GI exam question notes

Question 1

A 24-year-old woman presents to a gastrointestinal clinic with tiredness, bloating and weight loss. On questioning she describes experiencing bouts of diarrhoea with an offensive smell. Endoscopy and duodenal biopsy shows flattening of villi and increased lymphocytes in the lamina propria and surface epithelium. In addition, there is gross crypt hyperplasia.

Answer 1

coeliac’s disease

Question 2

A 27-year-old man is admitted with a 2-week history of epigastric pain. He describes a “gnawing pain” that wakes him from sleep but has tended to be better during the day after he has eaten. Identify the most likely cause of his pain.

Answer 2

duodenal ulcer

Question 3

A middle-aged woman is seen in A&E with upper abdominal pain. In the past, she has had short-lived episodes of upper abdominal pain and is known to have gallstones. Now she complains of a 12-hour history of upper abdominal pain. Her temperature is elevated and blood tests reveal a leukocytosis. Identify the most likely cause of her pain.

Answer 3

cholecystitis

Question 4

A young woman on the oral contraceptive pill describes having had recurrent miscarriages in the past. She is admitted to hospital with abdominal pain, tender hepatomegaly and ascites. Identify the most likely cause of pain.

Answer 4

hepatic vein thrombosis

Question 5

A 70-year old woman describes colicky left-sided abdominal pain associated with bloating and flatulence. She has a fever and a leukocytosis. There is mild left iliac fossa tenderness. Identify the most likely cause of pain.

Answer 5

diverticulitis

Question 6

‘Cherry red’ benign proliferations of blood vessels observed on the abdomen are known as:

Answer 6

Campbell de Morgan spots

Question 7

A 20-year-old woman presents with diarrhoea. Over the past few months she has lost weight and suffered with recurrent abdominal pain and mouth ulcers

Answer 7

Crohn’s disease

Question 8

A 45-year-old woman presents with intermittent right upper quadrant pain after eating a large meal. Inflammatory markers, pulse and temperature are normal

Answer 8

biliary colic

Question 9

tenesmus

Answer 9

a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness.

Question 10

Which hepatitis cannot be vaccinated against?

Answer 10

hepatitis D

Question 11

A 50-year-old woman presents with constant right upper quadrant pain, fever and yellowing of the sclera. She has a history of gallstones. She is jaundiced, pyrexial and has raised inflammatory markers

Answer 11

ascending cholangitis

charcot’s triad

Question 12

A 40-year-old man with a history of back pain presents with epigastric pain and passing black, tarry stools. His pain is relieved by eating is a stereotypical history of:

Answer 12

duodenal ulcer

tarry stools: indicate digested blood, hence more upper GI

Question 13

A 40-year-old man with a history of alcohol excess presents with severe epigastric pain.

Serum lipase levels are elevated is a stereotypical history of:

Answer 13

acute pancreatitis

Question 14

Right upper quadrant pain, fever, jaundice in a question is most likely to indicate:

Answer 14

ascending cholangitis

Question 15

a 20-year-old woman presents with recurrent episodes of abdominal pain associated with bloating. The pain is relieved on defecation. She normal passes 3 loose stools with mucous in the mornings

Answer 15

Irritable bowel syndrome

Question 16

a 70-year-old man presents with anorexia, weight loss and painless jaundice

Answer 16

pancreatic cancer

Question 17

A 45-year-old woman presents with fatigue and pruritus. Blood tests show a raised bilirubin, ALP and IgM level is a stereotypical history of:

Answer 17

Primary biliary cirrhosis

Question 18

An elderly man presents with severe central abdominal pain radiating to the back associated with hypotension

Answer 18

ruptured abdominal aortic aneurysm

Question 19

a 30-year-old presents with a two-day history of vomiting and watery, non-bloody diarrhoea. This is associated with colicky abdominal pain. Temperature is normal.

Answer 19

gastroenteritis

Question 20

An obese 50-year-old woman presents with pain in the RUQ which radiates to the interscapular region. She is apyrexial and not jaundiced

Answer 20

biliary colic

Question 21

a 40-year-old woman with a history of Crohn’s disease presents with central abdominal pain, vomiting and not opening her bowels for 24 hours

what might be happening?

two words lol

Answer 21

intestinal obstruction

Question 22

middle aged female, fatigue, pruritus, raised IgM

Answer 22

primary biliary cirrhosis

Question 23

female, middle-aged, episodic RUQ pain

Answer 23

biliary colic

Question 24

A 50-year-old obese man with a history of type 2 diabetes mellitus is noted to have mild hepatomegaly on examination. He drinks one glass of wine per week. Blood tests show a slightly raised ALT and a liver ultrasound shows increased echogenicity

Answer 24

non alcoholic fatty liver disease

Question 25

a 65-year-old woman presents with jaundice, weight loss and passing clay-coloured stools. She also describes recurrent bouts of colicky RUQ abdominal pain. On examination a mass is palpable in the RUQ

Answer 25

cholangiocarcinoma

Question 26

a 50-year-old man presents with epigastric pain worsened by eating

Answer 26

gastric ulcer

Question 27

A 20-year-old man presents with a 3 week history of bloody diarrhoea associated with tenesmus

Answer 27

ulcerative colitis

Question 28

Gardner’s syndrome

Answer 28

multiple colonic polyps, osteomas, epidermoid cysts

Question 29

Psuedomembranous colitis

Answer 29

• swelling of large intestine
• due to overgrowth of C.Diff
• commonly seen after antibiotic use
• causes diarrhoea

Question 30

Acute cholecystitis

Answer 30

• RUQ pain
• inflammation / infection secondary to gall stones
• positive murphy’s sign: arrest of inspiration on palpation of RUQ
• fever and raised inflammatory markers

Question 31

Ascending cholangitis

Answer 31

• RUQ pain
• bacterial infection of the biliary tree
• common predisposing factor in gallstones
• Charcot’s triad:
  1. RUQ pain
  2. Fever
  3. Jaundice

Question 32

A 45-year-old woman presents with fatigue and pruritus. Blood tests show a raised bilirubin, ALP and IgM level

Answer 32

primary biliary cholangitis
- more common in middle aged females

• raised bilirubin, ALT, IgM

Question 33

Primary biliary cholangitis

Answer 33

• autoimmune
• T cells attack cells lining bile duct
• bile leaks
• anti-mitochondria antibodies AMAs found in patients blood
• excess cholesterol, xanthoma, ALP, GGT, bilirubin, IgM

Question 34

a 30-year-old presents with a two-day history of vomiting and watery, non-bloody diarrhoea. This is associated with colicky abdominal pain. Temperature is normal.

Answer 34

gastroenteritis

Question 35

a 75-year-old woman presents with colicky pain typically in the LLQ associated with diarrhoea and fever

Answer 35

diverticulitis

Question 36

A patient with a history of heartburn presents with odynophagia. There no weight loss, vomiting or anorexia

Answer 36

oesophagitis

Question 37

A 35-year-old woman presents with pain on the right side of her back. This is constant and associated with fever and rigors

Answer 37

acute pyelonephritis

Question 38

A 65-year-old woman presents with jaundice, weight loss and passing clay-coloured stools. She also describes recurrent bouts of colicky RUQ abdominal pain. On examination a mass is palpable in the RUQ

Answer 38

cholangiocarcinoma

Question 39

a middle-aged patient presents with dysphagia of both liquids and solids from the start. They also complain of regurgitation and a persistent cough

Answer 39

achalasia

lower oesophageal sphincter fails to open during swallowing.