GI exam question notes Flashcards
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.
coeliac’s disease
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.
duodenal ulcer
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.
cholecystitis
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.
hepatic vein thrombosis
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.
diverticulitis
‘Cherry red’ benign proliferations of blood vessels observed on the abdomen are known as:
Campbell de Morgan spots
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
Crohn’s disease
A 45-year-old woman presents with intermittent right upper quadrant pain after eating a large meal. Inflammatory markers, pulse and temperature are normal
biliary colic
tenesmus
a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness.
Which hepatitis cannot be vaccinated against?
hepatitis D
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
ascending cholangitis
charcot’s triad
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:
duodenal ulcer
tarry stools: indicate digested blood, hence more upper GI
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:
acute pancreatitis
Right upper quadrant pain, fever, jaundice in a question is most likely to indicate:
ascending cholangitis
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
Irritable bowel syndrome
a 70-year-old man presents with anorexia, weight loss and painless jaundice
pancreatic cancer
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:
Primary biliary cirrhosis
An elderly man presents with severe central abdominal pain radiating to the back associated with hypotension
ruptured abdominal aortic aneurysm
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.
gastroenteritis
An obese 50-year-old woman presents with pain in the RUQ which radiates to the interscapular region. She is apyrexial and not jaundiced
biliary colic
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
intestinal obstruction
middle aged female, fatigue, pruritus, raised IgM
primary biliary cirrhosis
female, middle-aged, episodic RUQ pain
biliary colic
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
non alcoholic fatty liver disease
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
cholangiocarcinoma
a 50-year-old man presents with epigastric pain worsened by eating
gastric ulcer
A 20-year-old man presents with a 3 week history of bloody diarrhoea associated with tenesmus
ulcerative colitis
Gardner’s syndrome
multiple colonic polyps, osteomas, epidermoid cysts
Psuedomembranous colitis
- swelling of large intestine
- due to overgrowth of C.Diff
- commonly seen after antibiotic use
- causes diarrhoea
Acute cholecystitis
- RUQ pain
- inflammation / infection secondary to gall stones
- positive murphy’s sign: arrest of inspiration on palpation of RUQ
- fever and raised inflammatory markers
Ascending cholangitis
- RUQ pain
- bacterial infection of the biliary tree
- common predisposing factor in gallstones
- Charcot’s triad:
1. RUQ pain
2. Fever
3. Jaundice
A 45-year-old woman presents with fatigue and pruritus. Blood tests show a raised bilirubin, ALP and IgM level
primary biliary cholangitis
- more common in middle aged females
- raised bilirubin, ALT, IgM
Primary biliary cholangitis
- 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
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.
gastroenteritis
a 75-year-old woman presents with colicky pain typically in the LLQ associated with diarrhoea and fever
diverticulitis
A patient with a history of heartburn presents with odynophagia. There no weight loss, vomiting or anorexia
oesophagitis
A 35-year-old woman presents with pain on the right side of her back. This is constant and associated with fever and rigors
acute pyelonephritis
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
cholangiocarcinoma
a middle-aged patient presents with dysphagia of both liquids and solids from the start. They also complain of regurgitation and a persistent cough
achalasia
lower oesophageal sphincter fails to open during swallowing.
