Clinical Essentials

Question 1

Haematemesis is caused by bleeding where?

Answer 1

Oesophagus, stomach or duodenum

Question 2

For melaena to be produced, blood has to be in the GI tract for how long?

Answer 2

More than 12 hours

Question 3

Melaena is usually caused by bleeding from where?

Answer 3

Upper GI tract

Question 4

What medication almost always causes stool to become black?

Answer 4

Oral iron supplements

Question 5

Central, colicky abdominal pain is most suggestive of which diagnosis?

Answer 5

Intestinal obstruction

Question 6

Central, constant, severe abdominal pain is most suggestive of which diagnosis?

Answer 6

Intestinal ischaemia

Question 7

Pain which is generalised throughout the entire abdomen is most suggestive of which diagnosis?

Answer 7

Peritonitis

Question 8

What are the 4 main causes of ascites?

Answer 8

Heart/liver/renal failure or abdominal/pelvic malignancy

Question 9

Which causes of ascites are associated with a SAAG value of > 11g/L?

Answer 9

Liver and heart failure

Question 10

Pale urine/dark stools and pruritus occur alongside which type of jaundice?

Answer 10

Obstructive

Question 11

Diarrhoea at what time is most worrying and suggestive of a significant pathology such as a malignancy or IBD?

Answer 11

At night

Question 12

Steatorrhoea can be caused by disease where?

Answer 12

Pancreas or small intestine

Question 13

Rectal bleeding associated with pain suggests what two potential diagnoses?

Answer 13

Anal fissure or haemorrhoids

Question 14

Which commonly prescribed group of drugs is known for causing constipation as a side effect?

Answer 14

Opioids

Question 15

What are some drugs which can contribute to the risk of GI bleeding and dyspepsia?

Answer 15

NSAIDs, aspirin, calcium channel blockers and SSRIs

Question 16

What happens to the platelet count in inflammatory and infective conditions of the GI tract?

Answer 16

Low

Question 17

Upper GI bleeding may show what abnormality on U&Es?

Answer 17

Raised urea

Question 18

Liver failure may interfere with the reliability of which inflammatory marker?

Answer 18

CRP

Question 19

Which blood test is most sensitive as a marker of the liver’s synthetic function?

Answer 19

Coagulation screen

Question 20

Folate is sometimes increased in those with what abnormality of the GI tract?

Answer 20

Small intestinal bacterial overgrowth

Question 21

What is the tumour marker for hepatocellular carcinoma?

Answer 21

AFP

Question 22

CEA is the tumour marker for which malignancy?

Answer 22

Colorectal

Question 23

What is the tumour marker for pancreatic cancer?

Answer 23

Ca 19.9

Question 24

Which immunoglobulin is most likely to be elevated in individuals with primary biliary cholangitis?

Answer 24

IgM

Question 25

Which immunoglobulin is raised in the early stages of infection?

Answer 25

IgM

Question 26

Which immunoglobulin is most likely to be elevated in those with autoimmune hepatitis?

Answer 26

IgG

Question 27

Which immunoglobulin is raised in the late stages of infection or in response to previous infection?

Answer 27

IgG

Question 28

What stool test is used to look for the presence of ova, cysts and parasites in the stool?

Answer 28

Microscopy

Question 29

What stool test is used to screen for common bacterial and viral infections of the GI tract?

Answer 29

PCR

Question 30

An immunoassay test to detect what is used first line as a screening test for C. difficile infection?

Answer 30

Glutamate dehydrogenase

Question 31

If a glutamate dehydrogenase test for C. difficile infection is positive, what test is done next?

Answer 31

Toxin immunoassay

Question 32

A low level of what in the stool is suggestive of pancreatic insufficiency?

Answer 32

Faecal elastase

Question 33

What stool test is used to differentiate between IBS and IBD?

Answer 33

Faecal calprotectin

Question 34

Which stool test is used for bowel screening?

Answer 34

Faecal immunochemistry test

Question 35

A raised 24-hour urine level of what will be raised in individuals with neuroendocrine tumours of the small intestine?

Answer 35

5-HIAA

Question 36

Breath tests are most commonly used to detect which conditions affecting the GI tract? (not including H. pylori infection)

Answer 36

Lactose intolerance and small intestine bacterial overgrowth

Question 37

How long should PPIs be stopped for before any testing for H. pylori infection is undertaken?

Answer 37

2 weeks

Question 38

What is the best non-invasive test for H. pylori detection?

Answer 38

Urea breath test

Question 39

What does the presence of leuconychia represent?

Answer 39

Hypoalbuminaemia

Question 40

What does the presence of koilonychia represent?

Answer 40

Iron deficiency anaemia

Question 41

Where is Virchow's node?

Answer 41

Left supraclavicular area

Question 42

What is Virchow's node most suggestive of?

Answer 42

Gastric cancer

Question 43

Which abdominal scar may be present in the RUQ following an open cholecystectomy?

Answer 43

Kocher's

Question 44

What is the name for a transverse suprapubic scar which may be seen in individuals who have undergone a Caesarian section or hysterectomy?

Answer 44

Pfannelstein's

Question 45

The presence of how many spider naevi suggests an underlying liver disease?

Answer 45

More than 5

Question 46

What is the cause of corneal arcus in patients aged < 50?

Answer 46

Hypercholesterolaemia

Question 47

Hyperpigmented macules around the mouth are pathognomonic of which condition?

Answer 47

Peutz-Jeuger's syndrome

Question 48

Which type of stoma will usually be located in the RIF?

Answer 48

Ileostomy

Question 49

Which type of stoma will usually be located in the LIF?

Answer 49

Colostomy

Question 50

Which type of stoma is usually spouted?

Answer 50

Ileostomy

Question 51

Which type of stoma contains formed stool?

Answer 51

Colostomy

Question 52

Which type of stoma contains liquid stool?

Answer 52

Ileostomy

Question 53

A transplanted kidney forms an easily palpable mass where?

Answer 53

Iliac fossa

Question 54

What are some potential causes of absent bowel sounds?

Answer 54

Perforation, peritonitis, paralytic ileus

Question 55

What causes bowel sounds to be high pitched and tinkling?

Answer 55

Intestinal obstruction

Question 56

What is the endoscopic investigation of choice for imaging the oesophagus, stomach and duodenum?

Answer 56

Upper GI endoscopy

Question 57

What is the radiological investigation of choice for imaging the oesophagus?

Answer 57

Barium swallow

Question 58

What is the radiological investigation of choice for imaging the stomach?

Answer 58

Barium meal

Question 59

What endoscopic investigation can be used to image the small intestine (beyond the duodenum)?

Answer 59

Capsule endoscopy

Question 60

What radiological investigations can be used to image the small intestine?

Answer 60

Barium follow through, CT/MR-enterogram

Question 61

What endoscopic investigation can be used to image the left side of the colon?

Answer 61

Sigmoidoscopy

Question 62

What endoscopic investigation can be used to image the whole colon?

Answer 62

Colonoscopy

Question 63

What radiological investigations can be used to image the large intestine?

Answer 63

CT abdo/pelvis, CT pneumocolon

Question 64

What endoscopic investigation can be used to image the biliary tree?

Answer 64

ERCP

Question 65

What imaging investigations can be used to image the biliary tree?

Answer 65

Ultrasound, MRCP, CT abdo

Question 66

A small bowel obstruction can be diagnosed radiologically if the small intestine diameter is greater than what?

Answer 66

3cm

Question 67

Plicae circularis and haustrations are found on the small and large intestines respectively. How can these be used to tell the two apart on imaging?

Answer 67

Plicae circularis transverse the bowel while haustrations do not

Question 68

A large bowel obstruction can be diagnosed radiologically if the large intestine diameter is greater than what?

Answer 68

6cm

Question 69

The coffee bean sign on abdominal radiograph is suggestive of what diagnosis?

Answer 69

Sigmoid volvulus

Question 70

Thumbprinting and lead-pipe colon can both be features of what on AXR?

Answer 70

Mucosal inflammation

Question 71

For toxic megacolon to be diagnosed on imaging, the transverse colon must be dilated greater than what?

Answer 71

6cm

Question 72

What investigation is a type of ultrasound which can be used to assess liver fibrosis?

Answer 72

Transient elastography

Question 73

How long should patients fast for before an upper GI endoscopy?

Answer 73

6 hours

Question 74

Sigmoidoscopy visualises the large intestine up to where?

Answer 74

Splenic flexure

Question 75

When are oral nutritional supplements given?

Answer 75

When diet is inadequate to meet nutritional needs

Question 76

Give some examples of enteral feeding?

Answer 76

NG tube, NJ tube, PEG tube

Question 77

When is a nasogastric tube used for enteral feeding?

Answer 77

If oral supplementation is unsafe

Question 78

When is a nasojejunal tube used for enteral feeding?

Answer 78

If there is delayed gastric emptying

Question 79

When is a gastrostomy (PEG tube) used for enteral feeding?

Answer 79

When > 4 weeks of enteral feeding is required

Question 80

When is parenteral feeding required?

Answer 80

Intestinal failure

Question 81

Refeeding syndrome causes low plasma levels of which 3 electrolytes?

Answer 81

Potassium, magnesium and phosphate

Question 82

What effect does refeeding syndrome have on blood glucose levels?

Answer 82

Hypoglycaemia

Question 83

When refeeding patients, NICE recommends that patients should only receive 50% of their daily requirements for the first two days if they haven't eaten in how long?

Answer 83

More than 5 days

Question 84

Which vitamin is given IV when refeeding patients, to prevent deficiency?

Answer 84

Thiamine (vitamin B1)

Question 85

What is the first line test to ensure an NG tube is in the correct position in the stomach?

Answer 85

Aspiration and pH check

Question 86

What is the second line test to ensure an NG tube is in the correct position in the stomach?

Answer 86

Chest/abdo x-ray

Question 87

Which type of endoscopic haemostasis only lasts for up to a few hours and should always be used alongside a more definitive mechanism?

Answer 87

Adrenaline injection

Question 88

What type of tube is used to perform a balloon tamponade to stabilise bleeding varices before TIPS or definitive endoscopy can be performed?

Answer 88

Sengstaken-Blakemore tube

Question 89

What endoscopic technique can be used to treat early oesophageal cancers and dysplasia in Barrett's oesophagus?

Answer 89

Radiofrequency ablation

Question 90

Which interventional radiological technique can be used to treat GI bleeding which cannot be stopped endoscopically?

Answer 90

Angiography with embolisation

Question 91

Which interventional radiological technique can be used to place stents in the GI tract while avoiding the need for endoscopy?

Answer 91

Fluoroscopy

Question 92

What are the two main contraindications to paracentesis?

Answer 92

Pregnancy and coagulation problems

Question 93

Paracentesis is indicated when what symptoms occur as a result of large volume ascites?

Answer 93

Shortness of breath or abdominal pain

Question 94

How long can a paracentesis drain be in for?

Answer 94

6 hours