gastro

Question 1

Patients with dyspepsia and no red flag symptoms should be offered

Answer 1

4 weeks of full or standard dose proton pump inhibitor (PPI) treatment

Question 2

second-line treatment IBS

Answer 2

Low-dose amitriptyline

Question 3

gastroenterological condition are probiotics MOST likely to be beneficial for

Answer 3

Irritable bowel syndrome

Question 4

peristomal skin rash - inflamed and painful ulcers around the stoma site with purple edges

Answer 4

Pyoderma gangrenosum

Question 5

Alongside hyponatraemia, which SINGLE electrolyte imbalance is MOST particularly associated with high-output stomas?

Answer 5

Hypomagnesaemia

Question 6

occurs between one and three hours of eating mackerel or tuna

Answer 6

Scombrotoxin food poisoning

Question 7

food poisoning is characterised by a prodromal malaise, abdominal pain, diarrhoea, with vomiting being uncommon

Answer 7

Campylobacter

Question 8

further treatment for IBS if pharmacological therapy has not controlled symptoms and declines CBT

Answer 8

Hypnotherapy

Question 9

patients with oral lesions should be tested for what GI disease

Answer 9

coeliac

Question 10

tiredness + itching + positive anti mitochondrial DNA

Answer 10

Primary biliary cirrhosis

Question 11

erythema nodosum is associated with what GI condition

Answer 11

ulcerative colitis

Question 12

one clinical feature that could differentiate UC with Chron’s

Answer 12

bleeding almost always in UC

Question 13

was diagnosed with gastroenteritis now has back pain which imporves on movement, diagnosis? Management?

Answer 13

reactive arthritis - naproxen

Question 14

bdominal pain or discomfort that is either relieved by defaecation or associated with altered bowel frequency or stool form

Answer 14

IBS

Question 15

first-choice blood test to diagnose suspected coeliac disease is IgA tissue transglutaminase (tTGA). If serology is negative, then

Answer 15

Total serum IgA

Question 16

steps in diagnosing coeliac disease

Answer 16

first choice - iga TGA, if negative then serum total IgA - is positive fo this then IgG endomysial and/or IgG TGA

Question 17

treatment for severe oesophagitis - with dose

Answer 17

full dose PPI (lansoprazole 30mg OD) then if not better, high dose PPI

Question 18

can be used to estimate risk of advanced liver fibrosis

Answer 18

FIB-4

Question 19

Which one of the following co-infections MOST significantly ACCELERATES the progression of hepatitis C (HCV)-associated liver disease

Answer 19

HIV

Question 20

presence of Howell–Jolly bodies

Answer 20

post Splenectomy

Question 21

oesophagitis as side effect of whichh meds (x3)

Answer 21

non-steroidal anti-inflammatory drugs, bisphosphonates and tetracyclines

Question 22

patients with what SHOULD always be tested for coeliac

Answer 22

type 1 diabetes, irritable bowel syndrome, dermatitis herpetiformis, autoimmune thyroid disease (such as Graves’ disease) and any first-degree relatives of people with coeliac disease.

Question 23

Medications may cause or worsen dyspepsia

Answer 23

NSAIDs, CCB, nitrates, theophyllines, bisphosphonates and steroids

Question 24

Which is the SINGLE MOST likely risk factor for developing non-alcoholic fatty liver disease (NAFLD)?

Answer 24

Type 2 diabetes

Question 25

Campylobacter enteritis Severe infections are treated with

Answer 25

clarithromycin

Question 26

common medication (non antibiotics) causing recurrent c diff infection

Answer 26

omeprazole/PPI

Question 27

First line treatment for all patients with primary biliary cholangitis (also known as primary biliary cirrhosis)

Answer 27

oral ursodeoxycholic acid

Question 28

monitoring when on oral mesalazine

Answer 28

renal function before starting, at 3 months and then annually

Question 29

LFT raised in hepatitis A (usually)

Answer 29

AST

Question 30

when to stop statin in view of LFTS

Answer 30

when LFTs doubles in 3 months from baseline

Question 31

urgent referral for upper GI scope criteria

Answer 31

any age with dysphagia, over 55 with weight loss and who has either upper abdominal pain, relfux, dyspepsia

Question 32

abdominal pain relieved by defecation

Answer 32

IBS

Question 33

should be considered for people with IBS who do not respond to drug treatments after a year of trial and who continue to experience ongoing symptoms

Answer 33

Cognitive behavioural therapy, hypnotherapy

Question 34

Grey Turner’s and Cullen’s signs

Answer 34

acute pancreatitis

Question 35

PR bleeding in IBD

Answer 35

almost always in UC, arounf half in Chron's

Question 36

hernia - inferior to the lateral tubvercle

Answer 36

Femoral hernia

Question 37

hernia - superior medial to pubic tubercle

Answer 37

inguinal hernia

Question 38

skip lesions

Answer 38

Chron's

Question 39

LIF pain with microcytic anaemia

Answer 39

colorectal cancer

Question 40

urgent referral to be seen within two weeks for hernias

Answer 40

wome with hernia to distinguish femoral vs inguinal

Question 41

Which is the SINGLE MOST likely biochemical abnormality with non-alcoholic fatty liver disease (NAFLD)

Answer 41

Relatively greater rise in alanine aminotransferase (ALT) than aspartate aminotransferase (AST)

Question 42

test of eradication for h pylori (even if not recommended)

Answer 42

urea breath test after 4 weeks

Question 43

severity scale for U/c

Answer 43

Truelove and Witts’ severity index

Question 44

patient with positive Iga TTG, what to do next

Answer 44

refer to gastroenterologist for endomysial biopsy

Question 45

normal screening pathway for colorectal cancer

Answer 45

FIT every 2 years

Question 46

MOST likely malignant complication of untreated coeliac disease

Answer 46

Lymphoma

Question 47

MOST appropriate monitoring investigation for nafld

Answer 47

Enhanced liver fibrosis (ELF) test

Question 48

Which is the SINGLE MOST appropriate way of confirming compliance with a gluten-free diet?

Answer 48

Immunoglobulin A (IgA) tissue transglutaminase - in most patients will be negative after one year of gluten free diet

Question 49

toxic megacolon is a complication of

Answer 49

uc

Question 50

MOST significant risk factor for development of more advanced liver disease in a patient with non-alcoholic fatty liver disease (NAFLD)

Answer 50

Hypertension

Question 51

Medications identified as risk factors for gallbladder disease include

Answer 51

semaglutide (glp1), hrt, ceftriaxone

Question 52

Which is the SINGLE MOST likely vitamin deficiency associated with coeliac disease?

Answer 52

Vitamin D

Question 53

grades the severity of liver cirrhosis

Answer 53

Child–Pugh

Question 54

classification grades the severity of liver cirrhosis includes which parameters

Answer 54

Albumin, bilirubin, international normalised ratio (INR) and the degree of both ascites and encephalopathy

Question 55

Which ONE of the following is the MOST LIKELY most common cause of dyspepsia among adults?

Answer 55

Functional dyspepsia