Gastrointestinal Flashcards
1
Q
- Dysphagia
A 47-year-old woman presents to your clinic with a three-month history of
dysphagia. There is no history of drastic weight loss and the patient experiences
symptoms when swallowing solids but not liquids. Which of the following is not an
obstructive cause of dysphagia?
A. Pharyngeal carcinoma
B. Oesophageal web
C. Retrosternal goitre
D. Peptic stricture
E. Achalasia
A
E
2
Q
- Abdominal pain (1)
You see a 47-year-old man in clinic with a three-month history of epigastric dull
abdominal pain. He states that the pain is worse in the mornings and is relieved
after meals. On direct questioning, there is no history of weight loss and the
patient’s bowel habits are normal. On examination, his abdomen is soft and
experiences moderate discomfort on palpation of the epigastric region. The most
likely diagnosis is:
A. Gastric ulcer
B. Gastro-oesophageal reflux disease (GORD)
C. Duodenal ulcer
D. Gastric carcinoma
E. Gastritis
A
C
3
Q
- Management of peptic ulcer disease
A 55-year-old woman is referred by her GP for upper gastrointestinal (GI) endoscopy
following a four-month history of epigastric pain despite treatment with antacids
and proton pump inhibitors (PPIs). The results demonstrate a duodenal ulcer
coupled with a positive campylobacter-like organism (CLO) test. The patient has no
past medical history and has no known drug allergies. The most appropriate
treatment is:
A. Seven-day course of twice daily omeprazole 20 mg, 1 g amoxicillin and
500 mg clarithromycin
B. Seven-day course of twice daily omeprazole 20 mg
C. Seven-day course of twice daily omeprazole 20 mg and 1 g amoxicillin
D. Seven-day course of twice daily omeprazole 20 mg and 500 mg
clarithromycin
E. Seven-day course of twice daily 1 g amoxicillin and 500 mg
clarithromycin
A
A
4
Q
- Peptic ulcer disease
Which of the following is the most common cause of duodenal ulcers?
A. NSAIDs
B. Helicobacter pylori
C. Alcohol abuse
D. Chronic corticosteroid therapy
E. Zollinger–Ellison syndrome
A
B
5
Q
- Investigation of gastro-oesophageal reflux disease
You see a 48-year-old lorry driver, who presents to you with a three-month history
of heartburn after meals which has not been settling with antacids and PPIs. You
suspect that the patient has a hiatus hernia. The most appropriate investigation for
diagnosing a hiatus hernia is:
A. Computer tomography (CT) scan
B. Chest x-ray
C. Upper GI endoscopy
D. Barium meal
E. Ultrasound
A
D
6
Q
- Complications of gastro-oesophageal reflux disease
You see a 56-year-old man who was admitted for an elective upper GI endoscopy
due to longstanding GORD which has failed to improve on antacids and PPIs. Your
registrar suspects that this patient may have Barrett’s oesophagus and asks you to
define what this is. The most appropriate description of Barrett’s oesophagus is:
A. Metaplasia of the squamous epithelium of the lower third of the
oesophagus to columnar epithelium
B. Metaplasia of the columnar epithelium of the upper third of the oesophagus
to squamous epithelium
C. Metaplasia of the columnar epithelium of the lower third of the
oesophagus to squamous epithelium
D. Metaplasia of the squamous epithelium of the upper third of the
oesophagus to columnar epithelium
E. Metaplasia of the squamous epithelium of the middle third of
the oesophagus to columnar epithelium
A
A
7
Q
- Diarrhoea (1)
You see a 25-year-old woman who presents with a 24-hour history of watery
diarrhoea. She states that she has opened her bowels 11 times since her onset of
symptoms. Associated symptoms include nausea and vomiting with abdominal
cramps and pain which started in the evening following a barbeque meal in the
afternoon that day. The patient is alert and orientated and her observations include
a pulse rate of 69, blood pressure of 124/75 and temperature of 37.1°C. On
examination, her abdomen is soft, there is marked tenderness in the epigastric
region and bowel sounds are hyperactive. The patient is normally fit and well with
no past medical history. The most likely diagnosis is:
A. Irritable bowel syndrome
B. Gastroenteritis
C. Ulcerative colitis
D. Laxative abuse
E. Crohn’s disease
A
B
8
Q
- Management of diarrhoea
A 35-year-old woman presents with a 24-hour history of watery diarrhoea. She has
opened her bowels nine times since the onset of her symptoms. You diagnose
gastroenteritis after learning that the patient and her family all ate at a new
restaurant and the rest of her family have had similar problems. The most appropriate
management is:
A. Oral rehydration advice, anti-emetics and discharge home
B. Oral antibiotic therapy and discharge home
C. Admission for intravenous fluid rehydration
D. Admission for intravenous antibiotic therapy
E. No treatment required
A
A
9
Q
- Investigation of diarrhoea
A 56-year-old man presents with a 2-week history of diarrhoea which has not
settled following an episode of ‘food poisoning’. Which of the following would be
the most appropriate investigation?
A. Full blood count
B. Urea and electrolytes
C. Stool sample for microscopy, culture and sensitivities
D. Abdominal x-ray
E. Liver function tests
A
C
10
Q
- Diarrhoea (2)
You are questioned by your registrar regarding bacteria responsible for causing
blood-stained diarrhoea. From the list below, select the organism which is not
responsible for causing blood-stained diarrhoea.
A. Campylobacter spp.
B. Salmonella spp.
C. Escherichia coli
D. Shigella spp.
E. Stapylococcus spp.
A
E
11
Q
- Hepatomegaly
A 69-year-old man present with a 2-week history of abdominal pain which has
worsened over the last few days. On examination, the patient is jaundiced and the
abdomen is distended with tenderness in the epigastric region. In addition, there is
a smooth hepatomegaly and shifting dullness. Which of the following is a cause of
hepatomegaly?
A. Iron deficiency anaemia
B. Budd–Chiari syndrome
C. Ulcerative colitis
D. Crohn’s disease
E. Left-sided heart failure
A
B
12
Q
- Jaundice (1)
You see a 19-year-old Caucasian man in your clinic who presents with a history of
transient jaundice. On direct questioning, you ascertain that the jaundice is
noticeable after periods of increased physical activity and subsides after a few days.
The patient has no other symptoms and physical examination is unremarkable. Full
blood count is normal (with a normal reticulocyte count) and liver function tests
reveal a bilirubin of 37 μmol/L. The most appropriate management is:
A. Reassure and discharge
B. Start on a course of oral steroids
C. Request abdominal ultrasound
D. Request MRCP
E. Refer to Haematology
A
A
13
Q
- Jaundice (2)
You see a 54-year-old woman, referred to accident and emergency through her GP,
with a week’s history of jaundice and right upper quadrant abdominal pain.
Associated symptoms include dark urine and pale stools. There is no history of
weight loss and the patient does not consume alcohol. Her liver function tests
reveal a bilirubin of 40 μmol/L, ALT of 40 iu/L, AST 50 iu/L and ALP of 350 iu/L. The
most likely diagnosis is:
A. Gallstones
B. Viral hepatitis
C. Alcoholic hepatitis
D. Carcinoma of the head of the pancreas
E. Autoimmune hepatitis
A
A
14
Q
- Investigation of jaundice
You are asked by your registrar to request an imaging investigation for a 49-yearold
woman with jaundice and abdominal pain. She has a past medical history of
gallstones and you suspect this is a recurrence of the same problem. The most
appropriate imaging investigation is:
A. Abdominal x-ray
B. Abdominal ultrasound
C. Abdominal CT
D. Magnetic resonance imaging (MRI)
E. Endoscopic retrograde cholangiopancreatography (ERCP)
A
A
15
Q
- Drug-induced cholestasis
You see a 47-year-old woman who presents with a 3-day history of jaundice. You
assess her liver function tests (LFTs) and see that the ALP iu/L is raised at 350 iu/L,
AST 45 iu/L, ALT 50 iu/L and bilirubin 50 iu/L. The patient feels well in herself,
although she has noticed that her urine has become quite dark and her stools quite
pale. You assess her medication history. Which of the following drugs from the
patient’s medication history may be responsible for the cholestasis?
A. Co-amoxiclav
B. Bendroflumethiazide
C. Ramipril
D. Amlodipine
E. Aspirin
A
B
16
Q
- Constipation
During your on-call, you are bleeped to see an 80-year-old woman on the ward
who has not opened her bowels for the last 4 days. She is not known to have a
history of constipation. On examination, her observations are within normal range,
the abdomen is soft and there is mild discomfort at the left iliac fossa. Bowel
sounds are present and on PR examination, the rectum is empty. You consult your
registrar who asks you to prescribe an osmotic laxative. What is the most appropriate
treatment?
A. Ispaghula husk
B. Docusate sodium
C. Lactulose
D. Senna
E. Methylcellulose
A
C