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Question 1
Incorrect
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A 25-year-old professional who is working long hours develops intermittent periods of abdominal pain and bloating. She also notices a change in bowel habit and finds that going to the restroom helps to relieve her abdominal pain.
Which of the following drug treatments may help in the treatment of her colic and bloating symptoms?Your Answer: Loperamide
Correct Answer: Mebeverine
Explanation:Treatment Options for Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a common functional bowel disorder that affects mostly young adults, with women being more commonly affected than men. The diagnosis of IBS can be established using the Rome IV criteria, which includes recurrent abdominal pain or discomfort for at least one day per week in the last three months, along with two or more of the following: improvement with defecation, onset associated with a change in frequency of stool, or onset associated with a change in form (appearance) of the stool.
There are several treatment options available for IBS, depending on the predominant symptoms. Mebeverine, an antispasmodic, can be used to relieve colicky abdominal pain. Loperamide can be useful for patients with diarrhea-predominant IBS (IBS-D), while osmotic laxatives such as macrogols are preferred for constipation-predominant IBS (IBS-C). Cimetidine, a histamine H2 receptor antagonist, can help with acid reflux symptoms, but is unlikely to help with colic or bloating. Metoclopramide, a D2 dopamine receptor antagonist, is used as an antiemetic and prokinetic, but is not effective for colic and bloating symptoms.
In summary, treatment options for IBS depend on the predominant symptoms and can include antispasmodics, laxatives, and acid reflux medications. It is important to consult with a healthcare provider to determine the best course of treatment for each individual patient.
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This question is part of the following fields:
- Gastroenterology
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Question 2
Incorrect
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A 50-year-old man who has recently had a gastrectomy is informed that he will experience a deficiency in vitamin B12. What is the probable physiological reasoning behind this?
Your Answer: Achlorohydria
Correct Answer: Loss of intrinsic factors
Explanation:Effects of Gastrectomy on Nutrient Absorption and Digestion
Gastrectomy, whether partial or complete, can have significant effects on nutrient absorption and digestion. One of the most important consequences is the loss of intrinsic factors, which are necessary for the absorption of vitamin B12 in the ileum. Intrinsic factor is produced by the gastric parietal cells, which are mostly found in the body of the stomach. Without intrinsic factor, vitamin B12 cannot be absorbed and stored in the liver, leading to megaloblastic anemia and potentially serious complications such as dilated cardiomyopathy or subacute degeneration of the spinal cord.
Another consequence of gastrectomy is the loss of storage ability, which can cause early satiety and abdominal bloating after meals. This is due to the fact that the stomach is no longer able to hold as much food as before, and the remaining small intestine has to compensate for the missing stomach volume.
Achlorohydria is another common problem after gastrectomy, as the parietal cells that produce hydrochloric acid are also lost. This can lead to a range of symptoms such as abdominal bloating, diarrhea, indigestion, weight loss, malabsorption, and bacterial overgrowth of the small intestine.
Failed gastric emptying is not a major concern after gastrectomy, as it is unlikely to cause vitamin B12 deficiency. However, increased upper GI gut transit can affect the rate of nutrient absorption and lead to symptoms such as diarrhea and weight loss. Overall, gastrectomy can have significant effects on nutrient absorption and digestion, and patients should be closely monitored for any signs of malnutrition or complications.
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This question is part of the following fields:
- Gastroenterology
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Question 3
Correct
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A 47-year-old man presents to the Hepatology Clinic with mild elevations in levels of alkaline phosphatase (ALP) and aminotransferases. He has a history of type 2 diabetes mellitus and obesity, but denies alcohol use and past drug use. On physical examination, he is found to be obese with hepatomegaly. Laboratory studies show negative results for hepatitis and autoimmune liver disease. His aminotransferase, ALP, and autoimmune liver results are provided. What is the most appropriate treatment for this patient?
Your Answer: Weight loss
Explanation:Understanding Non-Alcoholic Fatty Liver Disease and Treatment Options
Non-Alcoholic Fatty Liver Disease (NAFLD) is a condition characterized by hepatic steatosis in the absence of alcohol or drug misuse. Patients with NAFLD often have other metabolic conditions such as obesity, hypertension, and dyslipidemia. Diagnosis involves ruling out other causes of hepatomegaly and demonstrating hepatic steatosis through liver biopsy or radiology. Conservative management with weight loss and control of cardiovascular risk factors is the mainstay of treatment, as there are currently no recommended medications for NAFLD.
Azathioprine is an immunosuppressive medication used in the management of autoimmune hepatitis. Before starting a patient on azathioprine, TPMT activity should be tested for, as those with low TPMT activity have an increased risk of azathioprine-induced myelosuppression. Liver transplant is indicated for patients with declining hepatic function or liver cirrhosis, which this patient does not have.
Naltrexone can be used for symptomatic relief of pruritus in patients with primary biliary cholangitis (PBC), but this patient has negative antibodies for autoimmune liver disease. Oral steroids are indicated in patients with autoimmune liver disease, which this patient does not have. Overall, understanding the diagnosis and treatment options for NAFLD is crucial for managing this condition effectively.
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This question is part of the following fields:
- Gastroenterology
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Question 4
Incorrect
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A 55-year-old woman presents to her General Practitioner (GP) after her friends told her that her skin and eyes have become yellow. She says that she has noticed this too, but over the past month it has become worse. Her clothes have become loose lately. Her past medical history includes type II diabetes mellitus, hypertension, dyslipidaemia and chronic obstructive pulmonary disease (COPD).
She has a 30-pack-year smoking history and consumes approximately 30 units of alcohol per week. In the past, the patient has had repeated admissions to the hospital for episodes of pancreatitis and she mentions that the surgeon explained to her that her pancreas has become scarred from these repeated episodes and is likely to cause her ongoing abdominal pain.
Which of the following is a risk factor for this patient’s most likely diagnosis?Your Answer:
Correct Answer: Chronic pancreatitis
Explanation:Risk Factors for Pancreatic Cancer
Pancreatic cancer is a serious condition that can be caused by various risk factors. One of the most common risk factors is chronic pancreatitis, which is often caused by excessive alcohol intake. Other risk factors include smoking, diabetes mellitus, and obesity.
In the case of a patient with weight loss and painless jaundice, pancreatic cancer is the most likely diagnosis. This is supported by the patient’s history of repeated acute pancreatitis due to alcohol abuse, which can lead to chronic pancreatitis and increase the risk of developing pancreatic cancer.
COPD, on the other hand, is caused by smoking but is not a direct risk factor for pancreatic cancer. Obesity is also a risk factor for pancreatic cancer, as it increases the risk of developing diabetes mellitus, which in turn increases the risk of pancreatic cancer. Hypertension, however, is not a recognised risk factor for pancreatic cancer.
It is important to identify and address these risk factors in order to prevent the development of pancreatic cancer. Quitting smoking, reducing alcohol intake, maintaining a healthy weight, and managing diabetes mellitus and hypertension can all help to reduce the risk of developing this serious condition.
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This question is part of the following fields:
- Gastroenterology
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Question 5
Incorrect
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A 38-year-old man presents to the clinic after an insurance medical. He was noted to have an abnormal alanine aminotransferase (ALT). Past history includes obesity, hypertension and hypercholesterolaemia, which he manages with diet control. He denies any significant alcohol intake. He has a body mass index (BMI) of 31.
Investigations:
Investigation Result Normal value
Haemoglobin 139 g/l 135–175 g/l
White cell count (WCC) 4.1 × 109/l 4–11 × 109/l
Platelets 394 × 109/l 150–400 × 109/l
Sodium (Na+) 143 mmo/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 85 μmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 150 IU/l 5–30 IU/l
Alkaline phosphatase 95 IU/l 30–130 IU/l
Bilirubin 28 μmol/l 2–17 µmol/l
Total cholesterol 6.8 mmol/l < 5.2 mmol/l
Triglycerides 3.8 mmol/l 0–1.5 mmol/l
Ultrasound of liver Increase in echogenicity
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Non-alcoholic fatty liver disease (NAFLD)
Explanation:Understanding Liver Diseases: NAFLD, Viral Hepatitis, Alcohol-related Cirrhosis, Wilson’s Disease, and Haemochromatosis
Liver diseases can have various causes and presentations. One of the most common is non-alcoholic fatty liver disease (NAFLD), which is closely associated with obesity, hypertension, diabetes, and dyslipidaemia. NAFLD is often asymptomatic, but some patients may experience tiredness or epigastric fullness. Weight loss is the primary treatment, although glitazones have shown promising results in improving liver function.
Viral hepatitis is another common liver disease, but there are no indicators of it in this patient’s history. Alcohol-related cirrhosis is often caused by excessive alcohol intake, but this patient denies alcohol consumption, making NAFLD a more likely diagnosis.
Wilson’s disease typically presents with neuropsychiatric symptoms or signs, and the presence of Kayser-Fleischer rings is a key diagnostic feature. Haemochromatosis, on the other hand, results from iron overload and is often associated with diabetes mellitus and bronzing of the skin.
Understanding the different types of liver diseases and their presentations is crucial in making an accurate diagnosis and providing appropriate treatment.
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This question is part of the following fields:
- Gastroenterology
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Question 6
Incorrect
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A 42-year-old man presents to A&E with sudden onset of severe epigastric pain and bright red blood in his vomit. He has a long history of heavy alcohol consumption. On examination, he has guarding over the epigastric region and cool extremities. He also has a distended abdomen with ascites and spider naevi on his neck and cheek. The patient is unstable hemodynamically, and fluid resuscitation is initiated. What is the most crucial medication to begin given the probable diagnosis?
Your Answer:
Correct Answer: Terlipressin
Explanation:Medications for Oesophageal Variceal Bleeds
Oesophageal variceal bleeds are a serious medical emergency that require prompt treatment. The most important medication to administer in this situation is terlipressin, which reduces bleeding by constricting the mesenteric arterial circulation and decreasing portal venous inflow. Clopidogrel, an antiplatelet medication, should not be used as it may worsen bleeding. Propranolol, a beta-blocker, can be used prophylactically to prevent variceal bleeding but is not the most important medication to start in an acute setting. Omeprazole, a proton pump inhibitor, is not recommended before endoscopy in the latest guidelines but is often used in hospital protocols. Tranexamic acid can aid in the treatment of acute bleeding but is not indicated for oesophageal variceal bleeds. Following terlipressin administration, band ligation should be performed, and if bleeding persists, TIPS should be considered.
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This question is part of the following fields:
- Gastroenterology
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Question 7
Incorrect
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A 56-year-old woman presents with abnormal liver function tests and symptoms of fatigue and itching for the past three months. She reports drinking 5 units of alcohol per week and denies any intravenous recreational drug use. She has no significant medical history and has a body mass index of 24 kg/m2. On examination, she has hepatomegaly but no jaundice. Ultrasound of the liver is normal. Laboratory investigations reveal a serum albumin of 38 g/L, serum alanine aminotransferase of 40 U/L, serum alkaline phosphatase of 286 U/L, and serum total bilirubin of 27 μmol/L. What is the most likely diagnosis?
Your Answer:
Correct Answer: Primary biliary cirrhosis
Explanation:Primary Biliary Cirrhosis: A Breakdown of Immune Tolerance
Primary biliary cirrhosis (PBC) is an autoimmune condition that affects middle-aged women. It is characterized by the breakdown of immune tolerance to mitochondrial antigens, leading to T cell-mediated destruction of the intrahepatic bile ducts. This process results in ductopenia, bile duct injury, and cholestasis, which eventually lead to liver injury and fibrosis, culminating in the development of cirrhosis.
Most patients with PBC are asymptomatic at diagnosis, but eventually develop symptoms such as itching and fatigue. Antimitochondrial antibodies (AMAs) are found in 95% of patients with PBC, making it a useful diagnostic marker.
While primary sclerosing cholangitis (PSC) is a possibility, it is more common in men and is usually accompanied by evidence of strictures or dilation on abdominal ultrasound scan. PSC also has a strong association with inflammatory bowel disease colitis. Alcoholic liver disease and autoimmune hepatitis are unlikely diagnoses in this case, as there is no history of excess alcohol consumption and the transaminitis (raised ALT and/or AST) commonly seen in autoimmune hepatitis is not present.
On the other hand, non-alcoholic fatty liver disease (NAFLD) is more likely to be seen in overweight or obese individuals with other metabolic risk factors such as diabetes mellitus and hyperlipidaemia. It is often incidentally detected through abnormal liver function tests in asymptomatic individuals.
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This question is part of the following fields:
- Gastroenterology
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Question 8
Incorrect
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A 52-year-old male construction worker has been admitted with haematemesis and is scheduled for an urgent upper GI endoscopy. According to the Rockall score, which feature would classify him as being in the high-risk category for a patient presenting with GI bleeding?
Your Answer:
Correct Answer: A history of ischaemic heart disease
Explanation:Scoring Systems for Gastrointestinal Bleed Risk Stratification
There are several scoring systems available to categorize patients with gastrointestinal bleeding into high and low-risk groups. The Rockall scoring system considers age, comorbidities such as ischaemic heart disease, presence of shock, and endoscopic abnormalities. Similarly, the Canadian Consensus Conference Statement incorporates endoscopic factors such as active bleeding, major stigmata of recent haemorrhage, ulcers greater than 2 cm in diameter, and the location of ulcers in proximity to large arteries. The Baylor bleeding score assigns a score to pre- and post-endoscopic features. On the other hand, the Blatchford score is based on clinical parameters alone, including elevated blood urea nitrogen, reduced haemoglobin, a drop in systolic blood pressure, raised pulse rate, the presence of melaena or syncope, and evidence of hepatic or cardiac disease.
These scoring systems are useful in determining the severity of gastrointestinal bleeding and identifying patients who require urgent intervention. By stratifying patients into high and low-risk groups, healthcare providers can make informed decisions regarding management and treatment options. The use of these scoring systems can also aid in predicting outcomes and mortality rates, allowing for appropriate monitoring and follow-up care. Overall, the implementation of scoring systems for gastrointestinal bleed risk stratification is an important tool in improving patient outcomes and reducing morbidity and mortality rates.
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This question is part of the following fields:
- Gastroenterology
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Question 9
Incorrect
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A 45-year-old woman comes to the Surgical Admissions Unit complaining of colicky abdominal pain and vomiting in the right upper quadrant. The pain started while eating but is now easing. During the examination, she appears restless and sweaty, with a pulse rate of 100 bpm and blood pressure of 125/86. An abdominal ultrasound reveals the presence of gallstones.
What is the most frequent type of gallstone composition?Your Answer:
Correct Answer: Cholesterol
Explanation:Gallstones are formed in the gallbladder from bile constituents. In Europe and the Americas, they can be made of pure cholesterol, bilirubin, or a mixture of both. Mixed stones, also known as brown pigment stones, usually contain 20-80% cholesterol. Uric acid is not typically found in gallstones unless the patient has gout. Palmitate is a component of gallstones, but cholesterol is the primary constituent. Increased bilirubin production, such as in haemolysis, can cause bile pigment stones, which are most commonly seen in patients with haemolytic anaemia or sickle-cell disease. Calcium is a frequent component of gallstones, making them visible on radiographs, but cholesterol is the most common constituent.
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This question is part of the following fields:
- Gastroenterology
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Question 10
Incorrect
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A 40-year-old woman has been visiting her doctor frequently over the past year due to recurring episodes of abdominal cramps and diarrhoea. She is concerned about the possibility of bowel cancer, as her father passed away from it at the age of 86. She has no other relevant family history. She also mentions that she needs a refill for her salbutamol inhaler, which she takes for her recently diagnosed asthma. Additionally, she has noticed an increase in hot flashes and wonders if she is experiencing early menopause. She has lost some weight, which she attributes to her healthy diet. What is the most probable diagnosis?
Your Answer:
Correct Answer: Gastrointestinal neuroendocrine tumour (NET)
Explanation:Diagnosis and Management of Gastrointestinal Neuroendocrine Tumour (NET)
A patient presenting with symptoms of diarrhoea, wheezing, and flushing may have a gastrointestinal neuroendocrine tumour (NET), also known as carcinoid syndrome. It is important to consider NET in the differential diagnosis, even in relatively young patients, as the average delay in diagnosis is 2-3 years.
Appropriate investigations include routine blood tests, gut hormone measurement, 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) measurement, cross-sectional imaging, and gastrointestinal endoscopy. Management options include somatostatin analogues, peptide receptor radiotargeted therapy (PRRT), and molecularly targeted treatments such as sunitinib or everolimus.
Health/illness-related anxiety, or hypochondriasis, should be a diagnosis of exclusion, and physical causes should be addressed first. Irritable bowel syndrome may cause similar symptoms, but without hot flashes or asthma. Colorectal or gastric adenocarcinoma may also be considered, but the symptoms are more consistent with a NET.
Most gastrointestinal NETs are low grade, and even in metastatic disease, the median overall survival is around 10 years. Early diagnosis and appropriate management can improve outcomes for patients with NET.
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This question is part of the following fields:
- Gastroenterology
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Question 11
Incorrect
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You are the Foundation Year doctor on the Gastroenterology ward round. The consultant is reviewing a new patient to the ward. This is a 32-year-old man with active Crohn’s disease. From the medical notes, you are aware that the patient has had a number of previous admissions to the Unit and poor response to conventional therapy. The consultant mentions the possibility of using a drug called infliximab, and the patient asks whether this is an antibiotic.
What is the mode of action of infliximab?Your Answer:
Correct Answer: Antibody against tumour necrosis factor-alpha (TNF-α)
Explanation:Common Disease-Modifying Agents and Their Targets
Disease-modifying agents (DMARDs) are a group of drugs used to treat various diseases, including rheumatic disease, gastrointestinal disease, and neurological conditions. These agents have different targets in the immune system, and some of the most common ones are discussed below.
Antibody against Tumour Necrosis Factor-alpha (TNF-α)
TNF-α inhibitors, such as infliximab and adalimumab, are used to treat rheumatic disease and inflammatory bowel disease. These agents increase susceptibility to infection and should not be administered with live vaccines.Antibody against CD20
Rituximab is a monoclonal antibody against CD20 and is used to treat aggressive non-Hodgkin’s lymphoma.Interleukin (IL)-1 Blocker
Anakinra is an IL-1 receptor antagonist used to treat rheumatoid arthritis.α-4 Integrin Antagonist
Natalizumab is a humanised monoclonal antibody against α-4-integrin and is used to treat multiple sclerosis.IL-2 Blocker
Daclizumab is a monoclonal antibody that binds to the IL-2 receptor and is used to prevent acute rejection following renal transplantation.Targets of Disease-Modifying Agents
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This question is part of the following fields:
- Gastroenterology
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Question 12
Incorrect
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A 50-year-old man presents with painless bleeding per rectum for two days. The blood was mixed with stool every time. There was no pain or tenesmus. There has been no loss of weight.
He has never experienced these symptoms before, although he has suffered from constipation over the past three years. At the clinic, he complained of mild fever, although on examination, his temperature was normal.
He has recently returned from a trip to India where he took part in a mountain expedition to Kedarnath. He takes no drugs, with the exception of thyroxine which he has taken for the past two years.
What is the immediate management?Your Answer:
Correct Answer: Stool microscopy & culture
Explanation:Rectal Bleeding in a Patient with a Recent Mountain Expedition
This patient has recently returned from a mountain expedition in a tropical country, where his diet and water intake may have been irregular. As a result, he is at risk of food and water-borne infections such as amoebiasis, which can cause bloody stools. To determine the cause of the bleeding, stool tests and microscopy should be conducted before treatment is initiated.
It is important to note that laxatives should not be used until the cause of the bloody stool is identified. In cases of colonic cancer, laxatives can cause intestinal obstruction, while in conditions such as inflammatory bowel disease, they can irritate the bowel walls and worsen the condition. The patient’s history of constipation is likely due to hypothyroidism, which is being treated.
While chronic liver disease can cause rectal bleeding, there is no indication of such a condition in this patient. When bleeding is caused by piles, blood is typically found on the toilet paper and not mixed with stools. Lower GI endoscopy may be necessary if the bleeding persists, but invasive tests should only be conducted when fully justified.
Observation is not an appropriate course of action in this case. In older patients, rectal bleeding should always be taken seriously and thoroughly investigated to determine the underlying cause.
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This question is part of the following fields:
- Gastroenterology
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Question 13
Incorrect
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A 22-year-old woman presents with unintentional weight loss and blood stained diarrhoea. The blood is fresh, and mucous is often present in the stool. On examination, she has oral ulcers, erythema nodosum and conjunctivitis. The mucosa looks abnormal and multiple biopsies are taken. Ulcerative colitis is suspected.
Which of the following findings would support a diagnosis of ulcerative colitis over Crohn’s disease?Your Answer:
Correct Answer: Crypt abscesses
Explanation:When differentiating between ulcerative colitis and Crohn’s disease, it is important to note that crypt abscesses are typical for ulcerative colitis, while other options are more commonly found in Crohn’s disease. Ulcerative colitis is the most common form of inflammatory bowel disease, with inflammation starting in the rectum and spreading upwards in a contiguous fashion. Patients typically experience left-sided abdominal pain, cramping, bloody diarrhea with mucous, and unintentional weight loss. Extra-intestinal manifestations may include seronegative arthropathy and pyoderma gangrenosum. Barium enema and colonoscopy are used to diagnose ulcerative colitis, with the latter revealing diffuse and contiguous ulceration and inflammatory infiltrates affecting the mucosa and submucosa only. Complications of long-term ulcerative colitis include large bowel adenocarcinoma, toxic megacolon, and primary sclerosing cholangitis. In contrast, Crohn’s disease usually presents with right-sided abdominal pain, watery diarrhea, and weight loss. Barium enema and colonoscopy reveal multiple ulcers and bowel wall thickening, with the microscopic appearance showing a mixed acute and chronic transmural inflammatory infiltrate with non-caseating granulomas. Terminal ileum involvement is typical for Crohn’s disease, while stricturing and fistula formation are common complications due to its transmural inflammatory nature. Overall, while both ulcerative colitis and Crohn’s disease are systemic illnesses, they have distinct differences in their clinical presentation and diagnostic features.
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This question is part of the following fields:
- Gastroenterology
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Question 14
Incorrect
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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.
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This question is part of the following fields:
- Gastroenterology
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Question 15
Incorrect
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A 28-year-old woman presented to her General Practitioner complaining of six months of intermittent uncomfortable abdominal distension and bloating, which changed with her menstrual cycle. These symptoms were interspersed with bouts of loose motions. She worked as a teacher in a busy school and found work very stressful; she had previously taken a course of sertraline for anxiety and depression. Examination, blood test results and sigmoidoscopy were all normal.
What is the most likely diagnosis?Your Answer:
Correct Answer: Irritable bowel syndrome
Explanation:Distinguishing Irritable Bowel Syndrome from Other Gastrointestinal Disorders
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects more women than men and is often associated with affective disorders. Symptoms of IBS may vary throughout the menstrual cycle, but it is important to rule out other possible diagnoses such as endometriosis. Physical exams and tests are typically normal in IBS, but any unintentional weight loss, rectal bleeding, nocturnal diarrhea, fecal incontinence, or onset of persistent GI symptoms after age 40 requires further assessment. Management of IBS may include dietary changes and medication such as antispasmodics, anti-diarrheals, laxatives, and even Antidepressants. Other gastrointestinal disorders such as chronic pancreatitis, diverticulitis, peptic ulcer disease, and ulcerative colitis have distinct clinical features that can help differentiate them from IBS.
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This question is part of the following fields:
- Gastroenterology
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Question 16
Incorrect
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A 24-year-old waitress who works at a restaurant in Spain has returned home to see her doctor because she is feeling unwell. She has been experiencing increasing nausea and fatigue and noticed that her urine had darkened a few days ago, and now her stools are pale. Additionally, she has been suffering from severe itching. During the examination, she was found to be jaundiced with scratch marks on her skin and a temperature of 38.1°C.
The following investigations were conducted:
- Haemoglobin: 120 g/l (normal range: 115–155 g/l)
- White cell count (WCC): 11.1 × 109/l (normal range: 4–11 × 109/l)
- Platelets: 170 × 109/l (normal range: 150–400 × 109/l)
- Prothrombin Test (PT): 17.1 s (normal range: 10.6–14.9 s)
- Erythrocyte sedimentation rate (ESR): 48 mm/hr (normal range: 0–10mm in the 1st hour)
- Alanine aminotransferase (ALT): 795 IU/l (normal range: 5–30 IU/l)
- Bilirubin: 100 μmol/l (normal range: 2–17 µmol/l)
- Alkaline phosphatase: 90 IU/l (normal range: 30–130 IU/l)
- Anti hepatitis A IgM markedly elevated
What is the most accurate prognosis for this 24-year-old waitress?Your Answer:
Correct Answer: She has a chance of progression to cirrhosis of approximately 0%
Explanation:Understanding Hepatitis A Infection
Hepatitis A infection is a common viral infection that spreads through the faeco-oral route, particularly in areas like North Africa. It is usually acquired through exposure to contaminated food or water. The infection typically presents with a prodrome of flu-like symptoms, followed by acute hepatitis with right upper quadrant tenderness, jaundice, pale stools, and dark urine.
Fortunately, hepatitis A is a self-limiting condition, and most people recover within 2-6 months without any significant complications. Death from hepatitis A is rare, occurring in only 0.2% of cases. However, relapsing hepatitis A can occur in up to 20% of cases, with each relapse being milder than the previous one.
Treatment for hepatitis A is mainly supportive, and there is no significant risk of progression to cirrhosis. Unlike hepatitis B and C, which are transmitted through blood products and sexual intercourse, hepatitis A and E are transmitted through the faeco-oral route. Therefore, practicing good hygiene and sanitation is crucial in preventing the spread of the infection.
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This question is part of the following fields:
- Gastroenterology
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Question 17
Incorrect
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A 60-year-old woman presents to the Emergency Department with a sudden onset of severe abdominal pain. She suffers with osteoarthritis in both her knees and often takes codeine and ibuprofen. She admits that she often consumes an excessive amount of alcohol. On examination, she appears unwell and is tachycardic. Abdominal examination reveals diffuse tenderness with guarding and reduced bowel sounds. The computerised tomography (CT) scan of her abdomen is shown below.
Which of the following is the most likely diagnosis, given the clinical scenario?Your Answer:
Correct Answer: Perforated peptic ulcer
Explanation:Differential Diagnosis for Acute Abdominal Pain: Perforated Peptic Ulcer vs Other Conditions
Acute abdominal pain is a common presentation in medical practice, and it can be caused by a variety of conditions. One of the most likely diagnoses in a patient with sudden onset of severe abdominal pain, diffuse tenderness, and guarding is a perforated peptic ulcer. This is especially true if the patient has a history of regular ibuprofen use and excess alcohol consumption without gastric protection. However, it is important to consider other potential causes of acute abdominal pain and rule them out through a thorough differential diagnosis.
Some of the other conditions that may present with acute abdominal pain include acute appendicitis, gastritis, acute cholecystitis, and small bowel obstruction with strangulation. Each of these conditions has its own characteristic symptoms and signs that can help differentiate it from a perforated peptic ulcer. For example, acute appendicitis typically presents with a gradual onset of dull umbilical pain that shifts to the right iliac fossa, while acute cholecystitis presents with right upper quadrant pain and Murphy’s sign. Gastritis may cause severe pain, but the abdomen is usually soft, and bowel sounds are not reduced. Small bowel obstruction typically presents with colicky pain, vomiting, and distension, and may be associated with a history of abdominal surgery or hernias.
In summary, while a perforated peptic ulcer is a likely diagnosis in a patient with sudden onset of severe abdominal pain, it is important to consider other potential causes and perform a thorough differential diagnosis to ensure appropriate management.
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This question is part of the following fields:
- Gastroenterology
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Question 18
Incorrect
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A 20-year-old male has been referred by his doctor due to experiencing severe bloody diarrhoea on and off for the past three months. After undergoing a barium enema, it was discovered that he has multiple ulcers and signs of inflammation that extend from his rectum to the mid transverse colon. A colonoscopy was performed and biopsies were taken from various sites, revealing acute and chronic inflammation that is limited to the mucosa. What is the most probable diagnosis for this patient?
Your Answer:
Correct Answer: Ulcerative colitis
Explanation:Differences between Ulcerative Colitis and Crohn’s Disease
Ulcerative colitis (UC) and Crohn’s disease are both types of inflammatory bowel disease that can cause bloody diarrhoea. However, UC is more likely to result in the passage of blood. The onset of UC usually begins in the distal part of the colon and progresses towards the proximal end. On the other hand, Crohn’s disease can affect any part of the gastrointestinal tract and can skip areas, resulting in disease occurring at different sites.
Histologically, Crohn’s disease affects the entire thickness of the bowel wall, while UC typically only affects the mucosa. This means that Crohn’s disease can cause more severe damage to the bowel wall and lead to complications such as strictures and fistulas. In contrast, UC is more likely to cause inflammation and ulceration of the mucosa, which can lead to symptoms such as abdominal pain and diarrhoea.
In summary, while both UC and Crohn’s disease can cause similar symptoms, there are important differences in their presentation and histological features. these differences is crucial for accurate diagnosis and appropriate management of these conditions.
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This question is part of the following fields:
- Gastroenterology
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Question 19
Incorrect
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An 80-year-old woman presents with a history of melaena on three separate occasions in the past three years. She reports having had many tests, including barium enemas, flexible sigmoidoscopies, and oesophagogastroduodenoscopies, which were all normal.
One year ago she required two units of blood to raise her haematocrit from 24% to 30%. She has been taking iron, 300 mg orally BD, since then.
The patient has hypertension, coronary artery disease, and heart failure treated with digoxin, enalapril, furosemide, and metoprolol. She does not have chest pain or dyspnoea.
Her body mass index is 32, her pulse is 88 per minute, and blood pressure is 120/80 mm Hg supine and 118/82 mm Hg standing. The conjunctivae are pale. A ventricular gallop is heard. There are bruits over both femoral arteries.
Rectal examination reveals dark brown stool that is positive for occult blood. Other findings of the physical examination are normal.
Barium enema shows a few diverticula scattered throughout the descending and transverse colon.
Colonoscopy shows angiodysplasia of the caecum but no bleeding is seen.
Technetium (99mTc) red cell scan of the colon is negative.
Haemoglobin is 105 g/L (115-165) and her haematocrit is 30% (36-47).
What would be the most appropriate course of action at this time?Your Answer:
Correct Answer: Continued observation
Explanation:Angiodysplasia
Angiodysplasia is a condition where previously healthy blood vessels degenerate, commonly found in the caecum and proximal ascending colon. The majority of angiodysplasias, around 77%, are located in these areas. Symptoms of angiodysplasia include maroon-coloured stool, melaena, haematochezia, and haematemesis. Bleeding is usually low-grade, but in some cases, around 15%, it can be massive. However, bleeding stops spontaneously in over 90% of cases.
Radionuclide scanning using technetium Tc99 labelled red blood cells can help detect and locate active bleeding from angiodysplasia, even at low rates of 0.1 ml/min. However, the intermittent nature of bleeding in angiodysplasia limits the usefulness of this method. For patients who are haemodynamically stable, a conservative approach is recommended as most bleeding angiodysplasias will stop on their own. Treatment is usually not necessary for asymptomatic patients who incidentally discover they have angiodysplasias.
Overall, angiodysplasia and its symptoms is important for early detection and management.
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This question is part of the following fields:
- Gastroenterology
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Question 20
Incorrect
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A 44-year-old woman is scheduled for splenectomy due to an enlarged spleen. The consultant advises the registrar to locate the tail of the pancreas during the procedure to prevent postoperative pancreatic fistula. Where should the tail of the pancreas be identified during the splenectomy?
Your Answer:
Correct Answer: Splenorenal ligament
Explanation:Peritoneal Structures Connecting Abdominal Organs
The human body has several peritoneal structures that connect abdominal organs to each other or to the posterior abdominal wall. These structures play an important role in maintaining the position and stability of the organs. Here are some examples:
1. Splenorenal Ligament: This ligament connects the spleen to the posterior abdominal wall over the left kidney. It also contains the tail of the pancreas.
2. Gastrosplenic Ligament: This ligament connects the greater curvature of the stomach with the hilum of the spleen.
3. Transverse Mesocolon: This structure connects the transverse colon to the posterior abdominal wall.
4. Gastrocolic Ligament: This ligament connects the greater curvature of the stomach with the transverse colon.
5. Phrenicocolic Ligament: This ligament connects the splenic flexure of the colon to the diaphragm.
These peritoneal structures are important for the proper functioning of the digestive system and for maintaining the position of the organs.
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This question is part of the following fields:
- Gastroenterology
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Question 21
Incorrect
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A 25-year-old woman comes to the Emergency Department with complaints of vomiting blood. She states that she had a heavy night of drinking and has vomited multiple times this morning. After the fourth time, she noticed about a tablespoon of fresh blood mixed in with the vomit. What is the probable reason for her haematemesis?
Your Answer:
Correct Answer: Mallory–Weiss tear
Explanation:Common Causes of Upper Gastrointestinal Bleeding
Upper gastrointestinal bleeding can be caused by various conditions. Here are some of the most common causes:
Mallory-Weiss Tear
This tear in the mucosa is usually caused by repeated vomiting, resulting in increased abdominal pressure. Young patients with a clear history may not require further investigation, and bleeding usually resolves without treatment.Oesophageal Varices
This condition should be considered in patients with signs of chronic liver disease or a history of heavy alcohol intake. Oesophageal varices can be life-threatening, with mortality rates as high as 30%.Peptic Ulceration
Peptic ulceration is a common cause of upper gastrointestinal bleeding, especially in patients who use non-steroidal anti-inflammatory drugs (NSAIDs), smoke, or have Helicobacter pylori infection. Patients with peptic ulcer disease should be tested for H. pylori and treated accordingly.Reflux Oesophagitis
This condition is characterized by heartburn and can be asymptomatic. It is usually an incidental finding on endoscopy and can be treated with antacid medication.Haemophilia
Haemophilia is a condition that increases the risk of bleeding due to the absence of clotting factors. While spontaneous gastrointestinal bleeding is rare, patients may present with spontaneous bleeding in other parts of the body, such as joints. -
This question is part of the following fields:
- Gastroenterology
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Question 22
Incorrect
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What is the most likely diagnosis for a 45-year-old woman who has had severe itching for three weeks and presents to your clinic with abnormal liver function tests and a positive anti-TPO antibody?
Your Answer:
Correct Answer: Primary biliary cholangitis
Explanation:Autoimmune Diseases and Hepatic Disorders: A Comparison of Symptoms and Diagnostic Findings
Primary biliary cholangitis is characterized by severe itching, mild jaundice, and elevated levels of alkaline phosphatase, ALT, and AST. Anti-mitochondrial antibody is positive, and LDL and TG may be mildly elevated. Patients may also exhibit microcytic anemia and elevated anti-TPO levels, as seen in Hashimoto’s thyroiditis. In contrast, primary sclerosing cholangitis affects men and is associated with colitis due to inflammatory bowel disease. Anti-mitochondrial antibody is often negative, and p-ANCA is often positive. Addison’s disease is characterized by fatigue, weakness, weight loss, hypoglycemia, and hyperkalemia, and may coexist with other autoimmune diseases. Autoimmune hepatitis is characterized by elevated levels of ANA, anti-smooth muscle antibody, anti-mitochondrial antibody, and anti-LKM antibody, with normal or slightly elevated levels of alkaline phosphatase. Chronic viral hepatitis is indicated by elevated levels of HBs antigen and anti-HBC antibody, with anti-HBs antibody indicating a history of prior infection or vaccination.
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This question is part of the following fields:
- Gastroenterology
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Question 23
Incorrect
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A 14-year-old girl with cystic fibrosis complains of abdominal pain. She denies any accompanying nausea or vomiting. What is the most probable cause of her symptoms?
Your Answer:
Correct Answer: Distal intestinal obstruction syndrome
Explanation:Distal Intestinal Obstruction Syndrome in Cystic Fibrosis Patients
Distal intestinal obstruction syndrome is a common complication in 10-20% of cystic fibrosis patients, with a higher incidence in adults. The condition is caused by the loss of CFTR function in the intestine, leading to the accumulation of mucous and fecal material in the terminal ileum, caecum, and ascending colon. Diagnosis is made through a plain abdominal radiograph, which shows faecal loading in the right iliac fossa, dilation of the ileum, and an empty distal colon. Ultrasound and CT scans can also be used to identify an obstruction mass and show dilated small bowel and proximal colon.
Treatment for mild and moderate episodes involves hydration, dietetic review, and regular laxatives. N-acetylcysteine can be used to loosen and soften the plugs, while severe episodes may require gastrografin or Klean-Prep. If there are signs of peritoneal irritation or complete bowel obstruction, surgical review should be obtained. Surgeons will often treat initially with intravenous fluids and a NG tube while keeping the patient nil by mouth. N-acetylcysteine can be put down the NG tube.
Overall, distal intestinal obstruction syndrome is a serious complication in cystic fibrosis patients that requires prompt diagnosis and treatment. With proper management, patients can avoid severe complications and maintain their quality of life.
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This question is part of the following fields:
- Gastroenterology
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Question 24
Incorrect
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A 50-year-old man presents with sudden onset of upper abdominal pain and vomiting. His vital signs are stable upon triage.
During the physical examination, he appears to be in significant distress and has a tense abdomen upon palpation.
What initial test should be performed to confirm a perforation?Your Answer:
Correct Answer: Erect chest X-ray
Explanation:The Importance of an Erect Chest X-Ray in Diagnosing Perforated Abdominal Viscus
When a patient presents with acute abdominal pain, it is crucial to consider the possibility of a perforated abdominal viscus, which requires immediate surgical intervention. The first-line investigation for this condition is an erect chest X-ray, which can detect the presence of free air under the diaphragm (pneumoperitoneum). To ensure accuracy, the patient should be in a seated position for 10-15 minutes before the X-ray is taken. If the patient cannot sit up due to hypotension, a lateral decubitus abdominal film may be used instead. However, in most cases, a CT scan of the abdomen and pelvis will be requested by the surgical team.
Other diagnostic methods, such as a urine dipstick, liver function tests, and bedside ultrasound, are not effective in detecting a perforation. While plain abdominal films may show signs of perforation, they are not the preferred method of diagnosis. In cases of perforation, the presence of free abdominal air can make the opposite side of the bowel wall appear clearer, which is known as the Rigler’s signs or the double wall sign.
In conclusion, an erect chest X-ray is a crucial diagnostic tool in identifying a perforated abdominal viscus. Early detection and intervention can prevent serious complications and improve patient outcomes.
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This question is part of the following fields:
- Gastroenterology
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Question 25
Incorrect
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A 35-year-old woman is found to have gallstones during an abdominal ultrasound. The surgeon informs her that one of the stones is quite large and is currently lodged in the bile duct, about 5 cm above the transpyloric plane. The surgeon explains that this plane is a significant anatomical landmark for several abdominal structures.
What structure is located at the level of the transpyloric plane?Your Answer:
Correct Answer: Origin of the superior mesenteric artery
Explanation:The transpyloric plane, also known as Addison’s plane, is an imaginary plane located at the level of the L1 vertebral body. It is situated halfway between the jugular notch and the superior border of the pubic symphysis and serves as an important anatomical landmark. Various structures lie in this plane, including the pylorus of the stomach, the first part of the duodenum, the duodeno-jejunal flexure, both the hepatic and splenic flexures of the colon, the fundus of the gallbladder, the neck of the pancreas, the hila of the kidneys and spleen, the ninth costal cartilage, and the spinal cord termination. Additionally, the origin of the superior mesenteric artery and the point where the splenic vein and superior mesenteric vein join to form the portal vein are located in this plane. The cardio-oesophageal junction, where the oesophagus meets the stomach, is also found in this area. It is mainly intra-abdominal, 3-4 cm in length, and houses the gastro-oesophageal sphincter. The ninth costal cartilage lies at the transpyloric plane, not the eighth, and the hila of both kidneys are located here, not just the superior pole of the left kidney. The uncinate process of the pancreas, which is an extension of the lower part of the head of the pancreas, lies between the superior mesenteric vessel and the aorta, and the neck of the pancreas is situated along the transpyloric plane.
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This question is part of the following fields:
- Gastroenterology
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Question 26
Incorrect
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A 56-year-old woman presents to her General Practitioner (GP) after experiencing ‘indigestion’ for the past six months. She has been using over-the-counter treatments without relief. She reports a burning-type sensation in her epigastric region which is present most of the time. Over the past four months, she has lost approximately 4 kg in weight. She denies dysphagia, melaena, nausea, or vomiting.
Upon examination, her abdomen is soft and non-tender without palpable masses.
What is the next step in managing her symptoms?Your Answer:
Correct Answer: Refer urgently as a suspected gastro-oesophageal cancer to be seen in two weeks
Explanation:Appropriate Management of Suspected Gastro-Oesophageal Malignancy
Suspected gastro-oesophageal malignancy requires urgent referral, according to NICE guidelines. A patient’s age, weight loss, and dyspepsia symptoms meet the criteria for referral. An ultrasound of the abdomen may be useful to rule out biliary disease, but it would not be helpful in assessing oesophageal or stomach pathology. Treatment with proton pump inhibitors may mask malignancy signs and delay diagnosis. Helicobacter testing can be useful for dyspepsia patients, but red flag symptoms require urgent malignancy ruling out. A barium swallow is not a gold-standard test for gastro-oesophageal malignancy.
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This question is part of the following fields:
- Gastroenterology
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Question 27
Incorrect
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You have a geriatric patient who presents with massive haematemesis. He is agitated with a pulse of 110 bpm and a blood pressure of 130/90 mmHg. He is a known alcoholic.
What is the best step in the management for this elderly patient?Your Answer:
Correct Answer: Endoscopy
Explanation:Management of Upper Gastrointestinal Bleeding: Endoscopy, Laparotomy, Sengstaken-Blakemore Tube, and IV Antibiotics
In cases of upper gastrointestinal bleeding, prompt and appropriate management is crucial. For patients with severe haematemesis and haemodynamic instability, immediate resuscitation and endoscopy are recommended by the National Institute for Health and Care Excellence (NICE) guidelines. Crossmatching blood for potential transfusion is also necessary. Urgent endoscopy within 24 hours of admission is advised for patients with smaller haematemesis who are haemodynamically stable.
Laparotomy is not necessary unless the bleeding is life-threatening and cannot be contained despite resuscitation or transfusion, medical or endoscopic therapy fails, or the patient has a high Rockall score or re-bleeding. The insertion of a Sengstaken-Blakemore tube may be considered for haematemesis from oesophageal varices, but endoscopy remains the primary diagnostic and therapeutic tool.
Prophylactic antibiotics are recommended for patients with suspected or confirmed variceal bleeding at endoscopy. However, arranging for a psychiatric consult is not appropriate in the acute phase of management, as the patient requires immediate treatment and resuscitation.
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This question is part of the following fields:
- Gastroenterology
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Question 28
Incorrect
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A 56-year-old man comes to the Emergency Department with haematemesis. His friends report that he drank a large amount of alcohol earlier and had prolonged vomiting because he is not used to drinking so much. During the examination, his vital signs are: pulse 110 bpm, blood pressure 100/60 mmHg. There are no notable findings during systemic examination.
What is the most likely cause of the haematemesis in this case?Your Answer:
Correct Answer: Mallory-Weiss tear
Explanation:Causes of haematemesis and their associated symptoms
Haematemesis, or vomiting of blood, can be caused by various conditions affecting the upper gastrointestinal tract. Here we discuss some of the common causes and their associated symptoms.
Mallory-Weiss tear
This type of tear occurs at the junction between the oesophagus and the stomach, and is often due to severe vomiting or retching, especially in people with alcohol problems. The tear can cause internal bleeding and low blood pressure, and is usually accompanied by a history of recent vomiting.Peptic ulcer disease
Peptic ulcers are sores in the lining of the stomach or duodenum, and can cause epigastric pain, especially after eating or when hungry. Bleeding from a peptic ulcer is usually associated with these symptoms, and may be mild or severe.Oesophageal varices
Varices are enlarged veins in the oesophagus that can occur in people with chronic liver disease, especially due to alcohol abuse or viral hepatitis. Variceal bleeding can cause massive haematemesis and is a medical emergency.Barrett’s oesophagus
This condition is a type of metaplasia, or abnormal tissue growth, in the lower oesophagus, often due to chronic acid reflux. Although Barrett’s mucosa can lead to cancer, bleeding is not a common symptom.Gastritis
Gastritis is inflammation of the stomach lining, often due to NSAIDs or infection with Helicobacter pylori. It can cause epigastric pain, nausea, and vomiting, and may be associated with mild bleeding. Treatment usually involves acid suppression and eradication of H. pylori if present.In summary, haematemesis can be caused by various conditions affecting the upper digestive system, and the associated symptoms can help to narrow down the possible causes. Prompt medical attention is needed for severe or recurrent bleeding.
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This question is part of the following fields:
- Gastroenterology
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Question 29
Incorrect
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A 22-year-old man presents to the Student Health Service after a ‘flu like’ illness. He has noticed that his eyes have become yellow over the past two days and he has been off his food. On examination, there are no significant abnormal findings.
Investigations:
Investigation Result Normal value
Haemoglobin 140 g/l 135–175 g/l
White cell count (WCC) 6.4 × 109/l 4–11 × 109/l
Platelets 230 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 80 μmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 25 IU/l 5–30 IU/l
Bilirubin 67 μmol/l 2–17 µmol/l
Lactate Dehydrogenase (LDH) 105 IU/l 100–190 IU/l
Urine bile salts +
Hepatic ultrasound scan – Normal
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Gilbert syndrome
Explanation:Differential Diagnosis for a Patient with Elevated Bilirubin Levels
One possible cause of elevated bilirubin levels is Gilbert syndrome, an autosomal recessive condition that results in a deficiency of glucuronyl transferase activity. This condition leads to an increase in unconjugated bilirubin levels, which can become more pronounced during periods of fasting or illness. Treatment for Gilbert syndrome is not necessary, and the prognosis is excellent without significant long-term effects.
Hepatitis A is another possible cause of elevated bilirubin levels, particularly in individuals who have traveled to areas where the virus is common or who have occupational exposure to contaminated materials. Symptoms of hepatitis A include flu-like symptoms, anorexia, nausea, vomiting, and malaise, followed by acute hepatitis with jaundice, pale stools, and dark urine. However, the absence of risk factors and normal alanine aminotransferase levels make hepatitis A unlikely.
Infectious mononucleosis, caused by the Epstein-Barr virus, can also cause elevated bilirubin levels. Symptoms typically include acute tonsillitis and flu-like symptoms, as well as viral hepatitis. However, the absence of upper respiratory tract infection symptoms, normal ALT levels, and the lack of lymphocytosis make this diagnosis unlikely.
Autoimmune hemolysis is another possible cause of elevated bilirubin levels, but normal hemoglobin and lactate dehydrogenase levels make this diagnosis unlikely.
Hepatitis B is a viral infection that is primarily transmitted through sexual contact and intravenous drug use. Symptoms include acute hepatitis with jaundice, and chronic infection can develop in some cases. However, normal ALT levels and the absence of risk factors make this diagnosis unlikely.
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This question is part of the following fields:
- Gastroenterology
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Question 30
Incorrect
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A 38-year-old woman has chronic pancreatitis. She has lost weight and has troublesome diarrhoea. She reports that she has had diarrhoea daily and it has a strong, malodorous smell. The unintentional weight loss is 7 kg over the last year and she has had a general decrease in energy.
Which preparation would be most suitable to decrease her diarrhoea?Your Answer:
Correct Answer: Pancreatin
Explanation:Common Gastrointestinal Medications and Their Uses
Pancreatin is a mixture of digestive enzymes that aid in the digestion of carbohydrates, lipids, and proteins. It is used in conditions where there is a lack of pancreatic enzyme production, such as cystic fibrosis and chronic pancreatitis. Pancreatin should be taken with meals and may cause side-effects such as nausea and hypersensitivity.
Co-phenotrope is a combination drug that controls the consistency of faeces following ileostomy or colostomy formation and in acute diarrhoea. It is composed of diphenoxylate and atropine and may cause side-effects such as abdominal pain and lethargy.
Cholestyramine binds bile in the gastrointestinal tract, preventing its reabsorption. It is used in conditions such as hypercholesterolaemia and primary biliary cholangitis. Side-effects may include constipation and nausea.
Loperamide is an antimotility agent used in acute diarrhoea. It may cause side-effects such as constipation and nausea.
Psyllium, also known as ispaghula, is a bulk-forming laxative that aids in normal bowel elimination. It is mainly used as a laxative but may also be used to treat mild diarrhoea.
Understanding Common Gastrointestinal Medications
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This question is part of the following fields:
- Gastroenterology
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