Gastrointestinal Flashcards
1
Q
- Dysphagia
A 47-year-old woman presents to your clinic 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
A
E
2
Q
- Abdominal pain (1)
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 (GORD)
C. Duodenal ulcer
D. Gastric carcinoma
E. Gastritis
A
C
3
Q
- Management of peptic ulcer disease
A 55-year-old woman is referred 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 has no known drug allergies. The most appropriate
treatment is:
A. Seven-day course of twice daily omeprazole 20 mg, 1 g amoxicillin and
500 mg clarithromycin
B. Seven-day course of twice daily omeprazole 20 mg
C. Seven-day course of twice daily omeprazole 20 mg and 1 g amoxicillin
D. Seven-day course of twice daily omeprazole 20 mg and 500 mg
clarithromycin
E. Seven-day course of twice daily 1 g amoxicillin and 500 mg
clarithromycin
A
A
4
Q
- Peptic ulcer disease
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
A
B
5
Q
- Investigation of gastro-oesophageal reflux disease
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) scan
B. Chest x-ray
C. Upper GI endoscopy
D. Barium meal
E. Ultrasound
A
D
6
Q
- Complications of gastro-oesophageal reflux disease
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
A
A
7
Q
- Diarrhoea (1)
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 37.1°C. 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 most likely diagnosis is:
A. Irritable bowel syndrome
B. Gastroenteritis
C. Ulcerative colitis
D. Laxative abuse
E. Crohn’s disease
A
B
8
Q
- Management of diarrhoea
A 35-year-old woman presents with a 24-hour history of watery diarrhoea. She has
opened her bowels nine times since the onset of her symptoms. You diagnose
gastroenteritis after learning that the patient and her 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
A
A
9
Q
- Investigation of diarrhoea
A 56-year-old man presents with a 2-week history of diarrhoea which has 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 sensitivities
D. Abdominal x-ray
E. Liver function tests
A
C
10
Q
- Diarrhoea (2)
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 diarrhoea.
A. Campylobacter spp.
B. Salmonella spp.
C. Escherichia coli
D. Shigella spp.
E. Stapylococcus spp.
A
E
11
Q
- Hepatomegaly
A 69-year-old man present 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 following 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
A
B
12
Q
- Jaundice (1)
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
noticeable 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 37 μmol/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
A
A
13
Q
- Jaundice (2)
You see a 54-year-old woman, referred to accident and emergency through her GP,
with a week’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 40 μmol/L, ALT of 40 iu/L, AST 50 iu/L and ALP of 350 iu/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
A
A
14
Q
- Investigation of jaundice
You are asked by your registrar to request an imaging investigation for a 49-yearold
woman with jaundice and abdominal pain. She has a past medical history of
gallstones and you suspect this is a recurrence 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 (ERCP)
A
A
15
Q
- Drug-induced cholestasis
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
A
B
16
Q
- Constipation
During your on-call, you are bleeped to see an 80-year-old woman on the ward
who has not opened her bowels for the last 4 days. She is not known to have a
history of constipation. On examination, her observations are within normal range,
the abdomen is soft and there is mild discomfort at the left iliac fossa. Bowel
sounds are present and on PR examination, the rectum is empty. You consult your
registrar who asks you to prescribe an osmotic laxative. What is the most appropriate
treatment?
A. Ispaghula husk
B. Docusate sodium
C. Lactulose
D. Senna
E. Methylcellulose
A
C
17
Q
- Finger clubbing
Which of the following gastroenterological conditions would give rise to finger
clubbing?
A. Hepatocellular carcinoma
B. Ulcerative colitis
C. Irritable bowel syndrome
D. Hepatocellular carcinoma
E. Pancreatic carcinoma
A
B
18
Q
- Abdominal pain (2)
You see an 80-year-old man who presents to accident and emergency with
epigastric pain. The pain started 3 days ago and today he noticed that the colour
of his stools has changed to a ‘tarry-black’ colour. Associated symptoms include
nausea and lethargy. The patient is a smoker of 20 cigarettes a day and has
recently finished eradication treatment for a duodenal ulcer. The patient is alert
and orientated with a pulse rate of 99 and blood pressure of 98/69, respiratory rate
of 18, oxygen saturations of 98 per cent on room air and temperature of 37.2°C.
On examination, the abdomen is soft with marked tenderness in the epigastric
region and bowel sounds are present. The rectum is empty, on PR examination,
with some traces of malaena. The patient has been started on high flow oxygen
and has been given some oral analgesia. The most appropriate next step in
managing this patient is:
A. Keep nil by mouth and arrange endoscopy
B. Request an erect chest x-ray
C. Intravenous pantoprazole
D. ECG
E. Intravenous cannulation and fluids
A
E
19
Q
- Causes of upper gastrointestinal bleeding
You see a 75-year-old man with an acute episode of haematemesis, who was
admitted the night before and is awaiting an upper GI endoscopy. You are asked on
the ward round about the common causes of upper GI bleeding. From the list below,
which of the following is the most common cause of upper GI bleeding?
A. Mallory–Weiss tear
B. Peptic ulcers
C. Oesophageal varices
D. Drug induced
E. Malignancy
A
B
20
Q
- Management of oesophageal varices
A 60-year-old man with alcoholic liver disease was admitted with an upper GI
bleed secondary to oesophageal varices. The patient undergoes endoscopic variceal
banding and is discharged after 2 weeks in-hospital stay. Which of the following
medications would act as prophylaxis in preventing a rebleed from his oesophageal
varices?
A. Frusemide
B. Amlodipine
C. Ramipril
D. Propranolol
E. Irbesartan
A
D
21
Q
- Jaundice (3)
A 46-year-old woman presents to your clinic with a week’s history of jaundice. Her
past medical history includes longstanding atrial fibrillation and hypertension.
Physical examination reveals hepatomegaly. You assess her liver function which
shows a bilirubin of 41 iu/L, AST 111 iu/L, ALT 55 iu/L and ALP 98 iu/L. There is no
history of travel. You have a look at the patient’s medication history. Which of the
following drugs below is likely to have caused the derangement in the patient’s
liver function?
A. Aspirin
B. Ramipril
C. Amiodarone
D. Bendroflumethiazide
E. Amlodipine
A
C
22
Q
- Clinical signs of chronic liver disease
A 67-year-old man presents feeling unwell and complaining of general malaise. He
mentions a long history of alcohol abuse and his past medical history shows
deranged liver function tests. Which of the following clinical signs does not form
part of chronic liver disease?
A. Finger clubbing
B. Palmer erythema
C. Spider naevia
D. Koilonychia
E. Jaundice
A
D
23
Q
- Alcoholic liver disease
You see a 56-year-old man in your clinic with suspected alcoholic liver disease.
Liver function tests reveal a bilirubin of 36 iu/L, AST of 150 iu/L, ALT 75 iu/L and
ALP 100 iu/L. Which of the following blood test parameters would support a
diagnosis of alcoholic-related liver disease?
A. Normal mean cell volume (MCV)
B. Low MCV
C. Normal mean cell haemoglobin (MCH)
D. Low MCH
E. Raised MCV
A
E
24
Q
- Deranged liver function
You see a 52-year-old woman with rheumatoid arthritis in your clinic. She was
referred by her GP after her ALP levels were found to be abnormally high at
300 iu/L. In addition, she was also found to be serum anti-mitochondrial antibody
(AMA) positive. The most likely diagnosis is:
A. Primary biliary cirrhosis
B. Wilson’s disease
C. Heriditary haemochromotosis
D. Primary sclerosing cholangitis
E. Alcoholic liver disease
A
A
25
Q
- Ascites
A 47-year-old man presents complaining of weight gain, on examination there is
an abdominal distension with a fluid thrill. Which of following is not a cause of
ascites secondary to venous hypertension?
A. Congestive heart failure
B. Cirrhosis
C. Constrictive pericarditis
D. Budd–Chiari syndrome
E. Nephrotic syndrome
A
E
26
Q
- α1-antitrypsin deficiency
A 56-year-old man, diagnosed with emphysema, presents with a one-month history
of jaundice and ascites. Your registrar suspects that this patient may have liver
disease secondary to α1-antitrypsin deficiency. Select the most likely mode of
inheritance from the list below:
A. Autosomal dominant
B. X-linked dominant
C. Autosomal recessive
D. Polygenic
E. None of the above
A
C
27
Q
- Chronic liver disease
You see a 56-year-old woman who presents with a two-month history of jaundice.
Associated symptoms include lethargy and polyarthralgia. Her LFTs reveal a
bilirubin of 46 iu/L, AST 200, ALT 175, ALP 104. On examination, the patient is
jaundiced and has finger clubbing. There are several spider naevi on the front and
back of the trunk. Her abdomen is soft and there is a smooth hepatomegaly. Prior
to her onset of symptoms, the patient has been fit and well. Viral serology is normal
and anti-soluble liver antigen (SLA) is detected. You decide to start this patient on
treatment. The most appropriate treatment is:
A. Liver transplantation
B. Methotrexate
C. Prednisolone
D. Cyclosporin
E. Antivirals
A
C
28
Q
- Primary sclerosing cholangitis
You are told by your registrar that one of your inpatients has been diagnosed with
primary sclerosing cholangitis (PSC). Your registrar suspects that the patient may
have an associated condition. Primary sclerosing cholangitis is associated with
which of the following diseases?
A. Thyroid disease
B. Systemic sclerosis
C. Rheumatoid arthritis
D. Ulcerative colitis
E. Irritable bowel syndrome
A
D
29
Q
- Complications of primary sclerosing cholangitis
A 68-year-old man presents to his GP with signs of drastic weight loss. He is known
to have PSC. The GP suspects an underlying malignancy. Which of the following
tumours would a patient with primary sclerosing cholangitis be more at risk of
developing?
A. Hepatocellular carcinoma
B. Cholangiocarcinoma
C. Hepatic fibroma
D. Hepatic haemangioma
E. Pancreatic carcinoma
A
B
30
Q
- Liver tumours
During a ward round, you are questioned about tumours that may arise from the
liver parenchyma. Which of the following liver tumours is considered to be benign?
A. Angiosarcoma
B. Fibrosarcoma
C. Adenoma
D. Hepatoblastoma
E. Leiyomyosarcoma
A
C
31
Q
- Hepatocellular carcinoma
A patient on your ward is diagnosed with hepatocellular carcinoma. You are asked
to perform a tumour marker level on this patient. Which of the following tumour
markers are elevated in hepatocellular carcinoma?
A. α-fetoprotein
B. Carcinoembryonic antigen (CEA)
C. CA 15-3
D. HcG
E. CA 125
A
A
32
Q
- Jaundice (4)
A 64-year-old woman attends your clinic with a 2-week history of jaundice. Over
the last three months the patient has lost 10 kg. Associated symptoms include
decreased appetite, dark urine and pale stools. On examination, the patient is
jaundiced, her abdomen is soft and you can palpate a painless mass in the right
upper quadrant. From the list of answers below, select the initial most appropriate
investigation that you would request for this patient:
A. Abdominal x-ray
B. Abdominal CT
C. MRI of the abdomen
D. Abdominal ultrasound
E. ERCP
A
D
33
Q
- Rectal biopsy
A 28-year-old man undergoes a sigmoidoscopy for longstanding diarrhoea and
weight loss. On visualization of the rectum, the mucosa appears inflamed and
friable. A rectal biopsy is taken and the histology shows mucosal ulcers with
inflammatory infiltrate, crypt abscesses with goblet cell depletion. From the list of
answers below, which is the most likely diagnosis describing the histology report?
A. Crohn’s disease
B. Pseudomembranous colitis
C. Irritable bowel syndrome
D. Ulcerative colitis
E. No diagnosis – the report is inconclusive
A
D
34
Q
- Severity of ulcerative colitis
You are told by your registrar that one of the clinic patients has been admitted with
a ‘flare up’ of ulcerative colitis (UC) which he reports as being severe. From the list
of answers below, select the parameters which are likely to reflect a severe flare up
of ulcerative colitis:
A. Fewer than four bowel motions per day with large amounts of rectal
bleeding
B. Between four and six bowel motions per day with large amounts of
rectal bleeding
C. More than four bowel motions per day with large amounts of rectal
bleeding
D. More than five bowel motions per day with large amounts of rectal
bleeding
E. More than six bowel motions per day with large amounts of rectal
bleeding
A
E
35
Q
- Investigating inflammatory bowel disease
You read a report which was handwritten in a patient’s medical notes who you
suspect has inflammatory bowel disease. The report reads, ‘… there is cobblestoning
of the terminal ileum with the appearance of rose thorn ulcers. These findings are
suggestive of Crohn’s disease’. Select the most likely investigation that this report
was derived from:
A. Colonoscopy
B. Sigmoidoscopy
C. Barium follow through
D. Abdominal CT
E. Abdominal ultrasound
A
C
36
Q
- Management of ulcerative colitis
You are asked to see a 29-year-old woman diagnosed with ulcerative colitis 18
months ago. Over the last 4 days she has been experiencing slight abdominal
cramps, opening her bowels approximately 4–5 times a day and has been passing
small amounts of blood per rectum. The patient is alert and orientated and on
examination her pulse is 67, blood pressure 127/70, temperature 37.3°C and her
abdomen is soft with mild central tenderness. PR examination is nil of note. Blood
tests reveal haemoglobin of 13.5 g/dL and a CRP of 9 mg/L. The most appropriate
management plan for this patient is:
A. Admission to hospital for intravenous fluid therapy and steroids
B. Oral steroid therapy + oral 5-ASA + steroid enemas + discharge
C. Admission and refer to surgeons for further assessment
D. Oral steroid therapy and discharge home
E. Reassurance and discharge home with no treatment required
A
B
37
Q
- Crohn’s disease
A 29-year-old anxious man is diagnosed with mild Crohn’s disease. Due to time
constraints, the patient was asked to come back for a follow-up appointment to
discuss Crohn’s disease in more detail. The patient returns with a list of complications
he researched on the internet. Which of the following are not associated with
Crohn’s disease?
A. Cigarette smoking reduces incidence
B. Fistulae formation
C. Abscess formation
D. Non-caseating granuloma formation
E. Associated with transmural inflammation
A
A
38
Q
- Vitamin B12 deficiency
You see a 40-year-old woman who was diagnosed with Crohn’s disease ten years
ago. Due to a severe attack of Crohn’s which failed to respond to medical therapy,
she had a small bowel resection. Your registrar tells you that she is at risk of
developing vitamin B12 deficiency as a result of her surgery. Which part of the
small bowel is responsible for the absorption of vitamin B12?
A. Jejunum
B. Proximal ileum
C. Duodenum
D. Terminal ileum
E. None of the above
A
D
39
Q
- Diarrhoea (3)
A 47-year-old woman has been experiencing a four-month history of diarrhoea
and bloating. Associated symptoms include lethargy and weight loss. Full blood
count reveals haemoglobin of 9.3 d/gL and MCV 70 fL. Which of the following
investigations would be helpful in the patient’s diagnosis?
A. Anti-mitochondrial antibodies
B. Anti-smooth muscle antibodies
C. Anti-tissue transglutaminase antibodies
D. Anti-nuclear antibodies
E. Anti-neutrophil cytoplasmic antibodies
A
C
40
Q
- Weight loss
A 65-year-old man attends your clinic with a three-month history of weight loss of
approximately 9 kg despite a normal appetite. A full blood count reveals that his
haemoglobin is 9.0 g/dL (previous haemoglobin was 13.5 g/dL one year ago) and
the MCV is 71 fL. Abdominal examination is unremarkable and per rectum exam is
nil of note. The patient states that he has normal bowel habits and has been feeling
quite tired lately. The most appropriate management is:
A. Reassure and discharge
B. Arrange an upper and lower GI endoscopy
C. Prescribe iron tablet supplementation
D. Arrange an abdominal ultrasound
E. Arrange an abdominal x-ray
A
B
41
Q
A
