Investigations 2

Question 1

What is the first line investigation for a common bile duct stone ?
If the results are normal what would you do second and third line?

Answer 1

1. Abdominal USS

Next:
2. MRCP

3. Endoscopic US (if MRCP is unclear)

Question 1

What is the first line investigation for a common bile duct stone ?
If the results are normal what would you do second and third line?

Answer 1

1. Abdominal USS

Next:
2. MRCP

3. Endoscopic US (if MRCP is unclear)

Question 2

If someone presented with diarrhoea after a recent course of antibiotics, why would you send off a stool sample for culture?

Answer 2

Because the patient might have C. Diff

Question 3

List the contraindications for a barium swallow (4 things)

Answer 3

• Pregnant
• Oesophageal perforation
• Dysphagia
• Constipation

Question 4

What investigations would you do for someone with suspected B12 or folate deficiency? (3 things)

Answer 4

1. FBC
   - To determine MCV, Hb and haematocrit levels
   - blood film (help determine megaloblastic anaemia)
2. Measure serum cobalamin and folate levels
   - To determine the cause of anaemia
3. Additional Ix:
   - LFT
   - GGT
   -TFT
   All to identify an underlying cause

Question 5

When starting a patient on a statin what other relevant investigations should you do ?

Answer 5

Measure LFT’s before starting, 3 months after then at 1 year.

Question 5

When starting a patient on a statin what other relevant investigations should you do ? - also when would you measure HbA1c in a diabetic?

Answer 5

Measure LFT’s before starting, 3 months after then at 1 year.
If they are diabetic HbA1c should be measured at 3 months as well

Question 6

Infective endocarditis is associated with which type of cancer? So what must you do when an older patient presents with this?

Answer 6

Colon cancer

A colonoscopy should be done

Question 7

What type of cancer is Barretts oesophagus associated with?

Answer 7

Oesophageal cancer

Question 8

What classic histological finding is associated with stomach cancer?

Answer 8

Signet ring cells

Question 9

What blood test is required when sending someone for an upper GI cancer referral?

Answer 9

Recent eGFR within the last 3 months

just in case the patient needs to have a CT with contrast

Question 10

What investigations should be done for a patient presenting with oesophagus/stomach cancer?

Answer 10

Urgent direct access upper GI endoscopy

Question 11

What investigations should be done for a patient presenting with pancreatic cancer?

Answer 11

Urgent direct access CT scan

Question 12

What should be stopped 10 days before going for a colonoscopy?

Answer 12

Iron supplements.

- It interferes with the quality of the test

Question 13

IBS is a clinical diagnosis of exclusion, but what tests would you do to investigate other causes of the patients symptoms? (3 things)

Answer 13

1. FBC
   - Anaemia
   - Raised platelets
2. ESR+CRP
3. Coeliac serology

Question 14

How would you go about investigating haemorrhoids?

Answer 14

1.Clinical history

2. Physical exam
   - gently part the buttocks
3. PR exam
   - if possible without causing pain
   - you won’t feel internal haemorrhoids
   - this is done to rule out other causes (constipation, mass or rectal prolapse)
4. A rigid anoscope, proctoscope, or rectoscope
   - Can be used to make a DIAGNOSIS
   - Can classify severity and exclude sinister pathology

Question 15

What is the least invasive method to remove the gallbladder?

Answer 15

Laparoscopic cholecystectomy