Formative

Question 1

A 46yo man had a gastrectomy for treatment of a benign ulcer. Which hormone is then likely to be the most deficient as a result?

Answer 1

Gastrin

Question 2

A 20yo main consulted his GP complaining of bloating after eating. A barium meal showed normal gastric mucosal appearances but delayed gastric emptying. The excess production of which hormone may be responsible for this?

Answer 2

Cholecystokinin

Question 3

A 34yo man had pH monitoring of his stomach as part of a physiology trial. The pH of his gastric secretions was found to be 1.0. What mechanism is responsible for achieving this?

Answer 3

Hydrogen/potassium adenosine triphosphate pumps

Question 4

A digestive tract enzyme may be initially released in an inactive form. What is the best term to describe these compounds?

Answer 4

Zymogen

Question 5

A 19yo man ate a large bar of white chocolate. Which digestive process is most important in the digestion of this food?

Answer 5

Fat rich - emulsification

Question 6

A 23 yo man with a history of alcohol abuse presented with acute upper abdominal pain and vomiting. He was found to have raised serum amylase. What is the most likely diagnosis?

Answer 6

Acute pancreatitis

Question 7

A 47yo man was referred for investigation for impaired defecation. Describe the normal defecation mechanism?

Answer 7

Stretch receptors in the rectal wall activate parasympathetic centres in the spinal cord

Question 8

A 50yo man presents to A+E complaining of a 3 month history of epigastric pain and a 2 day history of a very high volume of vomiting. What is the most likely site of bowel obstruction to cause this?

Answer 8

Duodenum

Question 9

A 45yo woman had surgical removal of her distal ileum to treat IBD. Which vitamin is she at risk of becoming deficient in?

Answer 9

Vitamin B12 - site of absorption

Question 10

A 24yo man has an inherited defect and is unable to produce intrinsic factor. The absorption of which substance is most likely to be impaired?

Answer 10

Vitamin B12

Question 11

A 55yo man presents with a 6 week history of progressive painless jaundice and weight loss. On inspection, he is jaundiced. Abdominal palpation is normal. What is the most likely diagnosis?

Answer 11

Pancreatic cancer

Question 12

A 30yo man presented acutely with jaundice. He had been complaining of intermittent right hypochondriac pain and nausea for several months, but the pain had worsened. His urine was darker than usual and his stools are pale. Which imaging is the most appropriate for this instance?

Answer 12

Abdominal ultrasound - non-invasive

Question 13

A 45yo man was stabbed in the lower chest. The knife cut most of the vagus nerve fibres around the oesophagus. What is now likely to occur following this nerve injury?

Answer 13

Delayed gastric emptying

Question 14

A 40 yo main had a total colectomy to treat a colonic carcinoma. The operation was curative. What is now likely to occur as a result?

Answer 14

Hyponatraemia

Question 15

A 70yo woman presents with jaundice. She has been complaining of right abdominal pain and altered bowel habit for several months. On examination, she has a hard craggy mass in her right iliac fossa and hepatomegaly. An abdominal ultrasound is performed. What is the most likely finding in the liver at ultrasound?

Answer 15

Multiple liver metastases

Question 16

A 70yo man presented with abdominal pain, vomiting and abdominal distension. He reported absolute constipation. An abdominal radiograph showed multiple dilated loops of bowel. What findings on abdominal X-ray would be in keeping with small bowel obstruction rather than large bowel obstruction?

Answer 16

Central distribution of loops of bowel

Question 17

A 45yo man presents with massive haematemesis and melaena. Endoscopy reveals an actively bleeding posterior ulcer in the first part of the duodenum. Which artery is the most likely to be bleeding?

Answer 17

Gastro-duodenal artery

Question 18

A 30yo man was suspected of having impaired intestinal motility. Routine blood and imaging tests were normal. What may explain his impaired motility?

Answer 18

Segmentation contractions are reduced during a meal abnormally

Question 19

A patient had a cholecystectomy for treatment of chronic cholecystitis. During the operation, the surgeon noticed arterial blood loss from the gallbladder neck. Which artery is the most likely to be injured?

Answer 19

Cystic artery

Question 20

A 50yo patient with chronic peptic ulcer disease that had not responded to therapy had surgical removal of the gastric antrum to reduce gastric acid production. How does the surgical procedure reduce acid production?

Answer 20

Virtually eliminates gastrin production

Question 21

A 25 yo woman presented with a 6 week history of diarrhoea and oral apthous ulcers. Her stool contained blood and mucus. What is the most likely diagnosis?

Answer 21

Crohns disease - presence of ulcers in the mouth suggests extensive disease typical of CD rather than UC

Question 22

A 25yo man presented with fever, bloody diarrhoea and cramping for several weeks that did not resolve with antibiotic treatment. Proctosigmoidoscopy reveals red, raw mucosa and pseudopolyps. What is the most likely cause?

Answer 22

Ulcerative colitis

Question 23

A 20yo man presented with 12hr history of colicky peri-umbilical pain which has shifted to the right iliac fossa, fever and loss of appetite. What is the most likely diagnosis?

Answer 23

Acute appendicitis

Question 24

A 45yo heterosexual male was admitted to hospital after ingesting 25g of paracetamol 3 days earlier. He had no past medical history of relevance, took no regular medications and rarely consumed alcohol. What clinical signs would be most consistent with his presentation?

Answer 24

Paracetamol overdose linked to acute liver failure
Clinical signs of liver failure include jaundice, ascites, palpable hepatomegaly, disorientation, nausea and vomiting, malaise etc

Question 25

What is the most common cause of acute liver failure in the UK?

Answer 25

Paracetamol overdose

Question 26

A 71yo man had a malignant tumour of the middle third of the oesophagus. What is the most likely histopathological diagnosis?

Answer 26

Squamous carcinoma