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  • Question 1 - A 17-year-old Caucasian woman presents with lethargy and chronic nausea. Her mother is...

    Correct

    • A 17-year-old Caucasian woman presents with lethargy and chronic nausea. Her mother is worried she may be depressed. On examination, there are signs of chronic liver disease and a gold-yellow ring at the periphery of the iris in both eyes. Her serum copper level is low. What is the most likely diagnosis?

      Your Answer: Wilson’s disease

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
      25.7
      Seconds

  • Question 2 - Which of the following is most commonly associated with the development of pseudomembranous...

    Incorrect

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

      Your Answer: Ciprofloxacin

      Correct Answer: Cefuroxime

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
      20.1
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  • Question 3 - A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and...

    Incorrect

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

      Your Answer: Colonoscopy

      Correct Answer: Trial of dairy-free diet

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 4 - A 62-year-old female with a history of COPD and hypertension presents with pain...

    Incorrect

    • A 62-year-old female with a history of COPD and hypertension presents with pain on swallowing. Current medication includes a salbutamol and becotide inhaler, bendrofluazide and amlodipine. What is the most likely cause of the presentation?

      Your Answer: Myasthenia gravis precipitated by bendrofluazide

      Correct Answer: Oesophageal candidiasis

      Explanation:

      The history gives you a woman who is on inhaled steroid therapy. It is always a good idea for patients to rinse their mouths well after using inhaled steroids. Odynophagia (pain on swallowing) is a symptom of oesophageal candidiasis, which is the most likely answer given the steroids. Typically, you might see this in someone who is immunocompromised (classically, in HIV+ patients).

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 5 - 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: Arrange a jejunal biopsy

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

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
      31.5
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  • Question 6 - A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling...

    Incorrect

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

      Your Answer: Antiglutamic acid decarboxylase (GAD)

      Correct Answer: Anti-intrinsic factor (IF)

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 7 - An 18 year old prospective medical student is tested for hepatitis B. Her...

    Incorrect

    • An 18 year old prospective medical student is tested for hepatitis B. Her liver tests show alanine transaminase (ALT) 120 U/L and serology shows her to be positive for HBsAg, HBcAb and HBeAg, with a viral load of 105 genome equivalents/mL. A liver biopsy is reported as showing early fibrosis with evidence of moderate inflammation. Which of the following treatments should be offered?

      Your Answer:

      Correct Answer: Interferon alfa 2b

      Explanation:

      Interferon alfa alone, not interferon alfa and ribavirin, has been shown to achieve HBeAg seroconversion for patients with HBeAg-positive chronic hepatitis B.

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      • Gastroenterology
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  • Question 8 - A 16-year-old female presents with a two day history of right iliac fossa...

    Incorrect

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

      Your Answer:

      Correct Answer: Alvarado score

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 9 - A 27-year-old man with a long history of heavy alcohol intake is admitted...

    Incorrect

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

      Your Answer:

      Correct Answer: Mallory-Weiss tear

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 10 - 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 11 - A baby is born to a mother who is known to have chronic...

    Incorrect

    • A baby is born to a mother who is known to have chronic hepatitis B. The mothers latest results are as follows: HBsAg: Positive, HBeAg: Positive. What is the most appropriate strategy for reducing the vertical transmission rate?

      Your Answer:

      Correct Answer: Give the newborn hepatitis B vaccine + hepatitis B immunoglobulin

      Explanation:

      The Green Book guidelines report in an active infection (HBeAg+ and HBsAg+) to give the vaccine as well as immunoglobulin. If antibodies are present it is not active infection (anti-Hbe) and then in that case only the vaccine, and no immunoglobulin, would be given. The presence of HBeAg means a person is infectious and can transmit to other people.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 12 - A 28-year-old woman attends for review. She has a past history of a...

    Incorrect

    • A 28-year-old woman attends for review. She has a past history of a perianal abscess but nothing else of note. During the past few months she has twice presented to A&E complaining of grumbling abdominal pain. In addition, she has suffered intermittent episodes of bloody diarrhoea. Microcytic anaemia is found on blood testing and she has mild hypokalaemia. Albumin is reduced but other liver function tests are unremarkable. Barium imaging reveals a small bowel stricture with evidence of mucosal ulceration extending into the colon, interspersed with normal looking mucosa ‘skipping’. Given this clinical picture, which is the most likely diagnosis?

      Your Answer:

      Correct Answer: Crohn’s disease

      Explanation:

      The correct answer based on the clinical scenario is Crohn’s disease. Associated with this disease are abscesses and fistulas in the anorectal region, skip lesions, cobble stoning, stricturing, granulomas, and crypt distortion. The other answer choices are not correct. How to rule out ulcerative colitis: it only involves ileocolorectal regions, and this is above that level. You will not see crypt distortion and cobble stoning; it is a more superficial process.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 13 - A 17-year-old boy presents with a 2 day history of colicky abdominal pain,...

    Incorrect

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

      Your Answer:

      Correct Answer: Campylobacter infection

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 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.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 15 - A 27 year old woman presents with diarrhoea. She has had a previous...

    Incorrect

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

      Your Answer:

      Correct Answer: Bile Acid Malabsorption

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 16 - 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 17 - A 35-year-old gentleman with a history of alcohol excess presents to hospital with...

    Incorrect

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

      Your Answer:

      Correct Answer: Paracentesis

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 18 - 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 19 - With respect to liver cirrhosis, which of the following statements is correct? ...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 20 - A 42-year-old man with alcoholic liver disease is admitted with pyrexia. He has...

    Incorrect

    • A 42-year-old man with alcoholic liver disease is admitted with pyrexia. He has been unwell for the past three days and has multiple previous admissions before with variceal bleeding. Examination shows multiple stigmata of chronic liver disease, ascites and jaundice. Paracentesis is performed with the following results: Neutrophils 487 cells/ul. What is the most appropriate treatment?

      Your Answer:

      Correct Answer: Intravenous cefotaxime

      Explanation:

      This describes a clinical scenario of spontaneous bacterial peritonitis. The diagnosis is made when fluid removed (ascites) is found to have > 250/mm cubed of PMNs (polymorphonuclear leukocytes). Cefotaxime or another third generation cephalosporin is the treatment of choice.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 21 - A 29-year-old woman presents to clinic complaining of intermittent diarrhoea and constipation. Full...

    Incorrect

    • A 29-year-old woman presents to clinic complaining of intermittent diarrhoea and constipation. Full blood count and viscosity were normal. Flexible sigmoidoscopy was unremarkable. What is the next most appropriate management step?

      Your Answer:

      Correct Answer: High-fibre diet

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 22 - Which of the following statements is true concerning gastrin? ...

    Incorrect

    • Which of the following statements is true concerning gastrin?

      Your Answer:

      Correct Answer: Release is triggered by GI luminal peptides

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 23 - Which one of the following is most associated with the development of acute...

    Incorrect

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

      Your Answer:

      Correct Answer: Hyperchylomicronaemia

      Explanation:

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

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      • Gastroenterology
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  • Question 24 - 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 25 - A 45-year-old female develops profuse watery diarrhoea with lower abdominal pain seven days...

    Incorrect

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

      Your Answer:

      Correct Answer: Pseudomembranous colitis

      Explanation:

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

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      • Gastroenterology
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  • Question 26 - A 62-year-old woman with scleroderma and Reynaud’s phenomenon complains of weight loss and...

    Incorrect

    • A 62-year-old woman with scleroderma and Reynaud’s phenomenon complains of weight loss and has been referred for an opinion. Gastrointestinal associations of progressive systemic sclerosis include which of the following?

      Your Answer:

      Correct Answer: Oesophageal stricture

      Explanation:

      Oesophageal stricture is a complication of systemic sclerosis, think of the oesophagus as sclerosing (fibrosing) leading to stricture and you never forget. Based on the clinical presentation of systemic sclerosis this is more likely than pancreatic dysfunction, PSC, lymphoma, or diverticulitis. Additionally, CREST syndrome stands for: calcinosis cutis, Raynaud’s phenomenon (which the patient has), oesophageal dysmotility, sclerodactyly, and telangiectasias), this is a form of systemic sclerosis you should be familiar with.

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      • Gastroenterology
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  • Question 27 - 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 28 - 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.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 29 - 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.

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      • Gastroenterology
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  • Question 30 - A 24 year old presents with diarrhoea. She has had a previous ileal...

    Incorrect

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

      Your Answer:

      Correct Answer: Short bowel syndrome

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Gastroenterology (1/6) 17%
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