Gastroenterology RACP MCQs Flashcards
RACP 2022 Q13
13.A 56 year old woman has autoimmune hepatitis, hypertension and hyperlipidemia on azathioprine, perindopril and atorvastatin. She develops acute joint pain in her left MTP. Joint aspirate showed calcium pyrophosphate (?) crystals. What is your initial management?
a. Allopurinol
b. Probenicid
c. Feboxustat
d. Benzbromarone
RACP 2022 Q45.
A patient has a new diagnosis of diffuse large B cell lymphoma. He is about to start chemo with RCHOP. As part of his initial work up, his hepatitis B serology shows Hep B surface antigen negative, Hep B core antibody
positive, Hep B surface antibody positive. How would you manage this?
a. Do nothing as patient is immune
b. Check Hep B E antibody
c. Start antivirals
A
Patient is fully cured from past infection and no further intervention is required
(refer to Hepatitis powerpoint - JK)
RACP 2022 Q79
79.”A 64yo M is found to have large cell lymphoma, he is planned to commence
on cyclophosphamide, doxorubicin, vincristine(?), prednisone, and rituximab.
He was screened pre-treatment for hepatitis B, his results are as follows:
HbsAg negative
HbsAb positive
HbcAb positive
Viral load not detected
What is the most appropriate step before commencing chemotherapy?
a. antiviral medications
b. check hepatitis B e antibody
c. hepatitis B vaccine
d. no further treatment
D
Patient is fully cured from previous Hep B infection
(refer to Hepatitis powerpoint - JK)
RACP 2022 Q 85.EMQ:
A patient has been started on isoniazid for pulmonary tuberculosis. What nutritional supplementation does this patient need?
a. B1 (thiamine)
b. B2
c. B3 (niacin)
d. B4
e. B6 (pyridoxine)
f. B12
g. C
h. D
RACP 2022 86.EMQ:
A patient has been eating shaved ice for a month after having bariatric surgery. He now presents with ophthalmoplegia, ataxia and nystagmus. What nutritional supplementation does this patient need?
a. B1 (thiamine)
b. B2
c. B3 (niacin)
d. B4
e. B6 (pyridoxine)
f. B12
g. C
h. D
RACP 2022b 6
- What is the pathophysiology of malabsorption in coeliac disease?
A. reduced intestinal surface area
B. reduced brush border dissacharidases
C. increased enteric amylase
D. increased unabsorbed carbohydrates
RACP 2022 Q40.
A patient has macrocytic anaemia and you suspect pernicious anaemia. What is the
most Specific Antibody test?
A. Intrinsic factor
B. Methymalone acid
C. Parietal cell
D. Vitamin B 12
RCAP 2022 Q48
- What is the mechanism of action of lactulose when used as a laxative?
A. Not broken down by intestinal enzymes and remains in lumen, causing water to
remain in lumen
B. Stimulates intestinal cells to contract, increases intestinal motility
C. Cause increased secretion of fluid into the intestinal lumen and add bulk to stool
D. Reduces surface tension to allow more water to enter stool
RACP 2022 Q50
- What electrolyte abnormalities occur in refeeding syndrome?
A) K decrease, PO4 decrease, Mg decrease
B) K increase, PO4 decrease, Mg decrease
C) K increase, PO4 increase, Mg increase
D) K decrease, PO4 increase, Mg increase
RACP 2022 66. EMQ:
What receptor does this antiemetic act on? Ondansetron
A. 5-HT3
B. Dopamine
C. NK-1
D. Histamine
E. Acetylcholine
RACP 2022 67. EMQ: What receptor does this antiemetic act on? Aprepitant
A. 5-HT3
B. Dopamine
C. NK-1
D. Histamine
E. Acetylcholine
RACP 2021a Q36.
A 60 year old man presents with a two week history of pruritis, jaundice, dark urine, pale stools, and 6kg weight loss, but nil abdominal pain. In the month prior, he had a course of augmentin duo forte for a chest infection. He has a background history of a caecal cancer treated with right sided hemicolectomy. He smokes 20 cigarettes per day and drinks 2 standard drinks per day. His observations are: HR 88, BP 125/88, RR 12, temp 36.8C.
An abdominal ultrasound shows a dilated gallbladder with nil stones, dilated CBD to the level of the duodenum, and increased echogenicity throughout the liver. His LFTs are as follows:
Bilirubin 210
Albumin 34
ALT 40
ALP 610
GGT 340
What is the most likely diagnosis?
A. Drug induced liver injury related to Augmentin
B. Alcoholic liver disease
C. Widespread colorectal cancer
D. Head of pancreas cancer
RACP 2021b Q46.
A nurse has been exposed to a needlestick injury when caring for a patient. The patient has bloods with
serology is as follows: Hepatitis B surface antigen positive, HIV serology negative and Hepatitis C serology negative. The nurse’s blood tests from an earlier in the year show: Hepatitis B core negative, HIV negative, Hepatitis C negative and Hepatitis B surface antibody > 1000 IU.
What treatment do you suggest?
A. Prophylactic Entacavir
B. Hepatitis B immunoglobulin
C. Reassure and do no investigations
D. Hepatitis surface antigen serology at 6 and 12 weeks
RACP 2021a Q71
Q75. What is the histology at GOJ biopsy in Barrett’s oesophagus?
A. Goblet cell hyperplasia
B. Inflammation
C. Intestinal metaplasia
D. (Rhubarb)
C - intestinal metaplasia +/- acid-mucin–containing goblet cells
RACP 2021a Q88
Q88. You review a 24-year-old male who has Crohn’s disease with stricturing ileal disease. He underwent a
resection of bowel including the terminal ileum with primary anastomosis 2 years ago. His current medications
include azithromycin and infliximab.
He now comes to you with persistent diarrhea. You performed further investigations to assess the cause. His
faecal calprotectin was within normal limits. Colonoscopy including biopsy showed a patent ileocolonic anastomosis with no evidence of active inflammation. MRI of the abdomen showed normal bowel calibre without any active inflammation.
What is the most likely cause of his persistent diarrhea?
A. Bile salt malabsorption
B. Clostridium difficile infection
C. Coeliac disease
D. Short gut syndrome
RACP 2021b Q105
Q105. Persistence of which viral component prevents hepatitis B cure?
A. Covalently closed circular DNA
B. Hepatitis B surface antigen
C. Precore protein
D. Pregenomic RNA
A
(refer to Hepatitis powerpoint - JK)
RACP 2021b Q108
Q108. In which part of the gastrointestinal tract are bile salts absorbed?
A. Duodenum
B. Stomach
C. Ileum
D. Jejunum
C - distal ileum
RACP 2021 Q145. What is the most specific autoantibody for diagnosis of autoimmune hepatitis?
A. Anti smooth muscle (anti SMA)
B. Anti liver cytosol 1 (anti LC1)
C. Anti liver kidney microsomal (anti LKM)
D. Anti soluble liver antigen/liver pancreas (anti SLA/LP)
A
RACP 2021 Q148. Acute opioid withdrawal has been reported in patients with end stage liver disease when administered oxycodone-naloxone combination. This is best explained by:
A. Augmentation of endogenous partial agonists
B. Increased absorption due to gastric hyperaemia and gut oedema
C. Increased volume of distribution
D. Shunting of portal circulation to systemic circulation
RACP 2021 Q169 – Which protein releases iron into blood stream from enterocytes?
A. Ferritin
B. Hepcidin
C. Ferroportin
D. Transferrin
E. onwards - rhubarb
RACP 2021 Q6. A 70 year old male with a history of Parkinson’s disease presents with nausea and vomiting. Which of the
following medications would most likely cause an exacerbation of the patient’s Parkinson’s disease?
A. Cyclizine
B. Metoclopramide
C. Domperidone
D. Ondanestron
RACP 2021 Q25. A 70 year old man has a history of chronic constipation. He presents with abdominal swelling and distension,
abdo pain and vomiting. His abdominal x-ray is shown below. Exact image included in paper.
What is the most likely diagnosis?
A. Obstructive tumour
B. Pseudo obstruction
C. Faecal loading
D. Sigmoid volvulus
RACP 2021
Q55. What is the most likely explanation for persisting malabsorptive symptoms and villous atrophy in patients
with proven coeliac disease?
A. Ongoing dietary gluten intake
B. Pancreatic malabsorption
C. Intestinal Crohn’s disease
D. Collagenous atrophy
RACP 2021
Q97. Which of the listed immunosuppressive medications cause chronic diarrhoea?
A. Anti-thymocyte globulin
B. Tacrolimus
C. Cyclosporin
D. Sirolimus
E. Mycophenolate mofetil
F. Basiliximab
G. (Rhubarb)
H. (Rhubarb)
RACP 2021o
Q11. Markers in wilson disease
A. copper increased/ceruloplasmin reduced/ increased ALT:AST
B. Copper level increased/ceruloplasmin reduced/decreased ALT:AST ratio
C. Copper level decreased /ceruloplasmin increased/ increased ALT:AST
ratio
D. Copper level decreased/ ceruloplasmin increased/ decreased ALT:AST
ratio
RACP 2021o
42. Question describes faecal calprotectin being highly specific (or maybe
sensitive) in patients with IBD. What would happen to the negative predictive
value if the prevalence of IBD was found to be higher - such as in an IBD clinic?
a. NNP increased
b. NNP decreased
c. No change to NNP
RACP 2020a 4. A 35 year old male has chronic hepatitis, managed with tenofovir. Dipstick urinalysis show glycosuria and proteinuria. Which of the following findings are most consistent with tenofovir-induced Fanconi syndrome?
A) Hypocalcaemia
B) Hypomagnesaemia
C) Hypophosphataemia
D) Hypouricaemia
C
RACP 2020a
14. Patients with chronic liver disease feel more dyspnoea when standing up as opposed to lying down (orthodeoxia). An increase in what parameter explains this phenomenon?
A) Left ventricular preload
B) Cardiac output
C) Intra-abdominal pressure
D) Pulmonary capillary vasodilation
RACP 2020a 15. What is the most common side effect of osteltamivir?
A) Hepatitis
B) Rash
C) Nausea and vomiting
D) Confusion
RACP 2020a 24. A 36 year old male is admitted with 2 weeks of bloody diarrhoea associated with mild abdominal pain and tenesmus. On Examination his heart rate is 105. His Hb is 114 and WCC 14, with a CRP of 40. Stool culture is negative. A flexible sigmoidoscopy shows inflammation pass the splenic flexure. Biopsy demonstrated active inflammation consistent with ulcerative colitis. He is given 3 days of IV hydrocortisone 100mg QID with no improvement. Which of the following will increase his chance of recovery and minimise his risk of colectomy?
A) Methylprednisone
B) Azathioprine
C) Infliximab
D) Methotrexate
RACP 2020a
Q 39. A 50 year old female was recently in hospital and diagnosed with a 3cm gastric ulcer in the antrum. This was treated with adrenaline injections and diathermy coagulation. She has no medical history and takes ibuprofen/codeine (2 tablets a month) for headaches. On review 8 weeks later, she is well with no further symptoms. What is the next step in management? (Specifically NO mention of biopsy or H pylori testing in stem)
A) Discharge to GP’s care
B) Perform repeat gastroscopy
C) Urea breath test
D) Fructose hydrogen breath test
RACP 2020a
48. A 58 year old male admitted with bleeding duodenal ulcer secondary to NSAIDs. He is treated endoscopically, NSAIDs ceased, commenced on PPI. H pylori is negative. What should the optimal duration of PPI be?
A) 1 month
B) 2 months
C)12 months
D) Indefinitely
RACP 2020
56. EMQ Stem: What investigation would most likely lead to the diagnosis? A 30 year old female with primary sclerosing cholangitis presenting with 6 months of blood diarrhoea and bloating. She has not lost weight. She has a family history of small bowel lymphoma.
A) ACE Inhibitors
B) Calcium Channel Blockers
C) Vasopressin receptor, V2 antagonist
D) Anti-CD20 antibody
E) Terminal complement inhibitor
F) Loop diuretic
G) Cyclophosphamide
H) Corticosteroid
RACP 2020
57. EMQ Stem: What investigation would most likely lead to the diagnosis? 28 year old girl with RIF pain. History of perianal fistula and Iron Deficiency Anaemia.
A) CT colonoscopy
B) Pelvic MRI
C) Small bowel MRI
D) Colonoscopy
E) Capsule endoscopy
F) Stool MCS
G) Red cell scan
RACP 2020
66. What is the mechanism of liver injury in alpha-1 antitrypsin deficiency?
A) Excess protease activity
B) Lack of elastase inhibition
C) Mitochondrial dysfunction
D) Protein accumulation
RACP 2020
75. When therapeutic dose of paracetamol is administered, the blood concentration usually takes 2 hours to peak. If someone is overdosed on paracetamol e.g. taken 50g, it takes more than 6 hours to peak. What is the reason for this?
A) Given NAC
B) Given charcoal
C) Delayed absorption
D) Delayed elimination
RACP 2020
80. Needlestick injury of a nurse from a patient with HbSag positive blood. Nurse’s HbSAb titre >100IU/L
A) Hepatitis B Immunoglobulin
B) No treatment
C) Hepatitis B vaccination
D) Re-test hepatitis B antigen after 3 months
B
The nurse has immunity to Hep B virus
(refer to Hepatitis powerpoint - JK)
RACP 2020
2. Which gene for haemachromatosis
A. C282Y
B. DeltaF508
C. H63D
D. Useless wrong one
RACP 2020 6. Needlestick injury of patient with HbSag positive blood. Doctors HbAb titre >100
A. Hb immunoglobulin
B. Monitor at baseline and 6 months
C. Do nothing
D. Hep B booster vaccine
B
The doctor has immunity to Hep B virus
(refer to Hepatitis powerpoint - JK)
RACP 2020
37. An 87-year-old man presents for an outpatient appointment for 4 months history of poor appetite, eating only 1/4 of his meals and 5kg weight loss. He has a history of moderate-severe dementia with MMSE 10/30 and his wife makes his meals for him. He is on nutritional supplements. He weighs 55kg (BMI 19.5). What is the best management?
A) CT abdomen
B) Gastroscopy
C) Start olanzapine
D) Cease donepezil
RACP 2019a Question 1
What is the response rate of ledipasvir + sofosbuvir in Hepatitis C genotype 1?
A. 65%
B. 75%
C. 85%
D. 95%
RACP 2019a Question 29
A 45 year old lady develops abdominal pain and diarrhoea 15 minutes after every meal. She has a history of gastric Roux-en-y and depression for which she is on desvenlafaxine. What is the most likely cause of her symptoms?
A. Carcinoid syndrome
B. Dumping syndrome
C. Insulinoma
D. VIPoma
RACP 2019a Question 37
A 35 year old male has chronic hepatitis, managed with tenofovir. Dipstick urinalysis show glycosuria and proteinuria. Which of the following findings are most consistent with tenofovir-induced Fanconi syndrome?
A. Hypocalcaemia
B. Hypomagnesaemia
C. Hypophosphataemia
D. Hypouricaemia
RACP 2019a Question 46
A 30 year old man presents with a three month history of bloody diarrhoea associated with mucous, tenesmus and three kilograms of weight loss. He last travelled to Thailand six months ago. Blood tests revealed an anaemia with Hb 115 g/L, CRP 80 mg/L, ESR 25 mm/Hr. WCC, B12, iron and folate were normal. What is the most likely diagnosis?
A. Crohn’s disease
B. Ulcerative Colitis
C. Ischaemic colitis
D. Salmonella enteritis
RACP 2019 Question 65
A patient has the following hepatitis B serology: HBsAg negative, HBsAb positive, HBcAb positive (i.e. past infection). Which medication is has the highest risk of reactivation?
A. Rituximab
B. Tocilizumab
C. Prednisolone
D. Infliximab
RACP 2019 Question 73
A 45 year old man presents with pruritus and scleral icterus, but no abdominal pain. He has recently received a course of Augmentin DF for an infection. He has a history of colorectal cancer with hemicolectomy several years ago. He also has a history of heavy alcohol use. Vital signs are normal, and he is afebrile.
Bloods show:
High bilirubin, GGT, ALP, normal AST.
Normal Hb, WCC, PLT
Cannot recall if CRP, INR was given.
Abdominal US showed empty but dilated gallbladder, dilated common bile duct to the level of the duodenum, and increased homogeneous echogenicity of the liver.
What is the most likely diagnosis?
A. Antibiotic-induced cholestasis
B. Common bile duct stone-induced cholestasis
C. Disseminated colorectal cancer
D. Head of pancreas cancer
RACP 2019a
Question 79
In a patient with a background of decompensated cirrhosis and sarcopenia, with no previous episodes of hepatic encephalopathy, what is the recommended dietary intervention?
A. High calorie, high protein
B. High calorie, low protein
C. Low calorie, high protein
D. Low calorie, low protein
RACP 2019a Question 87
38yo female presents with haematemesis on a background of chronic osteoarthritis managed with ibuprofen. Endoscopy found a 3cm x 2cm bleeding antral ulcer which was successfully treated with adrenaline injection and diathermy. She was discharged on appropriate proton pump inhibitor therapy. She presents for follow up 2 months later, and is asymptomatic.
What is the most appropriate management?
A. Repeat Endoscopy
B. Urea breath test
C. Discharge to GP
D. Hydrogen breath test
RACP 2019b Question 31
The most common extra-intestinal manifestation of inflammatory bowel disease involves the:
A. Skin
B. Joints
C. Eyes
D. Liver
RACP 2019b Question 53
What is the role of transcobalamin II?
A. Binds intrinsic factor
B. Brings B12 to liver
C. Brings B12 to peripheries
D. Brings B12 to terminal ileum
RACP 2019b Question 57
What is the biggest risk factor for developing inflammatory bowel disease?
A. First degree relative with inflammatory bowel disease
B. 20 pack year smoking history
C. Previous Campylobacter enteritis
D. Previous fluoroquinolone use
RACP 2019b
Question 58
What is the mechanism of cirrhosis in alpha1 anti-trypsin deficiency?
A. Reduced inhibition of elastase
B. Increased protease
C. Protein accumulation in cells
D. Increased elastase
RACP 2018a Q 20
20.
.
A 19-year-old female with no other medical conditions presents to hospital after ingestion of 20 grams of paracetamol (immediate release formulation) combined with alcohol. Appropriate blood tests are obtained on admission and intravenous acetylcysteine is commenced immediately.
Results of investigations obtained 6 hours post-ingestion include serum paracetamol 150 mg/L (1000 μmol/L) and blood alcohol concentration 0.07% w/v (70 mg/100 mL or 15.2 mmol/L).
The paracetamol nomogram is shown:
What is the risk of this patient developing hepatitis due to paracetamol poisoning?
A. < 5%
B. 5–10%
C. 11–20%
D. 21–50%
E. > 50%
RACP 2018a Q39
39. A 33-year-old lady with known ulcerative colitis is now 9 days post-admission having failed hydrocortisone and infliximab. She has a temperature of 38 °C, 12 bloody bowel actions a day, abdominal discomfort and anorexia despite ciprofloxacin and metronidazole. Stool testing is
negative for viral, bacterial, protozoal and parasitic causes. Abdominal x-ray shows a colonic diameter of less than 5 cm.
What is the most appropriate next step in managing her ulcerative colitis?
A. Add meropenem.
B. Commence methylprednisolone.
C. Commence total parental nutrition.
D. Refer for colectomy.
E. Switch to cyclosporine.
RACP 2018a Q43
43. A 35-year-old Somalian lady with chronic hepatitis B is seen in clinic. Her liver function tests are normal. Her hepatitis B surface antigen is positive and surface antibody negative. An upper abdominal ultrasound reveals a liver of normal echotexture and size, with no splenomegaly or portal hypertension. A 2 cm hypoechoic lesion is noted in the right hepatic lobe.
What is the most appropriate next step to investigate the lesion?
A. Positron emission tomography scan.
B. Quadruple phase computed tomography.
C. Repeat ultrasound in 6 months.
D. Targeted liver biopsy.
E. Transient elastography.
RACP 2018a Q55
55. A 28-year-old male presents with an itchy, symmetrical, erythematous and vesicular rash in clusters over the shoulder, elbow, knees and buttocks. Which of the following conditions is most likely associated with his presentation?
A. Primary Biliary Cirrhosis
B. Autoimmune Hepatitis
C. Ulcerative Colitis
D. Coeliac Disease
E. Hepatitis C Infection
D - Coeliac disease
This patient likely has dermatitis herpetiformis (vesicular rash) which is associated with coeliac disease
RACP 2018a Q78
- A 90-year-old resident of a nursing home develops offensive diarrhoea after a 7-day period of constipation. He is being treated with paracetamol and a transdermal opioid for chronic persistent pain and has also received long-term coloxyl with senna two tablets daily. He had a 5-day course of cephalexin for a urinary tract infection 5 days ago. What is the most likely cause for the diarrhoea?
A. Clostridium difficile.
B. Diverticulitis.
C. Drug-induced colitis.
D. Laxative abuse.
E. Overflow diarrhoea.
RACP 2018a Q89
89. Which antibiotic should be used in addition to lactulose for the management of refractory hepatic encephalopathy?
A. Metronidazole.
B. Neomycin.
C. Rifaximin.
D. Sulfamethoxazole.
E. Vancomycin.
C
RACP 2018b Q139
138.In patients with hepatic encephalopathy, lactulose may be beneficial by increasing the amount of non-absorbable ammonium (NH4) formation in the colon. Which indirect mechanism of lactulose within the colon likely mediates this effect?
A. Decreases formation of acetic acid.
B. Decreases nitrogen excretion.
C. Decreases pH.
D. Increases disaccharidase activity within enterocytes.
E. Increases pH.
RACP 2018b Q144
144.Where in the gastrointestinal tract are bile acids actively reabsorbed?
A. Colon.
B. Duodenum.
C. Ileum.
D. Jejunum.
E. Rectum.
RACP 2018b Q167
167.Which hormone released from intestinal L cells can lead to delayed gastric emptying,
increased post-prandial insulin release and improved satiety?
A. Cholecystokinin.
B. Gastrin.
C. Ghrelin.
D. Glucagon.
E. Glucagon-like peptide-1 (GLP-1).
F. Histamine.
G. Peptide YY.
H. Secretin.
RACP 2018b Q168
168.Which hormone binds a plasma membrane-bound G-protein coupled receptor, leading to
increased glycogenolysis?
A. Cholecystokinin.
B. Gastrin.
C. Ghrelin.
D. Glucagon.
E. Glucagon-like peptide-1 (GLP-1).
F. Histamine.
G. Peptide YY.
H. Secretin.
RACP 2018b Q152
152.Where are chronic peptic ulcers associated with Helicobacter pylori infection most commonly located?
A. Duodenum.
B. Gastric antrum.
C. Gastric body.
D. Gastric fundus.
E. Gastro-oesophageal junction.
RACP 2017
A 40-year-old man receives treatment with oral Metronidazole for C. difficile diarrhoea which resolves his symptoms. He has repeat culture on a formed stool sample one week later, which is still positive for C. difficile toxin. What treatment do you give?
A. Fidaxomicin
B. Metronidazole
C. Vancomycin
D. No treatment is required
E. Faecal microbiota transplantation
RACP 2017
A 62-year-old woman is admitted for surgical management of fractured femur and her post-operative course was significant for hospital-acquired pneumonia requiring IV antibiotics. Later in her admission she develops profuse watery diarrhoea, opening her bowels up to 10 times per day. Her BP was 100/60 mm Hg, HR was 100bpm and temperature was 38.9oC. Her abdomen was mildly distended and tender. Blood tests revealed a total WCC 18.9, Hb 101, platelets 410, albumin 28, bilirubin 5, ALP 42, GGT 65, ALT 23 and AST 33. Colonoscopy is performed and the macroscopic appearance is depicted below
What is the most appropriate treatment?
a) Azathioprine
b) Infliximab
c) Metronidazole
d) Prednisolone
e) Vancomycin
RACP 2017
A 62-year-old female presents with 15 hours of severe epigastric pain. She drinks 70g of alcohol daily. There is no personal or family history of pancreatitis and she is on no regular medications.
Investigations reveal the following:
Urea 12
Creatinine 170
Bilirubin 48
GGT 128
Lipase 6000 / Amylase 4000
ALP & ALT within normal limits
WCC 19
CRP 150
CT abdomen, MRCP and Abdominal Ultrasound reveal gallstones in the gallbladder without features of cholecystitis or biliary dilatation.
Which of the following will improve her mortality in the first 24 hours?
A. Laparoscopic cholecystectomy
B. IV fluids
C. IV antibiotics
D. IV corticosteroids
E. ERCP
RACP 2017
A 65-year-old male presents with a two-week history of jaundice, dark urine and pale stools. He has lost 6 kg and has had a reduced appetite. His past history includes twenty pack years of smoking, IHD and a resected right sided colorectal cancer 5 years prior. On examination, he is non-tender in the RUQ and is icteric.
His bloods demonstrate:
Bili 100
ALT 47
GGT 546
ALP 123
His Liver US demonstrates a dilated gallbladder and common bile duct with dilatation seen all the way to the duodenum. The liver is also echogenic. What is the most likely cause of his symptoms?
A. Recurrent Colorectal Cancer
B. Alcoholic Liver Disease
C. Cancer of the Pancreatic Head
D. Cholecystitis
E. Cholangitis
RACP 2017
In addition to a Proton Pump Inhibitor, which of the following regimes makes up the primary treatment of Helicobacter pylori infection in Australia?
A. Doxycycline and Ciprofloxacin
B. Amoxicillin and Moxifloxacin
C. Metronidazole and Rifabutin
D. Amoxicillin and Clarithromycin
E. Metronidazole and Ciprofloxacin
RACP 2017
A 60-year-old man presents with pain on defecation over the last two days which is associated with bright red blood on toilet paper. The patient has a few years of intermittent constipation and diarrhoea. His grandmother had bowel cancer diagnosed at the age of 76. What is the most likely diagnosis in this patient?
A. Rectal Cancer
B. Anal fissure
C. Irritable Bowel Syndrome
D. Ulcerative Colitis
E. Pseudomembranous Colitis
RACP 2017
What substrate is used for the hydrogen/methane test in the diagnosis of small intestinal bacterial overgrowth?
A. Glucose
B. Fructose
C. Lactose
D. Mannitol
E. Sorbitol
RACP 2017
A 38-year-old woman with longstanding GI disease presents with diarrhea. Lab tests are as follows:
pH 7.09
pCO2 22
Na 134
Bicarb 8
Cl 98
K 2.6
Which of the following is the most correct interpretation of the above results?
A.High anion gap metabolic acidosis
B. High anion gap respiratory acidosis
C. Normal anion gap mixed respiratory acidosis metabolic acidosis
D. Normal anion gap respiratory acidosis
E. Normal anion gap metabolic acidosis
RACP 2017
Which of the following is most likely to be associated with a normal faecal calprotectin?
A. Colorectal Cancer
B. Diverticulitis
C. Ulcerative Colitis
D. Crohn’s disease
E. Irritable Bowel Syndrome
E
RACP 2017
Which feature shown on the hepatic biopsy below is most characteristic of Non-alcoholic steatohepatitis?
A. Hepatocyte ballooning
B. Piecemeal necrosis
C. Hepatic Steatosis
D. Bridging fibrosis
E. Stellate cell activation
RACP 2017
What is the role of trans-cobalamin II in vitamin B12 metabolism?
A. To bind to liberated vitamin B12 in the stomach
B. To co-operate with intrinsic factor
C. To transport vitamin B12 to the terminal ileum
D. To transport vitamin B12 to the peripheral tissues
E. To transport vitamin B12 to the liver
RACP 2016a Question 2
A 51yo lady was found to have deranged LFTs. She has a BMI of 29 and drinks 10g of alcohol every 2 days. Her medical background is notable for HTN and GORD, treated with perindopril and pantoprazole respectively. Abdominal exam was normal. LFTs described below:
AST Normal
ALT Normal
ALP 300 (~3xULN)
GGT 90 (~1.5x ULN)
Ferritin 660
INR 1.0
Bilirubin 8
Anti-smooth muscle Negative
Anti-LKM1 negative
Anti-mitochondrial antibody positive
What is the most likely cause for her LFT derangement?
A. Alcoholic hepatitis
B. Non-alcoholic steatohepatitis
C. Primary Biliary Sclerosis
D. Autoimmune hepatitis
E. Haemochromatosis
RACP 2016
Question 8
A 52 year old female presents with abdominal pain and jaundice. She has a background history of asthma, urticaria and obesity. She uses 3g Paracetamol per day for chronic back pain.
Her LFTs are as follows:
Bilirubin 67
Amylase 100
Lipase 108
ALT 346
AST 1400
GGT 380
What is the cause of her presentation?
A. NASH
B. Alcoholic liver disease
C. Choledocolithiasis
D. Paracetamol toxicity
E. PBC
RACP 2016a Question 32
A young man presents to you concerned regarding the possibility of having acquired hepatitis C. He admits to having used iv amphetamines over the past 6 months. What is the best test for ACTIVE hepatitis C?
A. IgG Hep C
B. IgM Hep C
C. P24 Hep C
D. Hep C RNA PCR
E. Western Blot
RACP 2016b Question 7
25 Male with pneumonia, treated with IV benzylpenicillin and PO azithromycin. His pneumonia improves but becomes very confused, with oedema on his CT brain
You suspected a defect with the urea cycle. If the diagnosis is correct which test is most likely to be abnormal?
A. Ammonia
B. Homocysteine
C. Lactate
D. Calcium
E. Very long chain lipids
RACP 2016b Question 20
Faecal microbiota transplant is a proven therapy in which of the following?
A. Pseudomembranous colitis
B. IBD
C. IBS
D. Pancreatitis
E. Microscopic colitis
RACP 2016b Question 33
A 40 yo alcoholic man who smokes 40 cigarettes per day presents with malaena, he takes regular esomeprazole 20mg and ibuprofen. He is found to have a 11mm clean based duodenal ulcer. Antral biopsies are negative for H pylori. What is the most likely cause of his gastric ulcer?
A) ibuprofen
B) H pylori
C) cigarette smoking
D) alcohol
E) Gastrinoma
RACP 2015 Q11
Most causes of hepatocellular injury are associated with elevated liver aminotransferases with
ALT>AST. Aside from Alcoholic Hepatitis, which condition most commonly causes an
increased AST:ALT ratio (i.e. AST>ALT)?
A. Ischaemic Hepatitis
B. EBV-Induced Hepatitis
C. Paracetamol Overdose
D. Hepatic Vein Thrombosis
E. Non-Alcoholic Fatty Liver Disease
RACP 2015
You are called to the ward to see a 48 year old woman with hepatitis B associated liver
cirrhosis. There is no documented history of recent alcohol use. She is agitated and
delirious. What is the preferred medication for this setting?
A. Diazepam
B. Haloperidol
C. Oxazepam
D. Risperidone
E. Rhubarb
RACP 2015
Question 42
A 42 year old female with T1DM is diagnosed with autoimmune hepatitis based on liver
biopsy and blood tests. Bloods shown: mildly deranged LFTs around 1.5-2x ULN, bilirubin 8, INR normal, elevated
CRP, positive anti-LKM Ab, HbA1c 12.6%
Biopsy results: mild changes of AIH (can’t remember exactly) plus marked steatosis
What treatment would you recommend for her autoimmune hepatitis?
A. Azathioprine
B. Mycophenolate
C. Observation
D. Prednisone
E. Vitamin E
RACP 2015
A 50 year old female with a background of liver cirrhosis presents with shortness of breath. On standing her Sp02 is 84%, this improves to 94% when she lays flat. What is the cause of
her SOB?
A. Intrapulmonary Shunt
B. Ascites
C. Diaphragmatic weakness
D. Pulmonary Effusion
E. Long QT syndrome
RACP 2015
Question 39
Bile acids undergoes enterohepatic circulation. In which part of the intestine bile acids are absorbed to return to the liver:
A. Ascending colon
B. Descending colon
C. Duodenum
D. Jejunum
E. Ileum
RACP 2015 Q98
Question 98:
55 year old male with chronic untreated hepatitis B. He was hypertensive to 180/100 on examination. Investigations showed normal renal function. He had a history of recurrent abdominal pain and fever. He also episodes of frank haematuria. What is the likely cause of hypertension?
A. IgA glomerulonephritis
B. Phaeochromocytoma
C. Polyarteritis Nodosa
D. Polycystic kidney disease
E. Primary hyperaldosteronism
F. Reflux nephropathy
G. Renal arterial fibromuscular dysplasia
H. Scleroderma
RACP 2015 Question 29
What is the pathophysiological mechanism for excessive flatulence?
A. Fermentation of carbohydrate by gastrointestinal microbes
B. Sphincter incompetence
C. Peristaltic dysfunction
D. Increased motility
E. Diverticular disease
RACP 2015
42 M presents with heartburn and dyspepsia. No other significant pmhx. Non smoker and non drinker. Gastroscope shows acute on chronic changes on biopsy with 20 eosinophils on high power. What is the next best management.
A. Budesonide slurry for eosinophilic esophagitis
B. CCB for dismotility
C. Fluconazole for candidiasis
D. Start on PPI and repeat scope
E. Refer for Nissen fundoplication
RACP 2015
45M diagnosed with colorectal cancer after colonoscopy. No family hx of cancer. Immunohistochemistry of biopsied specimens showed mismatch repair mutations in MLH 1, MSH2 and MSH6 both in th tumour and adjacent normal tissue. What is the most likely cause for his cancer?
A. Lynch syndrome
B. Familial adenomatous polyposis
C. Familial colorectal cancer
D. Microsatellite instability
E. Sporadic colon cancer
67 M with alcoholic Child Pugh C cirrhosis admitted with hepatic encephalopathy complicated by agitated delirium. What is the agent of choice for management of agitation in this setting?
A. Respiridone
B. Haloperidol
C. Diazepam
D. Oxazepam
E. Quetiapine
RACP 2014 a
Question 1:
A 56 year old male presents to hospital with confusion. He was recently discharged from hospital after an admission for acute pancreatitis, that was complicated by a pseudocyst, steatorrhea and glucose intolerance. He was discharged home on insulin, candesartan and pancreatic enzymes. On examination, he is confused and clammy. HR=97, BP=120/80 and temp 36.5. What is the most likely cause of his symptoms?
A. Dehydration
B. Malnutrition.
C. Sepsis
D. Pancreatitis
E. Hypoglycemia
RACP 2014 Question 11
A 25 year old female undergoes workplace screening for haemochromatosis. She is found to be homonymous for the HFE gene. She is currently asymptomatic with a normal clinical examination.
Laboratory findings:
Hb 120 (N 120-150)
Ferritin 145 (N 25-400)
Transferin 49% (N <45%)
What is the next best management?
A. Echocardiogram
B. Liver biopsy
C. Regular venesection
D. Reduction in dietary iron consumption
E. Repeat iron studies in 12 months.
RACP 2014
Question 48
A 28 year old male was diagnosed with Crohn’s disease several years ago. He had been anaemic at the time of diagnosis. Capsule endoscopy at the time showed extensive small bowel disease. He had a good clinical response to infliximab and blood tests normalised. He now complains of severe abdominal pain, distension and vomiting. Table of blood results given (normal, incl. CRP). Small bowel study shows jejunal stricture with proximal dilatation.
What would be the next best management option?
A. Add mesalazine
B. Change AZA to 6MP
C. Change infliximab to adalimumab
D. Surgery
E. Restart prednisolone
RACP 2014
Middled aged woman, overweight (BMI 32 or 36). Routine blood tests show abnormal LFTs.
Alcohol infrequent. Nil family history of liver disease. Only medications, perindopril for HTN and pantoprazole for GORD.
Raised BR, GGT, ALP, AST and ALT. Ferritin 638. Transferrin saturation <15%.
AMA, LKM Ab negative.
What is the most likely Dx?
A. Haemochromatosis
B. Alcoholic liver disease
C. Autoimmune hepatitis
D. Drug induced liver injury
E. Fatty liver disease
RACP 2014
What supplement is most likely to cause hepatotoxicity?
A. Fish oil
B. Chondroitin
C. Glucosamine
D. Valerian
E. Co-enzyme Q10
RACP 2014
Type 1 diabetes is commonly associated with coeliac disease. In a 23 year old woman with Type 1 diabetes, which nutritional deficiency will prompt you to do coeliac screening?
a) B12
b) Folate
c) Iron
d) Calcium
e) Vitamin D
RACP 2014
Q47. Gentleman with Child Pugh C cirrhosis - which benzodiazepine is most appropriate for treatment of alcohol withdrawal?
A. Clonazepam
B.Diazepam
C. Oxazepam
D. Nitrazepam
E. Chlordiazepoxide
RACP 2013a Q3
In a patient with cirrhosis, which of the following is most likely to precipitate encephalopathy?
A) Hypokalemia
B) Hypomagnesemia
C) Hyponatremia
D) Hypocalcaemia
E) Hypophosphotaemia
RACP 2013a Question 21
Hemachromatosis is a result of HFE mutation. It is inherited as an autosomal recessive disease with 25% penetrance. 1:10 in the population are carriers of this mutation. What is the likelihood of developing clinical phenotype of hemachromatosis in a male whose father was affected?
A) 1/4
B) 1/16
C) 1/20
D) 1/40
E) 1/80
RACP 2013 Question 36
In non-alcoholic fatty liver disease, which of the following is the single greatest predictor of advanced disease?
A. Cardiovascular disease
B. High serum triglycerides
C. Hypertension
D. Impaired fasting glucose
E. Type 2 diabetes
RACP 2013a
In a patient with NASH, what is the most important factor causing progression to fibrosis?
A. Hepatitis B viral load
B. HIV coinfection
C. Obesity
D. High alcohol intake
E. Smoking
RACP 2013
Question 38
Which of the following conditions has the strongest association with cryoglobulinaemia and normal complement levels?
A. HBV
B. HCV
C. Waldenstrom’s macroglobulinaemia
D. Tuberculosis
E. EBV
RACP 2013a
Question 39
A serum ascites to albumin gradient of 12 is most likely to be caused by which of the following?
A) Malignant ascites
B) Nephrotic syndrome
C) Pancreatitis
D) Portal hypertension
E) Tuberculous ascites
RACP 2013a Question 40
A 40yo male patient is admitted with recurrent pancreatitis. A CT scan reveals no pancreatic mass, but evidence of widespread lymphadenopathy. Dedicated liver imaging reveals a stricture in the common bile duct but no stones. He also has a history of parotiditis. What is the most likely diagnosis?
A. Lymphoma
B. IgG4 disease
C. Pancreatic cancer
D. Biliary malignancy
E. Primary sclerosing cholangitis
RACP 2013a Question 42
Where is the centre for control of appetite and satiety?
A. Amygdala
B. Hypothalamus
C. Frontal lobe
D. Pons
E. Anterior pituitary
RACP 2013a Question 53
Which of the following foods should be avoided in irritable bowel syndrome (to prevent diarrhoea)?
A. Fat
B. Protein
C. Sorbitol
D. Spicy food
E. Fructose
RACP 2013b Question 16
58 year old patient was admitted for bowel obstruction 3 months ago, treated with bowel rest, and after several days commenced on IV TPN. Her current medications include pantoprazole 40mg daily, paracetamol 1g QID, morphine 3.5mg S/C PRN & perindopril 5mg day.
Hb 130 WCC 6.7 Platelet 140
Na 135 K 3.4 Cr 114
Alb 30
Bilirubin 27 ALP 150 GGT 180 ALT 3280 AST 3400 APTT 33sec
INR 1.7
USS abdomen is unremarkable.
What is the likely cause of her abnormal blood tests?
A) Paracetamol toxicity
B) Choledocholithiasis
C) Ischaemic hepatitis
D) Budd-chiari syndrome
E) Autoimmune hepatitis
RACP 2013b Question 29
An 88M is admitted to ICU with sepsis secondary to community acquired pneumonia. He has a past history of AF, CCF and Parkinson’s disease. In ICU he is noted to have abdominal distension. His AXR is shown below:
What is the likely Dx?
A. Colonic pseudo-obstruction
B. Colon cancer
C. SBO secondary to adhesions
D. Diverticulitis
E. Sigmoid volvulus
RACP 2013b Question 44
A 45yo male is found to have an adenocarcinoma of the sigmoid colon. The rest of his colonoscopy was normal. He has no other family or personal history of cancer. Immunohistochemistry of the tumour showed mismatch repair mutations in MLH1, MSH2, and MSH6 in the tumour and adjacent normal tissue. What would be the surveillance recommendations for his children?
A. FOBT yearly from age 50
B. Colonoscopy 5 yearly from age 35
C. No surveillance
D. Yearly colonoscopy from age 25
E. Second yearly colonoscopy from age 45
RACP 2013b Question 69
A middle-aged patient presents with large volume, non-bloody, watery diarrhoea. Colonoscopy is normal, and a biopsy reveals a lymphocyte infiltration. What is the likely diagnosis?
A. Coeliac disease
B. Crohn’s disease
C. Ulcerative colitis
D. Microscopic colitis
E. TB
RACP 2013b Question 70
A patient with a mitral valve replacement is about to attend a gastroscopy with esophageal dilatation. He has no current active GIT infection. What endocarditis prophylaxis is recommended?
A. None
B. Erythromycin PO 30 min pre-procedure
C. Ciprofloxacin PO 30 min pre-procedure
D. IV ampicillin at time of surgery
E. IV cefazolin at time of surgery
RACP 2013b Question 84
56yo female, recurrent pancreatitis. Does not drink alcohol. Nil regular medications. She currently has acute pancreatitis. (Investigations consistent with acute pancreatitis)
CT abdomen NAD
MRCP NAD
What is the next best investigation?
A. ERCP
B. Endoscopic ultrasound
C. HIDA scan
D. Faecal fat collection for 3 days
E. CT abdomen
RACP 2013b Question 85
68 yo lady, presented with lethargy and anorexia. She underwent a partial gastrectomy 3 years ago for bleeding gastric ulcer. Her blood results showed: WBC 3.5, Hb 90, Plt 60. Blood film: oval erythrocytes, macrocytic erythrocytes, hypersegmented neutrophils, low platelets. BMB: cytoblastic picture.
What the most likely cause of her anaemia?
A Iron deficiency anaemia
B Anaemia of chronic disease
C AIHA
D Sideroblast anaemia
E Spur cell haemolysis
F Vitamin-B12 deficiency
F Thalassaemia
G Myelodysplasia
RACP 2013b
Question 86
38 year old woman with chronic liver disease due to alcohol. On examination has splenomegaly and signs of CLD. Blood film shows macrocytosis and acanthocytes. Also has hyperbilirubinaemia (although number not given for bilirubin). Hb low (about 80), WCC normal, plts low (about 50) and haptoglobin 5 (so high, although I can’t remember units). What is the diagnosis?
A Iron deficiency anaemia
B Anaemia of chronic disease
C AIHA
D Sideroblast anaemia
E Spur cell haemolysis
F Vitamin-B12 deficiency
F Thalassaemia
G Myelodysplasia
RACP 2013b Question 98
Barrett oesophagus is characterised by which of the following histopathology?
A. Columnar cell dysplasia
B. Specialised intestinal metaplasia
C. Eosinophilic oesophagitis
D. Crypt abscesses
E. Squamous cell metaplasia
RACP 2012a QUESTION 4
A person has 10 loose bowel motions per day. He does not have a history of
recent travel. Fecal microscopy revealed leukocytes and red cells. What is the
most likely cause?
A. Campylobacter jejuni
B. Giardia lambdia
C. Clostridium difficile
D. Enterotoxigenic E. coli
E. Rotavirus
RACP 2012b QUESTION 19
A 28 year old woman presents with a 2 year history of intermittent abdominal pain
and diarrhea. She smokes 20 cigarettes per day. A small bowel series (picture
below) shows a long stricture in the terminal ileum.
In addition to prednisone, what is the best initial management?
A. Infliximab
B. Cyclosporin
C. Smoking cessation
D. Surgery
E. Antibiotics
RACP 2012b QUESTION 91
A 54 year old woman presents with a history of increasing lethargy and pruritus.
Clinical examination is normal. Her investigations are shown below.
What is the diagnosis?
A. Autoimmune hepatitis
B. Systemic Lupus Erythematosis
C. Primary Biliary Cirrhosis
D. Drug induced hepatitis
E. Primary Sclerosing Cholangitis
RACP 2012b QUESTION 96
An 87 year old lady presented with abdominal pain. She has a history of atrial
fibrillation and hypertension. On examination, she was afebrile with generally tender abdomen but no focal areas of tenderness. Her electrolytes and an arterial blood gas are shown:
What is the most likely diagnosis?
A. Caecal volvulus
B. Septic Peritonitis
C. Mesenteric ischaemia
D. Constipation
E. Small bowel obstruction
RACP 2011
Question 34
A 28 year old female has a 2 year history of abdominal p ain an d diarrhoea. She
smokes 20 cigarettes a da y. A small bowel series shows a long stricture in the
terminal ileum .
In addition to prednisone, what is the best initial treatment?
A. Cyclosporine
B. Infliximab
C. Probiotics
D. Sulfasalazine
E. Smoking cessation
RACP 2011b Question 40
A 47M presented with wheezing, diarrhea, abdominal pain, skin flushing and a urinary 5 - Hydroxyindolacetic acid (5 -HIAA) assay = 120 m g/ml (range 2-5). An abdominal CT scan is shown below.
What is the most likely location of the primary tumour
A. Colon
B. Oesophagus
C. Rectum
D. Stomach
E. Small intestine
RACP 2010a Question 48
A 45 year old man is about to commence chemotherapy for lymphoma. Which of the following profiles carries the highest risk for reactivation of hepatitis?
RACP 2010b Question 26
65 y/o presenting with 3/12 proximal muscle weakeness. Her CK is 30,000.
What is the most likely cause of this picture ?
A. Hypothyroid
B. Inflammatory Bowel Disease
C. Celiac Disease
D. Malignancy
E. Sarcoidosis
RACP 2010b (Repeated from 2009)
A 72 year old man had a gastric resection for a mid-gastric adenocarcinoma one year ago. He now presents with symptomatic anaemia. The peripheral blood film shows macrocytosis, fragmented red
blood cells and moderate thrombocytopaenia (blood film shown). What is the most likely cause for this
man’s anaemia?
A. Iron deficiency
B. B12 deficiency
C. Anaemia of chronic disease
D. Acute blood loss
E. Metastatic disease
RACP 2010b Question 91
A 74 yo man presents with spontaneous bruising and muscle haematoma. He has a palpable liver of 12cm span, and enlarged spleen. He has no personal or family history of bleeding problems. His Full
blood count is shown below
- Hb =122
- WCC=10.1 (or 7.2)
- Plts=57 (or 88)
Which of the following is the most likely diagnosis?
A. Hepatic cirrhosis
B. MDS
C. Primary Myelofibrosis
D. SLE
E. Iron deficiency
RACP 2010b Question 97
89 year old nursing home resident is bed bound and dependent for all ADLs. Poor oral intake. Found to be incontinent of liquid faeces. AXR is performed. How would you manage this patient?
A. fiber supplements
B. glycerine suppository
C. phosphate-containing enema
D. loperamide
E. oral docusate
F. Sodium phosphate laxative
RACP 2009a QUESTION 45
A donut indulger comes to you one month after laparoscopic gastric banding surgery with lethargy having lost 7kg. His liver function tests before and one month after surgery are as follows:
What is the best explanation for his abnormal liver function tests?
A. Biliary obstruction
B. NASH exacerbation
C. Anaesthetic‐induced hepatitis
D. Malnutrition
E. Hepatitis B
RACP 2007b QUESTION 54
A 55-year-old woman presents with vague abdominal pain. Her CT scan is shown below.
A biopsy of the lesion shows spindle shaped cells. The most likely diagnosis is:
A. adenocarcinoma of esophagus.
B. gastrointestinal stromal tumour.
C. linitis plastica.
D. adrenal tumour.
E. renal cell tumour (hypernephroma).
RACP 2006b QUESTION 29
A 50-year-old male has chronic liver disease secondary to Hepatitis B infection. Previous endoscopy has revealed large oesophageal varices. Blood results are:
Albumin 32 g/L [38-55]
Prothrombin Time 14 seconds [8-12]
Platelet count 70 x 109/L [150-450]
On routine review, his alpha fetoprotein is 300 ng/mL [0-15]. His abdominal computed tomography (CT) scan is shown below.
The optimal treatment for this condition is:
A. chemoembolisation.
B. liver transplantation.
C. cryotherapy.
D. local resection.
E. radiofrequency ablation.
RACP 2006b
QUESTION 97
An otherwise well 55-year-old female undergoes upper endoscopy for investigation of mild reflux symptoms. An endoscopic image of the lower oesophagus is shown above. Biopsies demonstrate intestinal metaplasia with high grade dysplasia and no inflammation.
The most appropriate management is:
A. repeat endoscopy in six months.
B. surgical resection.
C. photodynamic therapy.
D. high dose proton-pump inhibitor (PPI) therapy.
E. thermal ablative therapy.
RACP 2005 Q14
A 60-year-old male presents with worsening dysphagia for solid and liquid food. Manometry is shown above (reference normal on left, patient tracing on right). The most likely diagnosis is:
A. hiatus hernia.
B. gastroesophageal reflux.
C. achalasia.
D. distal oesophageal malignancy.
E. presbyoesophagus.
RACP 2005a A 22-year-old male presents with his fourth episode of pancreatitis. A computed tomography (CT) scan of the pancreas is shown above. He has two first degree relatives with chronic pancreatitis. There is no other significant family history.
The most likely explanation for his episodes is:
A. cystic fibrosis.
B. alcoholic pancreatitis.
C. hyperparathyroidism.
D. hereditary pancreatitis.
E. haemochromatosis.
RACP 2005b
QUESTION 29
A 55-year-old woman presents with a 10-year history of rheumatoid arthritis and is on longstanding, stable treatment with methotrexate 10 mg weekly, folic acid 10 mg weekly, diclofenac 50 mg three times daily and prednis(ol)one 7.5 mg daily. She also has hypertension controlled with amlodipine 5 mg daily and mild type 2 (non-insulin-dependent) diabetes mellitus treated with diet and metformin 500 mg three times daily. She denies drinking alcohol.
On examination, she is overweight (body mass index (BMI) 28 kg/m2 [18-25]), with rheumatoid nodules, rheumatoid hand deformity and synovitis in the wrists and metatarsophalangeal (MTP) joints. Her blood pressure is 150/85 mmHg. There are no other abnormal signs.
Blood tests (which have been stable over 6 months) reveal:
A liver biopsy is planned.
Which of the following is most likely to be found on liver biopsy?
A. Methotrexate hepatotoxicity.
B. Amyloidosis.
C. Non-alcoholic fatty liver disease.
D. Chronic active hepatitis.
E. Cirrhosis.
RACP 2002b QUESTION 4
A 45-year-old Samoan man presents with epigastric pain and vomiting. He has been diagnosed with type 2 (non-insulin dependent) diabetes mellitus four years earlier and takes oral hypoglycaemic agents. He is otherwise well. At endoscopy, he is found to have a pyloric channel ulcer. Gastric biopsies reveal Helicobacter pylori gastritis. He is treated with a course of eradication therapy and successful eradication is confirmed by a negative urea breath test. Two months later, he presents with vomiting and abdominal fullness. A plain abdominal X-ray is shown below.
The most likely diagnosis is:
A. ulcer perforation.
B. small bowel obstruction.
C. gastric outlet obstruction.
D. diabetic gastroparesis.
E. gastric volvulus.
RACP 2002b QUESTION 19
A 37-year-old man is referred for assessment of a low platelet count. He has no symptoms and no past significant illnesses. He is noted on physical examination to have an enlarged spleen (5 cm below the costal margin). There is no lymphadenopathy and no signs of chronic liver disease. The liver span is normal. The remainder of the physical examination is normal. Full blood examination is normal apart from a platelet count of 78 x 109/L [150-450]. Serum electrolytes, urea, creatinine and liver function tests are also normal.
On further questioning, he recalls being beaten at the age of 17 and being hospitalised for several days. He also recalls requiring a nasogastric tube because of ‘pancreatic injury’.
Two non-sequential slices of an abdominal computed tomography (CT) scan are shown below.
The most likely explanation for these findings is:
A. pancreatic pseudocyst.
B. Budd-Chiari syndrome.
C. splenic vein thrombosis.
D. chronic myeloid leukaemia.
E. systemic lupus erythematosus.
RACP 2002b QUESTION 59
A 24-year-old man develops acute severe tonsillitis with high fever (39.8oC). He is treated with erythromycin. The next day he is noticed to be icteric. Abdominal examination is unremarkable.
The following blood tests are obtained:
The most likely explanation for his jaundice is:
A. haemolysis.
B. Epstein-Barr virus.
C. Gilbert’s syndrome.
D. Wilson’s disease.
E. erythromycin.
RACP 2002b QUESTION 59
A 24-year-old man develops acute severe tonsillitis with high fever (39.8oC). He is treated with erythromycin. The next day he is noticed to be icteric. Abdominal examination is unremarkable.
The following blood tests are obtained:
The most likely explanation for his jaundice is:
A. haemolysis.
B. Epstein-Barr virus.
C. Gilbert’s syndrome.
D. Wilson’s disease.
E. erythromycin.
RACP 2002b QUESTION 46
A 45-year-old Caucasian man is referred because of abnormal liver function tests. He complains of the recent onset of lethargy. Examination reveals a 15 cm smooth edged liver and some spider naevi.
Blood investigations show:
The next most appropriate blood test in the investigation of this patient is:
A. hepatitis serology.
B. autoimmune serology.
C. testing for the haemochromatosis gene (HFE).
D. alpha-1-antitrypsin phenotyping.
E. haemolysis screen.
RACP 2001a
Question 41
A patient undergoes a Schilling test because of vitamin B12 deficiency. The following results are obtained:
The most likely pathology is:
A. small bowel bacterial overgrowth.
B. pernicious anaemia.
C. partial (Billroth II) gastrectomy.
D. terminal ileal Crohn’s disease.
E. short bowel syndrome.
RACP 2001b Question 21
A 36-year-old woman presents with a 12-month history of lassitude, intermittent diarrhoea (described as watery, occurring up to six times a day), colicky abdominal pain, bloating and involuntary weight loss of 12 kg.
Blood tests reveal normal electrolytes, urea, creatinine and liver function tests. Her full blood count reveals a mild anaemia (haemoglobin 110 g/L [120-160]), but other indices are normal. Further blood tests show that she is iron and folate deficient.
Upper and lower gastrointestinal endoscopies are performed and the mucosa appears normal macroscopically. Shown below are sections of small bowel mucosa taken from the duodenum (A), distal to the major papilla, and from the terminal ileum (B).
The most likely diagnosis is:
A. Crohn’s disease.
B. coeliac disease.
C. irritable bowel syndrome.
D. giardiasis.
E. yersiniosis.
RACP 2001b Question 31
A critically ill 50-year-old patient in the intensive care unit develops abdominal distension. A supine abdominal X-ray is obtained and is shown below.
The most likely diagnosis is:
A. obstructing carcinoma at the splenic flexure.
B. colonic pseudo-obstruction.
C. small bowel paralytic ileus.
D. faecal loading.
E. sigmoid volvulus.
RACP 2001b Question 43
A 50-year-old woman is referred for investigation of longstanding bloating and watery diarrhoea. Her history includes treated vitamin B12 deficiency. She denies laxative abuse. Her blood pressure is 110/65 mmHg with a 10 mmHg postural fall. Examination of her heart, chest and abdomen reveals no abnormality.
Serum potassium is 3.1 mmol/L [3.5-5.0]. Serum sodium and creatinine are normal. Full blood examination, erythrocyte sedimentation rate (ESR), thyroid function tests and stool cultures are also normal. Urinary sodium is 2 mmol/L and urinary potassium is 50 mmol/L.
The appearance shown below is seen throughout the colon.
The most appropriate next investigation is:
A. upper gastrointestinal endoscopy and duodenal biopsy.
B. 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion.
C. small bowel enema.
D. 14C-xylose absorption test.
E. stool and urine testing for laxatives.
RACP 2000b
Question 11
A 28-year-old man was found apnoeic and pulseless. There were a syringe and needle nearby and he had well defined “track marks” (venous puncture marks) on his arms. He was successfully resuscitated at the scene and brought to the Accident and Emergency Department. On arrival, he was breathing spontaneously and was normotensive. Following routine investigations, he was admitted for observation.
The next day you are called because of the results of the liver function tests below. The patient is clinically unchanged.
The most likely cause for these liver function tests is:
A. acute hepatitis C.
B. post-CPR (cardiopulmonary resuscitation) liver trauma.
C. acute hepatitis A.
D. drug-induced hepatitis.
E. ischaemic hepatitis.
RACP 2000b Question 26
A 52-year-old man with known chronic liver disease, due to alcohol, is admitted to hospital because of increasing ascites, peripheral oedema and confusion. He has been abstinent from alcohol for over two years. His condition has been stable prior to this deterioration which has developed over the previous four weeks.
On examination, he is afebrile. His vital signs are normal. He has a flapping tremor, with moderate ascites and peripheral oedema to the knees. He is drowsy with disorientation. The liver span is decreased (10 cm by percussion) and the spleen is palpable 2 cm below the costal margin. No malignant cells are detected in ascitic fluid following ascitic fluid drainage. The fluid is a transudate.
A representative slice of an abdominal computed tomography (CT) scan is shown below.
The most likely cause for his deterioration is:
A. hepatocellular carcinoma.
B. multiple liver metastases.
C. gallstone disease.
D. portal vein thrombosis.
E. liver abscess.
RACP 2000b Question 39
A 50-year-old woman undergoes an upper abdominal ultrasound because of long standing intermittent epigastric pain. She has had no weight loss or fever. A representative slice of her ultrasound is shown below. Her liver function tests are normal. An endoscopy performed soon after shows a chronic duodenal ulcer with Helicobacter pylori gastritis.
Following successful H. pylori eradication therapy, her pain resolves. An abdominal computed tomography (CT) scan is performed in view of the ultrasound appearance; a representative slice is also shown below. The most likely diagnosis is:
A. liver metastases.
B. liver haemangiomata.
C. benign liver cysts.
D. liver abscesses.
E. hydatid disease.
RACP 2000b Question 82
A 24-year-old woman was investigated for right upper quadrant pain. The computed tomography (CT) scan of the upper abdomen is shown (below) before and following injection of contrast.Which one of the following is the next most appropriate investigation?
A. Abdominal ultrasonography.
B. Endoscopic retrograde cholangiopancreatography.
C. CT-guided biopsy.
D. Pooled labelled red blood cell nuclear scan.
E. Repeat abdominal CT scan in six months.
RACP 2000b Question 91
A 43-year-old man with a long history of ileal Crohn’s disease presents with rigors, a temperature of 39.8°C, lower abdominal pain and marked right iliac fossa tenderness. He is taking prednis(ol)one 10 mg/day and sulfasalazine 1 g twice/day. Blood cultures are obtained. An urgent computed tomography (CT) scan of the abdomen is shown below. Which one of the following is the most appropriate next step in this patient’s management?
A. Intravenous hydrocortisone.
B. Intravenous antibiotics.
C. Azathioprine.
D. Intravenous hydrocortisone and intravenous antibiotics.
E. Laparotomy.
RACP 2000b Question 96
A 63-year-old man presents to his general practitioner with a four-month history of crampy lower abdominal pain, increasing constipation and bright red rectal bleeding. There is mild left iliac fossa tenderness. He undergoes barium enema examination which is shown below. Which one of the following is the most appropriate next step in the management of this patient?
A. Abdominal ultrasonography.
B. Abdominal computed tomography (CT).
C. Colonoscopy.
D. Institution of a high fibre diet and therapy with antispasmodic agents.
E. Sigmoid colectomy.
RACP 1999a Question 65
A 35-year-old man with long standing ulcerative colitis has quiescent disease. He is on a maintenance regimen of salazopyrine 1 g bd and azathioprine 100 mg/day. At a routine follow up visit, he reports feeling well, with two formed stools a day and no blood or mucus. The physical examination is normal.
You perform some blood tests and the following results are available the next day:His liver function tests were normal two years ago. An abdominal ultrasound shows a normal sized liver with non-
dilated bile ducts. The gall bladder is normal with no calculi.
The most likely cause for these results is:
A. gall stone disease.
B. salazopyrine.
C. sclerosing cholangitis. *
D. azathioprine.
E. opportunistic infection.
RACP 1999a Question 81
A 28-year-old man was found apnoeic and pulseless. There were a syringe and needle nearby and he had well defined “track marks” (venous puncture marks) on his arms. He was successfully resuscitated at the scene and brought to the Accident and Emergency Department. On arrival, he was breathing spontaneously and was normotensive. Following routine investigations, he was admitted for observation.
The next day you are called because of the results of the liver function tests below. The patient is clinically unchanged. The most likely cause for these liver function tests is:
A. acute hepatitis C.
B. post-CPR (cardiopulmonary resuscitation) liver trauma.
C. acute hepatitis A.
D. drug-induced hepatitis.
E. ischaemic hepatitis. *
RACP 1999a Question 85
A 69-year-old man has a long history of dyspepsia and a previous peptic ulcer. After a recent severe flare of epigastric pain, he is referred for endoscopy which reveals an active duodenal ulcer. Antral biopsies show Helicobacter pylori infection. He receives 14 days treatment with “triple therapy” (bismuth, tetracycline and metronidazole).
The result of a 14C-urea breath test conducted six weeks after completion of therapy is illustrated (see following page).Which one of the following is the best interpretation of the test result?
A. Re-infection with H. pylori.
B. Failure of triple therapy to eradicate the infection. *
C. Test performed too soon after therapy.
D. Test is inaccurate in patients older than 65 years.
E. False positive due to oral infection.
RACP 1999a Question 95
A 46-year-old man has had pancolonic ulcerative colitis since age 23. He has had colonoscopies every two years for the last six years. He has been asymptomatic for three years, and has been prescribed sulphasalazine 1 g twice daily which he often forgets to take.
The photo shown was the appearance of the sigmoid colon. Biopsies show chronic active mucosal inflammation with low grade epithelial dysplasia.
The most appropriate management is:
A. regular sulphasalazine in increased dose.
B. regular sulphasalazine and prednis(ol)one.
C. endoscopic polypectomy.
D. sigmoid colectomy.
E. total colectomy.
