver disease

      Explanation:

      Non-Alcoholic Fatty Liver Disease (NAFLD) as a Cause of Liver Enzyme Abnormalities

      Non-alcoholic fatty liver disease (NAFLD) is a common cause of liver enzyme abnormalities, characterized by the accumulation of fat in the liver leading to inflammation. It is often associated with obesity, hypertension, dyslipidemia, and insulin resistance, which are part of the metabolic syndrome. However, other causes of hepatitis should be ruled out before making a diagnosis of NAFLD.

      Patients who are obese and diabetic are advised to lose weight and control their diabetes. A low-fat, low-calorie diet is usually recommended alongside treatment to lower HbA1c. Patients with NAFLD should avoid alcohol or other substances that could be harmful to the liver.

      It is important to note that deranged liver enzymes are not listed as side effects for amoxicillin in the British National Formulary. Therefore, if a patient presents with liver enzyme abnormalities, NAFLD should be considered as a possible cause and appropriate investigations should be carried out to confirm the diagnosis.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 14 - A 35-year-old patient presents with an abdominal mass that is primarily located around...

    Incorrect

    • A 35-year-old patient presents with an abdominal mass that is primarily located around the caecum and also involves the terminal ileum. There are no signs of weight loss or lymphadenopathy. The patient has a history of multiple oral ulcers and severe perianal disease, including fissures, fistulae, and previous abscesses that have required draining.

      What is the probable diagnosis?

      Your Answer:

      Correct Answer: Crohn's disease

      Explanation:

      Crohn’s Disease

      Crohn’s disease is a condition that affects different parts of the digestive tract. The location of the disease can be classified as ileal, colonic, ileo-colonic, or upper gastrointestinal tract. In some cases, the disease can cause a solid, thickened mass around the caecum, which also involves the terminal ileum. This is known as ileo-colonic Crohn’s disease.

      While weight loss is a common symptom of Crohn’s disease, it is not always present. It is important to note that the range of areas affected by the disease makes it unlikely for it to be classified as anything other than ileo-colonic Crohn’s disease.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 15 - A 35-year-old man with a family history of colorectal cancer presents for genetic...

    Incorrect

    • A 35-year-old man with a family history of colorectal cancer presents for genetic screening. Genetic testing is performed and he is diagnosed with hereditary non-polyposis colorectal cancer syndrome (HNPCC, or Lynch syndrome).
      What is his lifetime risk for developing colorectal cancer?

      Your Answer:

      Correct Answer: 50–70%

      Explanation:

      Understanding the Lifetime Risk of Colorectal Cancer in Hereditary Syndromes

      Hereditary syndromes such as HNPCC and FAP are associated with an increased risk of developing colorectal cancer. HNPCC syndrome has a lifetime risk of approximately 50-70% for colorectal cancer, as well as an increased risk for endometrial and ovarian cancer. Screening is recommended from age 25 and should include annual colonoscopy and other tests for women. FAP, on the other hand, has a 100% lifetime risk for colorectal cancer. Underestimating the lifetime risk for HNPCC syndrome can be dangerous, as it may lead to delayed or inadequate screening. It is important to understand the risks associated with these hereditary syndromes and to follow recommended screening guidelines.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 16 - A 33-year-old former intravenous (iv) drug abuser presents to outpatient clinic with abnormal...

    Incorrect

    • A 33-year-old former intravenous (iv) drug abuser presents to outpatient clinic with abnormal liver function tests (LFTs) at the recommendation of his general practitioner. Although he is not experiencing any symptoms, a physical examination reveals hepatomegaly measuring 4 cm. Further blood tests confirm that he is positive for hepatitis C, with a significantly elevated viral load of hepatitis C RNA. What would be the most crucial investigation to determine the appropriate management of his hepatitis C?

      Your Answer:

      Correct Answer: Hepatitis C genotype

      Explanation:

      Hepatitis C Management and Testing

      Hepatitis C is a viral infection that can be acquired through blood or sexual contact, including shared needles during intravenous drug use and contaminated blood products. While some patients may be asymptomatic, the virus can cause progressive damage to the liver and may lead to liver failure requiring transplantation if left untreated.

      Before starting treatment for chronic hepatitis C, it is important to determine the patient’s hepatitis C genotype, as this guides the length and type of treatment and predicts the likelihood of response. Dual therapy with interferon α and ribavirin is traditionally the most effective treatment, but newer oral medications like sofosbuvir, boceprevir, and telaprevir are now used in combination with PEG-interferon and ribavirin for genotype 1 hepatitis C.

      Screening for HIV is also important, as HIV infection often coexists with hepatitis C, but the result does not influence hepatitis C management. An ultrasound of the abdomen can determine the structure of the liver and the presence of cirrhosis, but it does not alter hepatitis C management. A chest X-ray is not necessary in this patient, and ongoing intravenous drug use does not affect hepatitis C management.

      Overall, proper testing and management of hepatitis C can prevent further liver damage and improve patient outcomes.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 17 - A 50-year-old woman presents with difficult-to-manage diabetes mellitus. She was diagnosed with gallstones...

    Incorrect

    • A 50-year-old woman presents with difficult-to-manage diabetes mellitus. She was diagnosed with gallstones a year earlier. She also complains of steatorrhoea and diarrhoea. There has been some weight loss over the past 6 months.
      Investigations:
      Investigation Result Normal value
      Haemoglobin 119 g/l 115–155 g/l
      White cell count (WCC) 4.7 × 109/l 4–11 × 109/l
      Platelets 179 × 109/l 150–400 × 109/l
      Sodium (Na+) 139 mmol/l 135–145 mmol/l
      Potassium (K+) 4.7 mmol/l 3.5–5.0 mmol/l
      Creatinine 120 μmol/l 50–120 µmol/l
      Glucose 9.8 mmol/l 3.5–5.5 mmol/l
      Somatostatin 105 pg/ml 10–22 pg/ml
      T1-weighted gadolinium-enhanced magnetic resonance imaging (MRI): 4-cm pancreatic tumour
      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Somatostatinoma

      Explanation:

      Overview of APUD Cell Tumours and their Presentations

      APUD cell tumours are rare and can affect various organs in the body. Some of the most common types include somatostatinoma, glucagonoma, insulinoma, gastrinoma, and VIPoma. These tumours can present with a range of symptoms, such as gallstones, weight loss, diarrhoea, diabetes mellitus, necrolytic migratory erythema, sweating, light-headedness, and peptic ulceration. Diagnosis can be challenging, but imaging techniques and hormone measurements can aid in identifying the tumour. Treatment options include surgery, chemotherapy, and hormone therapy. It is important to note that some of these tumours may be associated with genetic syndromes, such as MEN 1 syndrome.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 18 - A 32-year-old woman who was diagnosed with ulcerative colitis (UC) five years ago...

    Incorrect

    • A 32-year-old woman who was diagnosed with ulcerative colitis (UC) five years ago is seeking advice on the frequency of colonoscopy in UC. Her UC is currently under control, and she has no family history of malignancy. She had a routine colonoscopy about 18 months ago. When should she schedule her next colonoscopy appointment?

      Your Answer:

      Correct Answer: In four years' time

      Explanation:

      Colonoscopy Surveillance for Patients with Ulcerative Colitis

      Explanation:
      Patients with ulcerative colitis (UC) are at an increased risk for colonic malignancy. The frequency of colonoscopy surveillance depends on the activity of the disease and the family history of colorectal cancer. Patients with well-controlled UC are considered to be at low risk and should have a surveillance colonoscopy every five years, according to the National Institute for Health and Care Excellence (NICE) guidelines. Patients at intermediate risk should have a surveillance colonoscopy every three years, while patients in the high-risk group should have annual screening. It is important to ask about the patient’s family history of colorectal cancer to determine their risk stratification. Colonoscopy is not only indicated if the patient’s symptoms deteriorate, but also for routine surveillance to detect any potential malignancy.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 19 - A 45-year-old woman presents with sudden onset of constant abdominal pain. She tells...

    Incorrect

    • A 45-year-old woman presents with sudden onset of constant abdominal pain. She tells you she has a history of peptic ulcers. The pain is worse with inspiration and movement.
      On examination, there is rebound tenderness and guarding. There are absent bowel sounds. A chest X-ray shows free air under the diaphragm.
      What clinical sign tells you that the peritonitis involves the whole abdomen and is not localised?

      Your Answer:

      Correct Answer: Absent bowel sounds

      Explanation:

      Understanding the Signs and Symptoms of Peritonitis

      Peritonitis is a condition characterized by inflammation of the peritoneum, the membrane lining the abdominal and pelvic cavity. It can be caused by various factors, including organ inflammation, viscus perforation, and bowel obstruction. Here are some of the common signs and symptoms of peritonitis:

      Absent Bowel Sounds: This is the most indicative sign of generalised peritonitis, but it can also be present in paralytic ileus or complete bowel obstruction.

      Guarding: This is the tensing of muscles of the abdominal wall, detected when palpating the abdomen, which protects an inflamed organ. It is present in localised and generalised peritonitis.

      Pain Worse on Inspiration: Pain on inspiration can be a sign of either local or generalised peritonitis – the pain associated with peritonitis can be aggravated by any type of movement, including inspiration or coughing.

      Rebound Tenderness: This is a clinical sign where pain is elicited upon removal of pressure from the abdomen, rather than on application of pressure. It is indicative of localised or generalised peritonitis.

      Constant Abdominal Pain: This can have various causes, including bowel obstruction, necrotising enterocolitis, colonic infection, peritoneal dialysis, post-laparotomy or laparoscopy, and many more.

      Understanding these signs and symptoms can help in the early detection and treatment of peritonitis. If you experience any of these symptoms, it is important to seek medical attention immediately.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 20 - A 55-year-old man presents to the general practitioner (GP) with a 6-month history...

    Incorrect

    • A 55-year-old man presents to the general practitioner (GP) with a 6-month history of increasing difficulty with swallowing solid foods. He does not have any problems with swallowing liquids. He has always been overweight but has lost 5 kg in the past few months. He attributes this eating a little less due to his swallowing difficulties. He has a past history of long-term heartburn and indigestion, which he has been self-treating with over-the-counter antacids. The GP is concerned that the patient may have oesophageal cancer.
      Which one of the following statements with regard to oesophageal cancer is correct?

      Your Answer:

      Correct Answer: Achalasia predisposes to squamous carcinoma of the oesophagus

      Explanation:

      Understanding Oesophageal Carcinoma: Risk Factors, Diagnosis, and Prognosis

      Oesophageal carcinoma is a type of cancer that affects the oesophagus, the muscular tube that connects the throat to the stomach. In this article, we will discuss the risk factors, diagnosis, and prognosis of oesophageal carcinoma.

      Risk Factors

      Achalasia, a condition that affects the ability of the oesophagus to move food down to the stomach, and alcohol consumption are associated with squamous carcinoma, which most commonly affects the upper and middle oesophagus. Barrett’s oesophagus, a pre-malignant condition that may lead to squamous carcinoma, and gastro-oesophageal reflux disease (GORD) predispose to adenocarcinoma, which occurs in the lower oesophagus.

      Diagnosis

      Barrett’s oesophagus is a recognised pre-malignant condition that requires acid-lowering therapy and frequent follow-up. Ablative and excisional therapies are available. Most cases are amenable to curative surgery at diagnosis. Dysphagia, or difficulty swallowing, is an early manifestation of the disease and is typically experienced with solid foods.

      Prognosis

      Prognosis depends on the stage and grade at diagnosis, but unfortunately, the disease frequently presents once the cancer has spread. Therefore, early detection and treatment are crucial for improving outcomes.

      Conclusion

      Oesophageal carcinoma is a serious condition that requires prompt diagnosis and treatment. Understanding the risk factors, diagnosis, and prognosis can help individuals take steps to reduce their risk and seek medical attention if symptoms arise.

    • This question is part of the following fields:

      • Gastroenterology
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