1. A 63 year old female is admitted on the medical take with 6 weeks of bloody diarrhoea and abdominal pain. She has a CRP of 100 (<5). Which test is most likely to confirm diagnosis?
a) Abdominal Ultrasound
b) Abdominal X Ray
c) CT Abdomen
d) Flexible Sigmoidoscopy And Biopsies
2. A 46 year old man is admitted with 4 days of malaena and coffee ground vomiting. He is found to have a haemoglobin of 10g/dL (normal = 13g/dL). He recently injured his knee playing football. Which of the following is the most likely cause of his GI bleeding?
a) Angiodysplasia
b) Gastritis
c) Gastric ulcer
d) Mallory-Weiss tear
3. A 70 year old man presents with 3 weeks of dyspepsia, weight loss and odynophagia. The next best investigation is:
a) Abdominal X Ray
b) Barium swallow
c) CT abdomen
d) Oesophogastroduodenoscopy
4. A 19 year old male attends ED having noticed his skin has gained a yellowish tinge following a cold. He is concerned as his uncle died from cirrhosis. His liver function tests are Bili 62 ALP 85 ALT 32 Alb 39. The most likely diagnosis is:
a) Crigler-Najjar
b) Gilbert’s syndrome
c) Haemochromatosis
d) Hepatitis C
5. A 56 year old lady visits her GP due to pruritus and jaundice. Liver function tests reveal a high alkaline phosphatase. You suspect primary biliary cirrhosis. Which of the following is pathognomonic :
a) Anti-mitochondrial antibody
b) Anti-nuclear antibody
c) Anti-smooth muscle antibody
d) pANCA
6. You are asked to see an 18 year old girl in ED who was referred by her GP after becoming jaundiced. She is confused and drowsy on arrival. Blood tests show abnormal liver function tests with a elevated prothrombin time. Which is the most common cause of her current condition?
a) Autoimmune hepatitis
b) Hepatitis B
c) Mushroom poisoning
d) Paracetamol overdose
7. A 62 year old man with known bowel cancer is admitted into hospital with a liver abscess. The most likely organism to be grown on blood cultures is:
a) Clostridium difficile
b) Entamoeba histolytica
c) Escherichia coli
d) Streptococus Milleri
8. A 22 year old male has a colonoscopy and biopsies for suspected Crohn’s disease. What would you expect to see on histology to confirm the diagnosis?
a) Crypt abscesses
b) Goblet cell depletion
c) Non-caseating granulomas
d) Inclusion bodies
9. A 42 year old male with a history of alcohol excess is admitted with confusion. On examination he is found to be ataxic with nystagmus and ophthalmoplegia. Which of the following would be the next most appropriate treatment option?
a) Intravenous antibiotics
b) Intravenous N-acetylcysteine
c) Intravenous thiamine
d) Chlordiazepoxide
10. A 26 year old female with ulcerative colitis attends ED with acute onset of bloody diarrhoea. She is opening her bowels 14 times daily. Her observations show she is tachycardic at 100 bpm. Relevant blood tests include Hb 10.4 (12g/dL) and ESR 45. Which is the next most appropriate treatment?
a) Intravenous antibiotics
b) Intravenous hydrocortisone
c) Oral 5-aminosalicylates
d) Prednisolone
11. You are the on call house officer and are bleeped to the gastroenterology ward as a patient has had an episode of large volume haematemesis. On arrival the patient appears clammy and pale. His pulse is thready. He appears jaundiced and has a slightly distended abdomen. Which is the most likely source of bleeding in this gentleman?
a) Duodenal ulcer
b) Gastric ulcer
c) Mallory-Weiss tear
d) Oesophageal varices
12. A barium follow through shows strictures within the terminal ileum. This is most consistent with a diagnosis of
a) Coeliac disease
b) Crohn’s disease
c) Ulcerative colitis with reflux ileitis
d) Small bowel bacterial overgrowth
13. A 62 year old male is referred to ED with jaundice. He denies any pain but states he has noticed that his stools have become pale and his urine dark. He feels itchy all the time. Which of the following would you expect to be elevated?
a) AFP
b) CA 125
c) CA 19-9
d) CEA
14. A 26 year old male has been low in mood and withdrawn for six months. On examination he has a tremor of the upper limbs and has a shuffling gait. You note a yellow-brown ring around the iris. Which of the following would be the diagnostic?
a) Alfa-1 antitrypsin
b) Ceruloplasmin and urinary copper
c) Ferritin and transferrin saturations
d) Haemoglobin electrophoresis
15. A 21 year old female is admitted to ED hypoglycaemic, hypotensive and hypothermic. On further history taking, she reports nausea and vomiting for 3 months. The likely diagnosis is:
a) Addison’s disease
b) Alcohol excess
c) Hyperemesis gravidum
d) Hypothyroidism
a. Oesophagitis
b. Oesophageal carcinoma
c. Duodenal ulcer disease
d. Mallory-Weiss tear
e. Variceal bleeding
f. Barrett’s oesophagus
g. Gastric ulcer disease
h. GORD
1. Erosion of the mucosa which is associated with Helicobacter pylori infection in 90% of cases
2. Mucosal inflammation, which can be secondary to acid reflux, lax sphincter tone or H. Pylori infection
3. Haematemesis due to mucosal tearing from recurrent retching and vomiting.
4. Transformation of stratified columnar epithelium to columnar epithelium
Diarrhoea
a. Campylobacter
b. Norovirus
c. Cholera
d. Clostridium difficile
e. Coeliac disease
f. Laxative abuse
g. Streptococcus Viridans
h. Staphylococcus Aureus
5. A 50 year old female inpatient who develops profuse watery diarrhoea after 4 days of treatment for community acquired pneumonia
6. A 17 year old male presents acutely unwell with profuse watery diarrhoea with mucous flecks appearing like rice water. Mainstay of treatment is oral rehydration therapy and tetracycline antibiotics
7. A 25 year old house officer develops myalgia, diarrhoea and vomiting lasting for 48 hours
8. A 60 year old male presents with 24 hours of severe cramping abdominal pain with bloody diarrhoea following a meal of sweet and sour chicken at a restaurant. He is treated with erythromycin
Liver
a. Haemochromatosis
b. Wilson’s Disease
c. Alcoholic liver disease
d. Non-alcoholic fatty liver disease
e. Hepatitis B
f. Hepatitis C
g. Portal Vein Thrombosis
h. Diabetes Mellitus
9. A 62 year old male with a BMI of 31 and Type 2 Diabetes Mellitus presents with abnormal liver function tests showing an elevated ALT
10. A 42 year old male presents complaining of a loss of libido, polydipsia and polyuria. He appears tanned.
11. A 22 year old female is admitted to a psychiatric unit with acute psychosis. Blood tests show an elevated ALT, elevated prothrombin time and low albumin.
Jaundice
a. Pancreatic Head Carcinoma
b. Gilbert’s Syndrome
c. Primary Biliary Cirrhosis
d. Crigler-Najjar Syndrome
e. Metastatic Malignancy
f. Primary Sclerosing Cholangitis
g. Gallstone Pancreatitis
h. Diabetes Mellitus
12. Benign condition due to impaired uptake of unconjugated bilirubin by hepatocytes
13. Post hepatic jaundice due to extrinsic compression of the common bile duct
14. Autoimmune condition most commonly seen in middle aged women with symptoms of pruritus and lethargy .
15. Autoimmune disease resulting in intra and extrahepatic duct inflammation. Associated with ulcerative colitis.
SBAs
EMQs
1. D
2. C
3. D
4. B
5. A
6. D
7. D
8. C
9. C
10. B
11. D
12. B
13. C
14. B
15. A
1. C
2. A
3. D
4. F
5. D
6. C
7. B
8. A
9. D
10. A
11. B
12. B
13. A
14. C
15. F
