Gastroenterology

Question 1

Jaundice, non-tender palpable enlarged gallblader:

Answer 1

Courvoisier’s sign, think malignancy (cholangiocarcinoma or pancreas)

Question 2

Middle-aged woman, impaired LFTs, pruritus, Sjogren, AMA positive, diagnosis and management:

Answer 2

Primary biliary cholangitis, Ursodeoxycholic acid

Question 3

Hereditary pattern of haemochromatosis:

Answer 3

AR

Question 4

C difficile infection not responding to oral vanc or oral fidaxomicin

Answer 4

Oral vanc + IV metronidazole

Question 5

Antibiotic that causes cholestasis:

Answer 5

Co-amoxiclav

Question 6

DM drug that causes cholestasis:

Answer 6

Sulphonylureas (gliclazide)

Question 7

Management for suspected bleeding varices before endoscopy:

Answer 7

Terlipressin and IV antiniotics (quinolones)

Question 8

Double duct sign on imaging:

Answer 8

Pancreatic cancer

Question 9

Long-term disadvantage of PPIs

Answer 9

Osteoporosis and fractures

Question 10

Treatment and secondary prophylaxis for hepatic encephalopathy:

Answer 10

Lactulose, rifaximin.

Question 11

Diarrhoea, floating stools, swimming in pools:

Answer 11

Giardia

Question 12

Most common site affected by Crohn’s and UC:

Answer 12

Ileum, rectum

Question 13

Patient listed for endoscopy, recommendations on omeprazole?

Answer 13

Stop taking omeprazole 2 weeks before endoscopy

Question 14

First-line to maintain remission in left-sided or extensive ulcerative colitis:

Answer 14

Oral aminosalicylate (mesalazine)

Question 15

Incidenctal finding of NAFLD, next step:

Answer 15

Enhanced liver fibrosis blood test (ELF)

Question 16

Patient with ascitis presents with abdominal pain and fever, investigation and diagnosis:

Answer 16

Paracentesis, spontaneus bacterial peritonitis confirmed by neutrophil count >250 cells/ul

Question 17

Mild-to-moderate flare of ulcerative colitis (<6 stools/day, no systemic upset) management:

Answer 17

Topical aminosalicylate, if no remission in 4 weeks, add oral aminosalicylate

Question 18

Severe flare of ulcerative colitis (>6 stools/day + systemic upset) management:

Answer 18

IV steroids
IV ciclosporin 2nd line

Question 19

Most accurate determinant of acute liver failure as it is a measurement of the liver’s synthetic function:

Answer 19

Prothrombin time