mock questions

Question 1

what would a low serum ascites gradient indicate?

Answer 1

infection (less commonly - ectopic pregnancy)

Question 2

how is hep B most commonly transmitted?

Answer 2

sex

Question 3

what would indicate a chronic hep B infection?

Answer 3

lack of IgM, presence of IgG

Question 4

what can cause prehepatic jaundice?

Answer 4

gilbert’s syndrome, B12 anaemia

Question 5

what can cause intrahepatic jaundice?

Answer 5

liver cirrhosis, hepatitis

Question 6

what can cause post hepatic jaundice?

Answer 6

pancreatic cancer, gallstones, bile duct strictures

Question 7

what would be found in the blood of a pre or intrahepatic cause of jaundice?

Answer 7

high unconjugated bilirubin

Question 8

what would be found in the blood of a post hepatic cause of jaundice?

Answer 8

high conjugated bilirubin

Question 9

what would the symptoms of prehepatic jaundice be?

Answer 9

pallor, fatigue, exertional breathlessness

Question 10

what would the symptoms of intrahepatic jaundice be?

Answer 10

anorexia, fatigue, nausea, abdo pain

Question 11

what would the symptoms of post hepatic jaundice be?

Answer 11

RUQ pain, pale stools, dark urine, puritis, steatorrgoes, hepatomegaly

Question 12

what cancer marker might be present in someone with hepatocellular carcinoma and a family history of liver cancer?

Answer 12

alpha-fetoprotein

Question 13

the risk of which cancers would be increased with the presence of the alpha-fetoprotein cancer marker?

Answer 13

hepatocellular, testicular, ovarian

Question 14

what are the risk factors for developing hepatocellular cancer?

Answer 14

family history of liver, testicular or ovarian cancers, alpha-fectoprotein cancer marker, chronic hep B or C infection, heavy alcohol use, DM, obesity

Question 15

what are the aetiological causes of acites?

Answer 15

inflammation, low protein, malignancy

Question 16

what is a complication that could happen as a result of acites?

Answer 16

spontaneous bacterial peritonitis

Question 17

how should a patient be managed with spontaneous bacterial peritonitis?

Answer 17

empirical antibodies, use SEPSIS6 if sepsis occurs

Question 18

what is the gold standard investigation for NAFLD?

Answer 18

liver ultrasound - Diffuse fatty infiltration and abnormal echotexture
biopsy - needed for diagnosis

Question 19

what is the first line investigations for NAFLD?

Answer 19

enhances liver fibrosis test: assessing the level of fibrosis in the liver (<7.7 non-mild; >7.7-9.8 moderate; >9.8 severe)
LFTs - Increased AST + ALT. Ratio close to 1. If AST>ALT in a 2:1 ratio -> ALD
Increased bilirubin, ALP, GGT
FBC - Anaemia or thrombocytopenia

Question 20

A 30 year old female presents with constant RUQ pain with associated fever, nausea and vomiting. On examination the doctor applies pressure to the RUQ and asks the patient to breathe in. Suddenly the patient shouts in pain.
what is the likely diagnosis?

Answer 20

acute cholecystitis - due to no jaundice and murphys sign

Question 21

what is murphys sign?

Answer 21

elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive
e.g. On examination the doctor applies pressure to the RUQ and asks the patient to breathe in. Suddenly the patient shouts in pain.

Question 22

Mary is a 50 y.o lady who presents to her GP with generalized itching across her body over 2-weeks. Over this time, she has feeling increasingly tired and has no energy to do the things she used to do. She denies any changes to her bowel habits, weight loss or blood coming out from anywhere. However, she said that her husband has been commenting that she looks yellower recently. What antibody is likely to be found in this patient?

Answer 22

anti-mitochondrial antibodies

Question 23

what does a presence of anti-mitochondrial antibodies suggest?

Answer 23

primary biliary cholangitis

Question 24

what are the signs of PBC?

Answer 24

female, >45, history of autoimmune conditions, lethargy, itching, hepatomegaly, AMA antibodies, raised LFTs, low albumin

Question 25

what is the treatment for PBC?

Answer 25

Ursodeoxycholic acid + steroids + cholestyramine | If severe: Liver transplantation

Question 26

C282Y mutation =

Answer 26

haemochromatosis

Question 27

George is a 56 y.o gentleman complaining of tiredness. This has been going on for a week and during this time he noticed that he appears more tanned even without leaving his house. His glucose levels are raised. Genetic testing shows the presence of C282Y mutations. Both his levels for transferrin and ferritin is raised.

Answer 27

haemochromatosis

Question 28

when would you treat haemochromatosis?

Answer 28

if transferrin and ferritin are raised together, then treat with phlebotomy then iron-chelating drugs

Question 29

A 20 year old gentleman has shown up to his GP due to a recurrence of jaundice. He has mentioned he’s become more itchy lately and has developed a pain in his upper right abdomen. He is quite into his fitness and has mentioned he has noticed some muscle atrophy and weight loss. After further investigations, alternating strictures and dilated portions of the hepatic ducts are seen on ERCP.

Answer 29

primary sclerosing cholangitis

Question 30

what conditions is PSC associated with?

Answer 30

IBD, colon cancer and bile duct cancer

Question 31

how is PSC diagnosed?

Answer 31

MRI bile ducts

Question 32

how is PBC diagnosed?

Answer 32

AMA and /or raised ALP in blood tests

Question 33

John is a 22 y.o medical student. He noticed that for the past week, he had been having difficulties with picking up his pen and buttoning up his shirt. He has also been shaking involuntarily and thinks it gets worse when he is stressed. He has also noticed that his limbs are pretty stiff and that his movements are slow. His friends have said that he eyes seem to have taken on a different colour. What is the most likely diagnosis?

Answer 33

wilson's disease

Question 34

A 56 year old woman comes to A+E complaining of increased abdominal pain which seems to be worse 20 minutes after a meal. She mentioned that her stools have become more smellier than usual and tend to float. She tells you that this has happened before and that she is worried that this could be due to her alcohol habit. Under further investigations you notice her blood sugars are substantially elevated.

Answer 34

chronic pancreatitis

Question 35

what vitamin deficiencies would someone with chronic pancreatitis most likely have?

Answer 35

fat soluble vitamins - ADEK

Question 36

what are the signs of chronic pancreatitis?

Answer 36

pain worse following a meal, steatorrhoea, DM - due to damage to the beta cells, after 20 years

Question 37

how is chronic pancreatitis diagnosed?

Answer 37

CT or MRI - pancreatic duct dilation, calcification, atrophy or pseudocysts Endoscopic Ultrasound Fecal elastase tests -> Decreased elastase

Question 38

how is chronic pancreatitis treated?

Answer 38

Alcohol + smoking cessation Pain management Pancreatin + omeprazole

Question 39

Hepatitis A IgM : negative Hep B anti- HBs antibody: positive Hepatitis C Abs test: positive. what is the likely diagnosis?

Answer 39

acute hepatitis C infection with previous vaccination to hepatitis B

Question 40

describe the hepatitis C pathogen

Answer 40

positive sense single stranded RNA virus

Question 41

describe the hepatitis D pathogen

Answer 41

Negative sense single-stranded RNA virus

Question 42

describe the hepatitis B pathogen

Answer 42

Double stranded DNA virus

Question 43

Mason is a 30 y.o banker who recently developed a productive cough. The cough just came on and he is unsure of any triggers. He gets breathless on exertion. He smokes 1 pack every day. He overhears the doctors saying that his condition might be due to a deficiency of an enzyme in his blood. O/E: Hepatomegaly and hyperinflated chest. Both parents had emphysema before the age of 50. what is the diagnosis?

Answer 43

alpha-antitripsin deficiency

Question 44

how is alpha-antitripsin deficiency inherited?

Answer 44

autosomal recessive

Question 45

confusion, alcoholic, liver failure =

Answer 45

B1 deficiency

Question 46

what would a AST>ALT with a 2:1 ratio indicate?

Answer 46

alcoholic hepatitis / alcoholic liver disease

Question 47

raised ALP levels in an otherwise well 60 year old women?

Answer 47

postmenapause

Question 48

what would be suggestive of obstructive lung disease and liver disease?

Answer 48

alpha-antitripsin deficiency

Question 49

what does N-acetyl cysteine do?

Answer 49

given in paracetamol overdoses | Replenishes the supply of glutathione that conjugates NAPQI to non-toxic compounds

Question 50

what is charcot's triad?

Answer 50

fever, jaundice, abdominal pain | present in ascending cholangitis

Question 51

what can charcot's triad develop into?

Answer 51

reynold's pentad - adding confusion and hypotension

Question 52

what is the gold standard investigation for ascending cholangitis?

Answer 52

contrst enhansed dynamic CT scan

Question 53

what is ERCP and what can it lead to?

Answer 53

Endoscopic retrograde cholangiopancreatography, or ERCP = iatrogenic chronic pancreatitis

Question 54

what can having both PSC and IBD lead to?

Answer 54

increase the risk of colorectal and biliary system cancers so require annual colonoscopies

Question 55

what are the signs of haemochromatosis?

Answer 55

fatigue, weakness, non-specific abdominal pain erectile dysfunction, arrhythmias, irritability, skin bronzing and hepatomegaly

Question 56

what would be tested when haemochromatosis is suspected?

Answer 56

serum transferrin and serum ferritin

Question 57

what are kayser-fleocher rings?

Answer 57

copper deposits - wilson's disease

Question 58

what would suggest ascending cholangitis rather than biliary colic?

Answer 58

fever and rigors

Question 59

what is the gold standard investigation for wilson's disease?

Answer 59

liver biopsy

Question 60

what blood test is most indicative of liver damage?

Answer 60

raised ALT

Question 61

what blood marker would be raised the most in alcohol induced liver problems?

Answer 61

gamma-glutamyl transferase - Gamma-GT

Question 62

what can wernicke's encephalopthy lead to?

Answer 62

wernicke-korsakoff syndrome - includes memory loss

Question 63

Which benzodiazepine may be used to manage the effects of alcohol withdrawal?

Answer 63

Chlordiazepoxide

Question 64

how does delirium tremens present?

Answer 64

severe agitation, delusions and hallucinations, tremor, tachycardia, hypertension, hyperthermia, ataxia, arrhythmias, confusion