RACP-Gastro

Question 1

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

Answer 1

C- Primary biliary sclerosis

Anti-smooth muscle –> autoimmune hepatitis type 1

Anti-LKMI –> autoimmune hepatitis 2

Question 2

Activated charcoal is ineffective in the massive acute ingestion of:

A. carbamazepine
B. theophylline
C. paracetamol
D. lithium
E. colchicine

Answer 2

D. lithium

Question 3

A 50 year old female with a background history of Crohn’s disease presents with a 6 hour history of right loin pain. Her Crohn’s disease is currently inactive and is managed with azathioprine. She had a partial small bowel resection 5 years ago for a stricture. Her urinalysis is positive for blood +++
You suspect renal colic. What type of kidney stone is she likely to have?

A) Cysteine
B) Magnesium
C) Oxalate
D) Urate
E) Calcium

Answer 3

C) Oxalate

Question 4

Answer 4

D- sigmoid volvulus

Question 5

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

Answer 5

A. Ongoing dietary gluten intake

Question 6

Q75. What is the histology at GOJ biopsy in Barrett’s oesophagus?
A. Goblet cell hyperplasia
B. Inflammation
C. Intestinal metaplasia

Answer 6

C. Intestinal metaplasia

Question 7

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
This question and the answer options were well recalled.

Answer 7

A. Bile salt malabsorption