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  • Question 1 - A 32-year-old man presents with progressive central abdominal pain and vomiting associated with...

    Incorrect

    • A 32-year-old man presents with progressive central abdominal pain and vomiting associated with significant weight loss (five stone in 3 months).He gives a history of binge drinking and depression, and smokes twenty cigarettes per day. Because eating provokes abdominal pain and vomiting, he has eaten virtually nothing for a month. CT scanning of his abdomen showed a normal pancreas but dilated loops of small bowel with a possible terminal ileal stricture. His albumin level was 20 and C-reactive protein level was 50. Which statement is NOT true?

      Your Answer: His symptoms are consistent with a Crohn’s stricture

      Correct Answer: Infliximab should be prescribed as soon as possible

      Explanation:

      Stricturing is associated with Crohn’s disease, and elevated CRP supports this diagnosis in this patient, as well. Infliximab should not yet be started. Acute treatment is steroids (of a flare) however this man needs surgery. Although surgery should be avoided if at all possible in Crohn’s disease, and minimal surgery should occur (resecting as little as possible, given possible need for future resections), including possible stricturoplasty instead of resection. Chronic pancreatitis is unlikely given it would not cause stricture. Patients undergoing surgery should always have informed consent, which always includes risk of a stoma for any bowel surgery. Given the amount of weight he has lost he is at significant risk for refeeding syndrome, which can cause hypokalaemia, hypophosphatemia and hypomagnesemia.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 2 - A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and...

    Correct

    • 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: 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
      29.1
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  • Question 3 - A 72-year-old woman presents with a 3 month history of colicky abdominal pain...

    Correct

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

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

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 4 - A 60-year-old man with known ulcerative colitis and diverticular disease comes to clinic...

    Correct

    • A 60-year-old man with known ulcerative colitis and diverticular disease comes to clinic complaining of passing faeces per urethra. Cystoscopy confirms a fistula between his bladder and bowel. Which treatment is most likely to be effective?

      Your Answer: surgery

      Explanation:

      The best treatment for a colovesicular fistula is surgery. This is the only definitive treatment. If the patient is a poor surgical candidate, there can be an attempt to manage them non-operatively, but this is absolutely NOT the MOST EFFECTIVE therapy.

    • This question is part of the following fields:

      • Gastroenterology
      14.3
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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: No need for further investigation as the clinical response is diagnostic

      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
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  • Question 6 - A 50 year old man undergoes a colonoscopy due to the finding of...

    Incorrect

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

      Your Answer: 6 months

      Correct Answer: 3 years

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
      14.8
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  • Question 7 - 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: Spironolactone

      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 8 - 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: Flare of Crohn's disease

      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 9 - Which one of the following is most suggestive of Wilson’s disease? ...

    Correct

    • Which one of the following is most suggestive of Wilson’s disease?

      Your Answer: Reduced serum caeruloplasmin

      Explanation:

      In Wilson’s disease, serum caeruloplasmin is decreased. Skin pigmentation is not increased, but may become jaundiced. 24 hour urine copper excretion is increased. Hepatic copper concentration is increased. Serum copper level is also increased. Key point: high copper. Remember Kayser-Fleisher rings for the eyes in Wilson’s disease.

    • This question is part of the following fields:

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

    Incorrect

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

      Your Answer: Gastrinoma

      Correct Answer: VIPoma

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
      32.9
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  • Question 11 - 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.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 12 - Which one of the following statements regarding hepatocellular carcinoma is correct? ...

    Incorrect

    • Which one of the following statements regarding hepatocellular carcinoma is correct?

      Your Answer:

      Correct Answer: Diabetes mellitus is a risk factor

      Explanation:

      Diabetes is a risk factor for hepatocellular carcinoma. Screening has been shown to be effective. Bevacizumab is not used for advanced cases. The incidence is higher in men. Alcohol is not the most common underlying cause worldwide; this is from cirrhosis from diseases like hepatitis B and C.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 13 - A 63 year old man presents with painless jaundice and weight loss over...

    Incorrect

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

      Your Answer:

      Correct Answer: MRCP

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 14 - Which is the most common type of inherited colorectal cancer: ...

    Incorrect

    • Which is the most common type of inherited colorectal cancer:

      Your Answer:

      Correct Answer: Hereditary non-polyposis colorectal carcinoma

      Explanation:

      Hereditary non-polyposis syndrome (HNPCC) is the most common type of inherited colorectal cancer. It often presents in younger and younger generations down a family. FAP presents with 100’s-1000’s of polyps and is less common. Li-Fraumeni syndrome and Fanconi syndrome are rare. For Peutz-Jeghers syndrome, the thing you will look for in the question stem is discoloured spots on the lips, this is classic.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 15 - Which of the following stimulates bicarbonate secretion from the pancreas and liver? ...

    Incorrect

    • Which of the following stimulates bicarbonate secretion from the pancreas and liver?

      Your Answer:

      Correct Answer: Secretin

      Explanation:

      Secretin stimulates bicarbonate secretion from the pancreas and liver. VIP induces relaxation of the stomach and gallbladder, secretion of water into pancreatic juice/ bile, and inhibits gastric acid secretion/absorption. CCK classically stimulates gallbladder contraction and relaxation of the sphincter of Oddi. Gastrin stimulates the secretion of HCl by parietal cells in the stomach. Motilin, as the name suggests, increases motility.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 16 - 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.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 17 - A 25-year-old lady with a history of ulcerative colitis presents to clinic. She...

    Incorrect

    • A 25-year-old lady with a history of ulcerative colitis presents to clinic. She had extensive colitis 10 years ago, which has improved with medical treatment. Last year she had been diagnosed with primary sclerosing cholangitis. Her last colonoscopy was 6 months ago, which detected no active disease, and random biopsies were normal. She is remaining well and asymptomatic. When should colonic screening be performed on this patient?

      Your Answer:

      Correct Answer: Colonoscopy should be performed annually

      Explanation:

      Colonoscopy screening should begin 10 years after the first diagnosis in ulcerative colitis, given the increased risk for colon cancer. Given that she has developed primary sclerosing cholangitis, her risk of colon cancer is even higher. Colonoscopy screening should occur at 3 year intervals in the second decade, 2 year intervals in the third decade, and 1 year intervals by the first decade, making A the correct answer choice.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 18 - Which of the following forms of acute viral hepatitis has a much higher...

    Incorrect

    • Which of the following forms of acute viral hepatitis has a much higher mortality in pregnant than non-pregnant females?

      Your Answer:

      Correct Answer: Hepatitis E

      Explanation:

      Pregnant patient in a third world country with hepatitis: The answer is most likely Hepatitis E. The mortality for Hepatitis E in pregnant women is very high. It is transmitted faecal-orally. There is no hepatitis G. Hepatitis C, B, A are less likely to be the correct answer than E given it’s classic association with pregnancy and poor living conditions.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 19 - 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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  • Question 20 - A 74-year-old man presents with left-sided lower abdominal pain. He is obese and...

    Incorrect

    • A 74-year-old man presents with left-sided lower abdominal pain. He is obese and admits to a dislike of high fibre foods. The pain has been grumbling for the past couple of weeks and is partially relieved by defecation. He has suffered intermittent diarrhoea.   Blood testing reveals a neutrophilia, and there is also a microcytic anaemia. Barium enema shows multiple diverticula, more marked on the left-hand side of the colon.   Which diagnosis fits best with this clinical picture?

      Your Answer:

      Correct Answer: Diverticular disease

      Explanation:

      Given that he has diverticula in the clinical scenario combined with his presenting symptoms, it is likely that he has diverticular disease. A low fibre diet would support this diagnosis. Acute diverticulitis would require treatment with antibiotics. Depending on the severity (Hinchey classification) would determine if he needs oral or IV antibiotics, hospital admission or outpatient treatment. Sometimes abscesses or micro perforations occur, which typical require drainage and possibly surgical intervention. Diverticular disease is clearly a better answer than other possible answer choices, simply based on the symptoms presented in the prompt (and mention of low fibre).

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 21 - 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 22 - A 37-year-old social worker is referred to you with a long history of...

    Incorrect

    • A 37-year-old social worker is referred to you with a long history of diarrhoea and abdominal discomfort. She was diagnosed with irritable bowel syndrome 10 years ago and takes mebeverine, peppermint tablets and Gaviscon. She is a vegetarian and rarely drinks or smokes. Examination of all systems is normal. Her blood tests show macrocytic anaemia. An upper gastrointestinal endoscopy reveals oesophagitis, hypertrophy of the gastric body and multiple duodenal ulcers. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Zollinger–Ellison syndrome

      Explanation:

      This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from the hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. None of the other answer choices are a better answer than this. CT abdomen may potentially show a tumour, but this is not diagnostic for type.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 23 - A 43-year-old man is reviewed in the gastroenterology clinic. He has had troublesome...

    Incorrect

    • A 43-year-old man is reviewed in the gastroenterology clinic. He has had troublesome dyspepsia for the past six months which has not settled with proton pump inhibitor (PPI) therapy. During the review of his systems he also reports passing 6-7 watery stools per day. An OGD 3 weeks ago showed gastric erosions and ulcers. Which one of the following investigations is most likely to be diagnostic?

      Your Answer:

      Correct Answer: Fasting gastrin

      Explanation:

      This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from the hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. None of the other answer choices are a better answer than this. CT abdomen may potentially show a tumour, but this is not diagnostic for type.

    • This question is part of the following fields:

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

    Incorrect

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

      Your Answer:

      Correct Answer: Large intestine

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 25 - A 36-year-old man is being investigated for recurrent gastric and duodenal ulceration diagnosed...

    Incorrect

    • A 36-year-old man is being investigated for recurrent gastric and duodenal ulceration diagnosed at endoscopy. He has suffered from bouts of abdominal pain and intermittent diarrhoea although his weight is stable. Some of his investigations results are: Basal acid secretion 20 mEq/h (1–5), Fasting gastrin 200 pg/ml (<100), Secretin test: Basal gastrin 200pg/ml, Post-secretin 500pg/ml. Which of the following are responsible for the elevated gastrin levels?

      Your Answer:

      Correct Answer: Gastrinoma

      Explanation:

      This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. The secretin test is a test that can differentiate gastrinoma from other causes of high gastrin levels. Gastrin will rise after secretin injection if the patient has a gastrinoma.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 26 - The increased risk of oesophageal malignancy in patients with Barrett’s oesophagus is approximately:...

    Incorrect

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

      Your Answer:

      Correct Answer: 50 - 100 times risk

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 27 - Which of the following stimulates the secretion of gastrin? ...

    Incorrect

    • Which of the following stimulates the secretion of gastrin?

      Your Answer:

      Correct Answer: Amino acids

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 28 - A 76-year-old woman is admitted with a productive cough and pyrexia. Chest x-ray...

    Incorrect

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

      Your Answer:

      Correct Answer: Oral vancomycin for 14 days

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 29 - A 54-year-old female presents with fatigue and xerostomia. Bloods tests reveal the following:...

    Incorrect

    • A 54-year-old female presents with fatigue and xerostomia. Bloods tests reveal the following: Hb 13.9 g/dL, WBC 6.1 *109/L, Platelets 246 *109/L, Bilirubin 33 µmol/L, ALP 292 u/l ALT 47 u/l What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Primary biliary cirrhosis

      Explanation:

      With a bilirubin of 33, automatically the diagnosis from the choices listed is primary biliary cirrhosis or autoimmune hepatitis, not SLE, mono, or Primary Sjogren’s Syndrome. With autoimmune hepatitis, however, you would not expect such a high bilirubin and would expect very high AST/ALT, which here is just mildly elevated. This makes primary biliary cirrhosis the most likely answer. The classic presentation is itching in a middle-aged woman. The dry mouth is likely due to Sicca Syndrome, which occurs in 70% of cases of PBC, but with these liver function tests, PBC is most the likely answer.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 30 - 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:

      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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SESSION STATS - PERFORMANCE PER SPECIALTY

Gastroenterology (4/10) 40%
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