mock questions Flashcards
Steve, a 23-year-old male, presents to the GP with a 6 week history of diarrhoea. He tells
the GP he goes four times a day but often feels as if he has to go more. He says he is very
tired, has lost weight and has general abdominal cramping. He experienced a bout of
diarrhoea similar to this a year ago lasting for two months, where he also noticed blood in
his stool and some mucus. However this time there is none. On examination, Steve looks
pale with some swollen red patches at the corners of his mouth. What would you expect
to find on colonoscopy and biopsy?
Crohn’s disease
Patches of transmural inflammation throughout large bowel and terminal
ileum, with evidence of granulomas and deep ulceration.
Jane is a 15-year-old female who has come to the GP with her mother regarding her
weight. In the past month she has lost 7 kg unintentionally and has also complained of
feeling excessively tired. On further questioning, Jane reveals she has also had diarrhoea
three times a day for the past two months. When asked to describe her bowel movements
she explains that they looked paler and smellier than usual and were difficult to flush
away. Her mother is concerned, as Jane’s periods still have not started and thinks it could
be linked. Given your suspected diagnosis, what is the most appropriate initial test ?
coeliac disease
-IgA tissue transglutaminase or IgA endomysial antibody
Trevor, a 67-year-old male, has come to the GP regarding some difficulty swallowing for
three months. He explains that initially it felt like certain food like toast was getting stuck
in his throat, but now softer food like mashed potato was causing him pain during
swallowing for the past month. He has been treated for ‘reflux’ in the past, but feels the
medication isn’t helping and that his symptoms have become worse and has noticed some
persistent coughing. In the past week he has been unable to keep food down after meals
and mentioned there was some blood in the vomit. Trevor drinks 3 glasses of whiskey
every night and has smoked a pipe for the past 45 years. He admits his diet isn’t brilliant,
having frequent takeaways and that he’s always been ‘a bit more on the heavy side’.
Despite this, he thinks he might have lost around 9kg in the last month without trying. On
examination, there is no gurgling heard during palpation of Trevor’s neck and no halitosis.
What is the most likely diagnosis?
oesophageal cancer
Sally is a 19-year-old female who has turned up to A&E with acute abdominal pain. Upon
questioning, she explains that it started around 6 hours previously and gestures to the
umbilical region. Then, in the past 3 hours it has spread to over to her right lower
abdomen. She also mentions she started feeling nauseous 5 hours ago and has been sick 3
times in the past 3 hours (there was no blood or bile in her vomit). She also mentions she
has not had bowel movements in the past two days, and her urinary frequency remains
the same. The only medication she takes is the oral contraceptive pill, and she has no
other medical history. Her observations show that she is tachycardic and has a
temperature of 38.2ᵒC. On examination of her abdomen, she shows guarding and presents
some rebound tenderness. On palpation of her left iliac fossa, she complains of pain in her
right iliac fossa. From the following list, which diagnosis is most likely?
appendicitis
Sharon is a 55-year-old female who has come to the GP regarding variable bowel
movements. She explains that over the past 6 months she has suffered periods of both
constipation and diarrhoea. She also experiences crampy abdominal pain and often some
bloating, which usually comes on after eating but is relieved by defecation. She has never
noticed any blood in her stool, and her weight has remained stable in this time. When
questioned about her social history, she mentions that she has been very stressed recently
due to being fired and trying to find a new job and has not travelled abroad recently. What
treatment would be useful for Sharon?
IBS
Increasing exercise and altering fibre and fluid intake
Geoff, a 57-year-old male, has come to the GP regarding pain in his chest. Over the past 6
months he has been experiencing a ‘burning’ pain which rises up from the epigastric
region into his chest behind the sternum. He denies any chest tightness or pain in the jaw
and left arm. The pain seems to come on after every meal and is worse on lying down. He
also notes he has noticed it is becoming painful to swallow which makes it difficult. When
questioned about his lifestyle, he explains he smokes 10 cigarettes a day, 4 pints of beer
per night, and is aware that his weight is well above average. What is most likely to be
seen on endoscopy?
- The distal oesophageal epithelium undergoing metaplasia from stratified squamous
to simple columnar
Bob, a 30-year-old male, presents to the GP with a burning pain in his epigastric region
which gets worse when he is hungry or just after meals. He has become more reluctant to
eat and as a result has noticed some weight loss. Bob smokes 5 cigarettes a day and drinks
3 glasses of red wine each night. He is told to reduce his alcohol intake and to stop
smoking and is prescribed a PPI, however he comes back after 4 weeks with his symptoms
unchanged. You undertake a carbon- 13 urea breath test and the results come back
positive. What is the first line treatment?
Amoxicillin + Clarithromycin/Metronidazole - H.pylori causing peptic ulcers
Doris has been suffering from dyspepsia for the past 4 weeks, and after trying lifestyle
management her GP decides to try her on a Proton pump inhibitor (PPI).
Which cells do PPIs act on?
parietal cells
what is loperamide?
treatment for diarrhoea in IBS
what causes peptic ulcers?
h.pylori, increased acid, recurrent NSAID use, mucosal ischaemia
what is the gold standard investigation for large bowel obstruction?
abdominal CT
how is a duodenal ulcer felt?
They cause pain several hours after eating and the pain gets better when eating
where is the most common location of colon cancer?
distal colon
what can cause diverticula?
low fibre diet, obesity, smoking, NSAID use
what test is the bowel cancer screening programme?
faecal immunochemical tests
