SBA - Gastroenterology Flashcards
(40 cards)
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. Pharyngealcarcinoma B. Oesophageal web C. Retrosternalgoitre D. Pepticstricture E. Achalasia
Achalasia
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. Gastriculcer B. Gastro-oesophageal reflux disease (GORD) C. Duodenalulcer D. Gastriccarcinoma E. Gastritis
Duodenal ulcer
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 20mg, 1g amoxicillin and 500 mg clarithromycin
B. Seven-day course of twice daily omeprazole 20 mg
C. Seven-day course of twice daily omeprazole 20mg and 1g amoxicillin
D. Seven-day course of twice daily omeprazole 20mg and 500mg
clarithromycin
E. Seven-day course of twice daily 1g amoxicillin and 500mg
clarithromycin
Seven-day course of twice daily omeprazole 20mg, 1g amoxicillin and 500 mg clarithromycin
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–Ellisonsyndrome
Helicobacter pylori
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
Barium meal
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
Metaplasia of the squamous cell epithelium of the lower ⅓ of the oesophagus, to columnar epithelium
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
Gastroenteritis
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
Oral rehydration, anti-emetics?? and discharge
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. Abdominalx-ray E. Liver function tests
Stool sample for microscopy, culture and sensitivities
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.
Staphylocccus spp.
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. Ulcerativecolitis D. Crohn’s disease E. Left-sided heart failure
Budd-Chiari syndrome
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
Gilbert’s syndrome - reassure and discharge
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
Gallstones leading to conjugated hyperbilirubinaemia
You are asked by your registrar to request an imaging investigation for a 49-year- old 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)
Abdominal US
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 45iu/L, ALT 50iu/L and bilirubin 50iu/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
Bendroflumethiazide
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. Ispaghulahusk B. Docusate sodium C. Lactulose D. Senna E. Methylcellulose
Lactulose
Which of the following gastroenterological conditions would give rise to finger clubbing?
A. Hepatocellular carcinoma B. Ulcerative colitis C. Irritable bowel syndrome D. Hepatocellular carcinoma E. Pancreatic carcinoma
Ulcerative colitis
IBDs such as UC and CD known to cause finger clubbing
You see an 80-year-old man who presents to accident and emergency with epigastric pain. The pain started 3 days ago and today he noticed that the colour of his stools has changed to a ‘tarry-black’ colour. Associated symptoms include nausea and lethargy. The patient is a smoker of 20 cigarettes a day and has recently finished eradication treatment for a duodenal ulcer. The patient is alert and orientated with a pulse rate of 99 and blood pressure of 98/69, respiratory rate of 18, oxygen saturations of 98 per cent on room air and temperature of 37.2°C. On examination, the abdomen is soft with marked tenderness in the epigastric region and bowel sounds are present. The rectum is empty, on PR examination, with some traces of malaena. The patient has been started on high flow oxygen and has been given some oral analgesia. The most appropriate next step in managing this patient is:
A. Keep nil by mouth and arrange endoscopy B. Request an erect chest x-ray C. Intravenous pantoprazole D. ECG E. Intravenous cannulation and fluids
IV cannulation and fluids before any investigations to stabilise
You see a 75-year-old man with an acute episode of haematemesis, who was admitted the night before and is awaiting an upper GI endoscopy. You are asked on the ward round about the common causes of upper GI bleeding. From the list below, which of the following is the most common cause of upper GI bleeding?
A. Mallory–Weisstear B. Peptic ulcers C. Oesophageal varices D. Drug induced E. Malignancy
Oesophageal varices
A 60-year-old man with alcoholic liver disease was admitted with an upper GI bleed secondary to oesophageal varices. The patient undergoes endoscopic variceal banding and is discharged after 2 weeks in-hospital stay. Which of the following medications would act as prophylaxis in preventing a rebleed from his oesophageal varices?
A. Frusemide B. Amlodipine C. Ramipril D. Propranolol E. Irbesartan
Propranolol
A 46-year-old woman presents to your clinic with a week’s history of jaundice. Her past medical history includes longstanding atrial fibrillation and hypertension. Physical examination reveals hepatomegaly. You assess her liver function which shows a bilirubin of 41iu/L, AST 111iu/L, ALT 55iu/L and ALP98 iu/L. There is no history of travel. You have a look at the patient’s medication history. Which of the following drugs below is likely to have caused the derangement in the patient’s liver function?
A. Aspirin B. Ramipril C. Amiodarone D. Bendroflumethiazide E. Amlodipine
Amiodarone
A 67-year-old man presents feeling unwell and complaining of general malaise. He mentions a long history of alcohol abuse and his past medical history shows deranged liver function tests. Which of the following clinical signs does not form part of chronic liver disease?
A. Finger clubbing B. Palmer erythema C. Spider naevi D. Koilonychia E. Jaundice
Koilonychia - spooning of the fingers
You see a 56-year-old man in your clinic with suspected alcoholic liver disease. Liver function tests reveal a bilirubin of 36iu/L, AST of 150iu/L, ALT 75iu/L and ALP 100iu/L. Which of the following blood test parameters would support a diagnosis of alcoholic-related liver disease?
A. Normal mean cell volume (MCV) B. Low MCV C. Normal mean cell haemoglobin (MCH) D. Low MCH E. Raised MCV
Raised MCV
You see a 52-year-old woman with rheumatoid arthritis in your clinic. She was referred by her GP after her ALP levels were found to be abnormally high at 300iu/L. In addition, she was also found to be serum anti-mitochondrial antibody (AMA) positive. The most likely diagnosis is:
A. Primary biliary cirrhosis (PBC) B. Wilson’s disease C. Heriditaryhaemochromotosis D. Primary sclerosing cholangitis (PSC) E. Alcoholic liver disease
PBC
Primary biliary cirrhosis associated with +ve serum anti-mitochondrial antibody (AMA)
