Gastroenterology and hepatology Flashcards
A 47 year old presents to your clinical with a three-month history of dysphagia. There is no history of drastic weight loss and the patient experiences symptoms when swallowing solids but not liquids. Which of the following is not an obstructive cause of dysphagia? A. Pharyngeal carcinoma B. Oesophageal web C. Retrosternal goitre D. Peptic Stricture E. Achalasia
TBC
You see a 47 year old man in clinic with a three month history of epigastric dull abdominal pain. He states that the pain is worse in the mornings and is relieved after meals. On direct questioning, there is no history of weight loss and the patient's bowel habits are normal. On examination, his abdomen is soft and experiences moderate discomfort on palpation of the epigastric region. The most likely diagnosis is: A. Gastric Ulcer B. Gastro-oesophageal reflux disease. C. Duodenal Ulcer D. Gastric Carcinoma E. Gastritis
TBC
A 55 year old woman is reffered by her GP for upper Gastrointestinal (GI) endoscopy following a four month history of epigastric pain despite treatment with antacids and proton pump inhibitors (PPIs). The results demonstrate a duodenal ulcer coupled with a positive campylobacter like organism (CLO) test. The patient has no past medical history and no known drug allergies. The most appropriate treatment is:
A. Seven-day course of twice daily omeprazole 20mg, 1g amoxicillin and 500mg of clarithromycin
B. Seven-day course of twice daily omeprezole 20mg.
C. Seven-day course twice daily omeprazole 20mg and 1g amoxicillin.
D. Seven-day course of twice daily omeprazole 20 mg and 500mg clarithromycin.
E. Seven-day course of twice daily 1g amoxicillin and 500mg clarithromycin.
TBC
Which of the following is the most common cause of duodenal ulcers? A. NSAIDs B. Helicobacter Pylori C. Alcohol abuse D. Chronic corticosteroid therapy E. Zollinger-Ellison syndrome
TBC
You see a 48 year old lorry driver, who presents to you with a three month history of heartburn after meals which has not been settling with antacids and PPIs. You suspect that the patient has a hiatus hernia. The most appropriate investigation for diagnosing a hiatus hernia is: A. Computer tomography (CT) scam B. Chest x-ray C. Upper GI endoscopy D. Barium Meal E. Ultrasound
TBC
You see a 56-year-old man who was admitted for an elective upper GI endoscopy due to longstanding GORD which has failed to improve on antacids and PPIs. Your registrar suspects that this patient may have Barrett’s oesophagus and asks you to define what this is. The most appropriate description of Barrett’s Oesophagus is:
A. Metaplasia of the squamous epithelium of the lower third of the oesophagus to columnar epithelium.
B. Metaplasia of the columnar epithelium of the upper third of the oesophagus to squamous epithelium
C. Metaplasia of the columnar epithelium of the lower third of the oesophagus to squamous epithelium.
D. Metaplasia of the squamous epithelium of the upper third of the oesophagus to columnar epithelium.
E. metaplasia of the squamous epithelium of the middle third of the oesophagus to columnar epithelium.
TBC
You see a 25-year-old woman who presents with a 24-hour history of watery diarrhoea. She states that she has opened her bowels 11 times since her onset of symptoms. Associated symptoms include nausea and vomiting with abdominal cramps and pain which started in the evening following a barbeque meal in the afternoon that day. The patient is alert and orientated and her observations include a pulse rate of 69, blood pressure of 124/75 and temperature of 37.1ºC. On examination, her abdomen is soft, there is marked tenderness in the epigastric region and bowel sounds are hyperactive. The patient is normally fit and well with no past medical history. The mots likely diagnosis is: A. Irritable Bowel Syndrome B. Gastroenteritis C. Ulcerative Colitis D. Laxative abuse E. Crohn's disease
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A 35-year-old woman presents with a 24-hour history of watery diarhoea. She has opened her bowels nine times since the onset of her symptoms. You diagnose gastroenteritis after learning that the patient and he family all ate at a new restaurant and the rest of her family have had similar problems. The most appropriate management is:
A. Oral rehydration advice, anti-emetics and discharge home.
B. Oral antibiotic therapy and discharge home
C. Admission for intravenous fluid rehydration
D. Admission for intravenous antibiotic therapy
E. No treatment required.
TBC
A 35-year-old man presents with a 2-week history of diarrhoea which had not settled following an episode of ‘food poisoning’. Which of the following would be the most appropriate investigation?
A. Full blood count
B. Urea and electrolytes
C. Stool sample for microscopy, culture and sensitivites
D. Abdominal X-ray
E. Liver function tests
TBC
You are questioned by your registrar regarding bacteria responsible for causing blood-stained diarrhoea. From the list below, select the organism which is not responsible for causing blood-stained bacteria. A. Campylobacter spp. B. Salmonella spp. C. Escherichia coli D. Shigella spp. E. Staphylococcus spp.
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A 69-year-old man presents with a 2-week history of abdominal pain which has worsened over the last few days. On examination, the patient is jaundiced and the abdomen is distended with tenderness in the epigastric region. In addition, there is a smooth hepatomegaly and shifting dullness. Which of the folowing is a cause of hepatomegaly? A. Iron deficiency anaemia B. Budd-Chiari syndrome C. Ulcerative colitis D. Crohn's disease E. Left-sided heart failure
tbc
You see a 19-year old caucasian man in your clinic who presents with a history of transient jaundice. On direct questioning, you ascertain that the jaundice is noticable after periods of increased physical activity and subsides after a few days. The patient has no other symptoms and physical examination is unremarkable. Full blood count is normal (With a normal reticulocyte count) and liver function tests reveal a bilirubin of 37micromol/L. The most appropriate management is: A. Reassure and discharge B. Start on a course of oral steroids. C. Request abdominal ultrasound D. Request MRCP E. Refer to Haematology
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You see a 54-year-old woman, reffered to accident and emergency through her GP, with a wek's history of jaundice and right upper quadrant abdominal pain. Associated symptoms include dark urine and pale stools. There is no history of weight loss and the patient does not consume alcohol. Her liver function tests reveal a bilirubin of 40micromol/L, ALT of 40iu/L, AST 50iu/L, ALP 350iu/L. The most likely diagnosis is: A. Gallstones B. Viral hepatitis C. Alcoholic hepatitis D. Carcinoma of the head of the pancreas E. Autoimmune hepatitis
tbc
You are asked by the registrar to request an imaging investigation for a 49-year-old woman with jaundice and abdominal pain. She has a past medical history of gallstones and you suspect this is a recurrance of the same problem. The most appropriate imaging investigation is:
A. Abdominal X-ray
B. Abdominal ultrasound
C. Abdominal CT
D. Magnetic resonance imaging (MRI)
E. Endoscopic retrograde cholangiopancreatography
tbc
You see a 47-year-old woman who presents with a 3-day history of jaundice. You assess her liver function tests (LFTs) and see that the ALP iu/L is raised at 350 iu/L, AST 45 iu/L, ALT 50 iu/L and bilirubin 50 iu/L. The patient feels well in herself, although she has noticed that her urine has become quite dark and her stools quite pale. You assess her medication history. Which of the following drugs from the patient’s medication history may be responsible for the cholestasis?
A. Co-amoxiclav B. Bendroflumethiazide C. Ramipril D. Amlodipine E. Aspirin
tbc
