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Question 1
Incorrect
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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: Bacterial overgrowth
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.
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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 26-year-old office worker presents with a 3 year history of epigastric pain, especially 30 minutes after eating. This is associated with nausea and belching. She also describes constipation with occasional explosive diarrhoea. The stools are normally hard with mucus and she needs to strain with every motion. Abdominal pain is relieved after defecation but abdominal bloating persists. She wakes up an hour earlier each morning to finish her breakfast in order to prevent vomiting. She has missed work on a few occasions and feels that her weight has fluctuated. Past medical history includes scarlet fever. She is not on any regular medications except intermittent laxatives over the counter. Abdominal examination is normal. Rectal examination reveals an anal fissure. Investigation results: Haemoglobin (Hb 13.1 g/dL, White blood count (WBC) 6.0 × 109/L, Platelets 180× 109/L, Mean cell volume (MCV) 87 fL, International normalised ratio (INR) 1.0, Na+ 136 mmol/L, K+ 3.9 mmol/L, Urea 3.7 mmol/L, Creatinine 70 μmol/L, Albumin 39 glL. Liver function test normal. Anti-endomysial antibody negative. Thyroid function test normal. Gastroscopy normal. Flexible sigmoidoscopy and biopsy normal. Abdominal and pelvic ultrasound scans are normal. What is the most likely diagnosis to account for her symptoms?
Your Answer: Diarrhoea pre-dominant irritable bowel syndrome
Correct Answer: Overlap irritable bowel syndrome and functional dyspepsia
Explanation:This is most likely describing irritable bowel syndrome (IBS). Symptoms are either diarrhoea, constipation, or both, abdominal pain, bloating, of varying duration. It is a functional, not an organic problem, as far as research shows at this point. It is essentially a diagnosis of exclusion. Treatment is a high fibre diet with fluids. Caffeine should be avoided as this can worsen symptoms.
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This question is part of the following fields:
- Gastroenterology
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Question 3
Incorrect
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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: Irritable bowel syndrome
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).
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This question is part of the following fields:
- Gastroenterology
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Question 4
Incorrect
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Which one of the following is not associated with non-alcoholic steatohepatitis?
Your Answer: Sudden weight loss or starvation
Correct Answer: Type 1 diabetes mellitus
Explanation:There are two types of Non-alcoholic fatty liver disease (NAFLD); simple fatty liver and non-alcoholic steatohepatitis (NASH). Simple fatty liver and NASH are two separate conditions.
Simple fatty liver, also called non-alcoholic fatty liver (NAFL), is a form of NAFLD in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not progress to cause liver damage or complications.
Non-alcoholic steatohepatitis (NASH)
NASH is a form of NAFLD in which you have hepatitis and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer. Type I diabetes is not associated with NASH (non-alcoholic steatohepatitis), but type II diabetes is. Hyperlipidaemia, obesity, sudden weight loss/starvation and jejunoileal bypass are all associated with NASH. This is the most common cause of liver disease in the developed world. -
This question is part of the following fields:
- Gastroenterology
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Question 5
Incorrect
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A social worker has been diagnosed with hepatitis C infection. Which test will conclusively establish the presence of this infection?
Your Answer: IgM anti-HAV
Correct Answer: HCV RNA
Explanation:The most sensitive test for detecting Hepatitis C infection (acute) is HCA RNA; it can be detected 1-2 weeks after infection. Anti-HCV antibodies take at least 6 weeks to develop and be positive.
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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 53-year-old man is brought into the emergency department by the paramedics. He collapsed oat home suffering from a myocardial infarction and was subsequently resuscitated following a cardiac arrest. Blood tests show impaired liver function (ALT 1400 u/l). He is on a statin, and at his appointment last week his LFT was normal. There is nothing to note on examination and he is currently not complaining of any pain. Given this man's presentation, what is the most likely cause of his impaired liver function tests?
Your Answer: Budd-Chiari syndrome
Correct Answer: Ischaemic hepatitis
Explanation:When you have abnormal liver function tests after a cardiac arrest, the most likely aetiology, barring history that is known or given excluding this diagnosis, would be ischemia. Chronic alcohol abuse would not see an acute elevation like this. Hepatitis B is just unlikely given the clinical picture, ischemia is much more likely. The same is for Budd-Chiari syndrome (venous thrombosis) and Wilson’s disease.
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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 62-year-old female with a history of COPD and hypertension presents with pain on swallowing. Current medication includes a salbutamol and becotide inhaler, bendrofluazide and amlodipine. What is the most likely cause of the presentation?
Your Answer: Myasthenia gravis precipitated by bendrofluazide
Correct Answer: Oesophageal candidiasis
Explanation:The history gives you a woman who is on inhaled steroid therapy. It is always a good idea for patients to rinse their mouths well after using inhaled steroids. Odynophagia (pain on swallowing) is a symptom of oesophageal candidiasis, which is the most likely answer given the steroids. Typically, you might see this in someone who is immunocompromised (classically, in HIV+ patients).
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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 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: He should be informed of a risk of a stoma if surgery is indicated
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.
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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 32-year-old lady is found to be hepatitis B surface antigen positive. This positive result has persisted for more than six months. Hepatitis B envelope antigen (HBeAg) is negative. HBV DNA is negative. Her liver function tests are all entirely normal. Which of the following options would be the best for further management?
Your Answer: Liver biopsy but no antiviral therapy
Correct Answer: No antiviral therapy but monitor serology
Explanation:Again, remember the Hepatitis B serologies: In chronic hepatitis B infection, you have +HBsAg, +anti-HBc, (-)IgM antiHBc, and (-) anti-HBs. In acute hepatitis B infection, you have +HBsAg, + anti-HBc, + IgM anti-HBc, and negative anti-HBs. In immunity due to natural infection, you have negative HBsAg, + anti-HBc, and + anti-HBs. In immunity due to vaccination, you have negative HBsAg, negative anti-HBc, and positive anti-HBs. IN THIS CASE, the person is HBsAg+ for 6 months and everything else is negative, normal transaminase. They do not need antiviral therapy, but their serology should be monitored serially. There would be no reason to do a liver biopsy.
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This question is part of the following fields:
- Gastroenterology
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Question 10
Incorrect
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Which of the following forms of acute viral hepatitis has a much higher mortality in pregnant than non-pregnant females?
Your Answer: Hepatitis B
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.
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This question is part of the following fields:
- Gastroenterology
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Question 11
Incorrect
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A 45-year-old man who had a liver transplant just over 3 months ago, now has primary sclerosing cholangitis. He complains of fever, abdominal pain and diarrhoea, which has come on over the last week. He has a platelet count of 60 x 109/L and alanine transaminase (ALT) of 300 U/L with a normal bilirubin. He is taking tacrolimus and prednisolone for immunosuppression, and tells you that he recently stopped taking valganciclovir. What is the most likely diagnosis?
Your Answer: Recurrence of primary sclerosing cholangitis
Correct Answer: Donor-acquired cytomegalovirus
Explanation:The fact that he has recently stopped taking his valganciclovir, anti-viral, is key to the answer to this question. This makes the answer quite plainly donor-acquired CMV infection over all of the other answer choices. He needs to stay on prophylaxis against this, particularly in the first 3 months after transplant. Symptoms and presentations of CMV infection can include fever, abdominal pain, diarrhoea, pneumonitis, hepatitis, hematologic abnormalities, retinitis, and esophagitis.
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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 25-year-old woman is reviewed in clinic. She was previously treated with omeprazole, amoxicillin and clarithromycin for Helicobacter pylori (H. pylori). She remains on PPI therapy but continues to have epigastric discomfort. You suspect she has ongoing H. pylori infection and request a urea breath test to investigate this. How long would the patient need to stop her PPI therapy before the urea breath test?
Your Answer: 5 days
Correct Answer: 14 days
Explanation:PPI will affect the accuracy of the test. In general, most recommend discontinuing PPI therapy for 2 weeks prior to a urea breath test. PPI’s have an anti-H. pylori effect.
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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 24-year-old waiter applies for a job at a cafeteria. He gives a history of having had enteric fever 2 years ago. Which of the following investigations is most likely to indicate a chronic carrier status?
Your Answer: Vi agglutination test
Correct Answer: Culture of intestinal secretions
Explanation:The chronic asymptomatic carrier state is thought to be why there is continued appearance of the bacterium in human populations. As shedding of the organism is intermittent and sometimes at low levels, methods to detect it have been limited. The Salmonella typhi may be cultured from intestinal secretions, faeces or urine in chronic carriers and is recommended to confirm the diagnosis. Vi agglutination test can also be high in normal people in areas with typhoid endemic. Full blood count or blood culture would not be helpful to determine carrier status. Widal antigen test is unable to differentiate carriers from people with a hx of prior infection.
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This question is part of the following fields:
- Gastroenterology
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Question 14
Correct
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A 36-year-old man with diabetes is referred with abnormal liver biochemistry. Which of the following is in keeping with a diagnosis of haemochromatosis?
Your Answer: Transferrin saturation 78% (20-50)
Explanation:A high transferrin saturation is seen in hemochromatosis, as well as a high iron level (>30), a high ferritin level, and a LOW TIBC (<20). Think of it like the opposite findings of iron deficiency anaemia which is a low iron, low ferritin, high TIBC.
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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 22-year-old woman has ingested an unknown quantity of paracetamol tablets four hours ago. She now presents with nausea, vomiting, anorexia and right subchondral pain. Which of the following features suggest that she should be transferred to the liver unit?
Your Answer: ALT 800 units/L
Correct Answer: pH 7.25
Explanation:The most widely used prognostic predictors for acetaminophen over-ingestion is King’s College Criteria, which is: arterial PH < 7.3 after fluid resuscitation, Cr level > 3.4, PT > 1.8x control or > 100s, or INR > 6.5, and Grave III or IV encephalopathy.
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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 53-year-old woman presents with upper GI haemorrhage. She has a history of rheumatoid arthritis for which she is managed with low dose prednisolone, diclofenac and codeine phosphate. On examination in the Emergency ward her BP is 90/60 mmHg, pulse 100/min. You fluid resuscitate her and her BP improves to 115/80 mmHg, with a pulse of 80/min. Investigations; Hb 10.4 g/dL, WCC 6.1 x109/L, PLT 145 x109/L, Na+ 139 mmol/L, K+ 4.9 mmol/L, Creatinine 180 μmol/L, ECG – Lateral ST depression , Upper GI endoscopy reveals a large bleeding ulcer on the posterior aspect of the duodenum. It cannot be easily reached with the endoscope, and you decide to attempt embolization. Which of the following is the artery that should be targeted?
Your Answer:
Correct Answer: Posterior superior Pancreaticoduodenal artery
Explanation:The most common location for a duodenal ulcer bleed is the posterior duodenum (remember: posterior bleeds, anterior perforates). The perfusion to this area is most specifically from the posterior superior pancreaticoduodenal artery.
The anterior superior pancreaticoduodenal artery supplies the anterior region. The gastroepiploic artery supplies mostly the stomach. The splenic artery goes, obviously, toward the spleen, in the other direction. The gastroduodenal artery is a branch of the celiac artery, and it’s branches are the anterior superior pancreaticoduodenal artery and posterior superior pancreaticoduodenal artery.
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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 32-year-old woman was referred for endoscopy and found to have a duodenal ulcer and a positive urease test. She was given lansoprazole, amoxicillin and clarithromycin for 7 days. Which of the following is the most appropriate way of determining the successful eradication of H. pylori?
Your Answer:
Correct Answer: Urea breath test
Explanation:Urea breath test is the most sensitive test to determine if there has been RESOLUTION/ERADICATION of the infection with H. pylori. The best test for initial diagnosis would be EGD with biopsy.
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This question is part of the following fields:
- Gastroenterology
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Question 18
Incorrect
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A 74-year-old woman referred by her GP because of increasing weight loss, early satiety and increasing anorexia. She admits to 2 or 3 episodes of vomiting blood. The GP feels an epigastric mass. There is both a microcytic anaemia and abnormal liver enzymes. Her past history, which may be of importance, includes excess consumption of sherry and spirits, and a 30 pack-year smoking history. Which diagnosis fits best with this clinical picture?
Your Answer:
Correct Answer: Gastric carcinoma
Explanation:With a clinical history of weight loss, smoking, drinking alcohol, and hematemesis, the most likely answer is gastric carcinoma (also a mass). Based on symptomatology alone this is more likely than gastric lymphoma, as she has many risk factors for adenocarcinoma and/or squamous cell carcinoma. Helicobacter gastritis would not likely present with the severity of symptoms, neither would benign gastric ulcers.
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This question is part of the following fields:
- Gastroenterology
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Question 19
Incorrect
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If a patient has HIV what is the most likely cause of persistent watery diarrhoea?
Your Answer:
Correct Answer: Cryptosporidium
Explanation:When you have a patient with HIV and diarrhoea on the exam, think Cryptosporidium. In those who are immunocompetent this organism doesn’t usually cause symptoms, but in immunocompromised people like those with HIV, it causes infection and diarrhoea. Typically those with CD4 counts of <100 cells/µL1 have the greatest risk for prolonged, severe, or extraintestinal cryptosporidiosis.
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This question is part of the following fields:
- Gastroenterology
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Question 20
Incorrect
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With respect to liver cirrhosis, which of the following statements is correct?
Your Answer:
Correct Answer: The final common pathway of hepatic fibrosis is mediated by the hepatic stellate cell
Explanation:The development of hepatic fibrosis reflects an alteration in the normally balanced processes of extracellular matrix production and degradation. [6] The extracellular matrix, the normal scaffolding for hepatocytes, is composed of collagens (especially types I, III, and V), glycoproteins, and proteoglycans. Increased collagen in the space of Disse (space b/w sinusoids and hepatocytes) leads to capillarization of sinusoids, and stellate cells also have contractile properties when activated. This is fibrosis processes. This can lead to the development of portal hypertension.
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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 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.
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This question is part of the following fields:
- Gastroenterology
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Question 22
Incorrect
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Which one of the following is most suggestive of Wilson’s disease?
Your Answer:
Correct 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.
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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 17-year-old Caucasian woman presents with lethargy and chronic nausea. Her mother is worried she may be depressed. On examination, there are signs of chronic liver disease and a gold-yellow ring at the periphery of the iris in both eyes. Her serum copper level is low. What is the most likely diagnosis?
Your Answer:
Correct Answer: Wilson’s disease
Explanation:This patient has Wilson’s disease. They Kayser-Fleischer ring (ring that encircles the iris) is diagnostic of this. Low serum copper is seen in Wilson’s disease. With the Kayser-Fleischer ring, this makes all of the other answer choices incorrect.
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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 62-year-old lady is referred with painless jaundice and weight loss. Bilirubin is 214 mmol/L, alanine transaminase (ALT) 62 U/L, alkaline phosphatase (ALP) 605 U/L, albumin 34 g/L and prothrombin time 17 seconds. Ultrasound of the abdomen shows a grossly dilated biliary tree and a dilated pancreatic duct, but no mass is seen. What is the next most appropriate step in her management?
Your Answer:
Correct Answer: Abdominal CT scan
Explanation:This scenario is suggestive of a pancreatic head mass with obstructive jaundice and US showing a ‘double duct’ sign. A CT Scan would be recommended to evaluate for a pancreatic head mass. If a mass was found, the next step would then be to do an ERCP with EUS to obtain a biopsy of the mass for tissue diagnosis. Laparoscopy would not be recommended. CA19-9 would not be diagnostic.
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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 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.
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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 72-year-old woman presents with a 3 month history of colicky abdominal pain after eating, and diarrhoea. She has lost 7 kg in weight over the last few months. A recent gastroscopy and colonoscopy were normal. Her past medical history includes angina and a right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan. right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan. Blood tests revealed: Haemoglobin (Hb) 118 g/l, Mean corpuscular volume (MCV) 80 fl, White cell count (WCC) 12.3 x 109/L, Platelets 210 x 109/L, Na+ 133 mmol/L, K+ 5.2 mmol/L, Urea 8.1 mmol/L, Creatinine 134 mmol/L. Select the most appropriate further investigations.
Your Answer:
Correct Answer: Contrast-enhanced computed tomography (CT) of the abdomen
Explanation:The patient is 74 years old. She has had a recent gastroscopy and colonoscopy. She has a history of angina and a right CEA. She is having colicky abdominal pain after meals and weight loss, which points to a possible diagnosis of chronic mesenteric ischemia. Thus, you would want to do a contrast-enhanced CT scan of the abdomen to look for this. A 24 hour cardiac monitor would also be helpful to look for any abnormal rhythm that could be a potential aetiology of her disease.
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This question is part of the following fields:
- Gastroenterology
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Question 27
Incorrect
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Which of the following is consistent with a diagnosis of insulinoma?
Your Answer:
Correct Answer: Low fasting glucose, high insulin, high C peptide
Explanation:Insulinoma is associated with LOW fasting glucose, HIGH insulin level, and HIGH C peptide. Insulin-abuse or overdose will cause HGH insulin levels and a LOW C peptide. If the C peptide is low, be suspicious.
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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 28-year-old man who is admitted with bright red haematemesis, which occurred after a bout of vomiting. He had been out with friends on a stag party and consumed 12 pints of beer. Upper gastrointestinal (GI) endoscopy proves unremarkable and haemoglobin (Hb) is stable at 12.5 g/dl the morning after admission, there is no sign of circulatory compromise. There have been no previous similar episodes. Which of the following stems represents the best course of action for this patient?
Your Answer:
Correct Answer: Send home
Explanation:This is a classic clinical presentation, with alcohol intake and nausea/vomiting that leads to hematemesis, of a Mallory-Weiss tear. In Mallory-Weiss tear, they typically present as a hemodynamically stable patient after a night of binge drinking and excessive resultant vomiting. Given his EGD did not show any other pathology and he is now stable, he can be discharged home.
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This question is part of the following fields:
- Gastroenterology
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Question 29
Incorrect
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A 69-year-old man on the cardiology ward who is hypotensive, and tachycardic is having profuse melaena. He was commenced on dabigatran 150mg bd by the cardiologists 48 hours earlier for non-valvular atrial fibrillation. Following appropriate resuscitation which of the following treatments is most likely to improve his bleeding?
Your Answer:
Correct Answer: Idarucizumab (Praxbind)
Explanation:Idarucizumab (Praxbind) is a newer antidote for dabigatran, the first of its kind. It is a monoclonal antibody fragment that binds dabigatrin with a higher affinity than thrombin. It is very expensive.
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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 54-year-old plumber presents with general deterioration. He drinks approximately 25 units of alcohol each week and is a smoker of five cigarettes daily. Examination reveals that he is jaundiced, has numerous spider naevi on his chest and he has a temperature of 37.2°C. Abdominal examination reveals hepato-splenomegaly. Investigations reveal: Bilirubin 100 micromol/L (1-22), Alkaline phosphatase 310 iu/l (45 – 105), ALT 198 iu/l (5 – 35), AST 158 iu/l (1 – 31), Albumin 25 g/L (37 – 49), Hepatitis B virus surface antigen positive, Hepatitis B virus e antigen negative, Hepatitis B virus DNA awaited. What is the most likely diagnosis?
Your Answer:
Correct Answer: Chronic hepatitis B infection
Explanation:The clinical scenario describes a man in liver failure. Given the serological results, he is most likely to have a chronic hepatitis B infection. In chronic hepatitis B infection, you have +HBsAg, +anti-HBc, (-)IgM antiHBc, and (-) anti-HBs. In acute hepatitis B infection, you have +HBsAg, +anti-HBc, +IgM anti-HBc, and negative anti-HBs. in immunity due to natural infection, you have negative HBsAg, +anti-HBc, and + anti-HBs. In immunity due to vaccination, you have negative HBsAg, negative anti-HBc, and positive anti-HBs. While he could have a superimposed hepatitis D infection on top of hepatitis B, there is no mention of hepatitis D serology, make this an incorrect answer. The other choices do not involve hepatitis serologies.
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This question is part of the following fields:
- Gastroenterology
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SESSION STATS - PERFORMANCE PER SPECIALTY
