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Gastroenterology Quiz

Gastroenterology Quiz. Andy Smith Bingley Medical Practice. Regarding dysphagia . (a) a barium meal is always the first line investigation (b) patients with Barrett's oesophagus should be screened for lower oesophageal basal cell carcinoma

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Gastroenterology Quiz

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  1. Gastroenterology Quiz Andy Smith Bingley Medical Practice

  2. Regarding dysphagia (a) a barium meal is always the first line investigation (b) patients with Barrett's oesophagus should be screened for lower oesophageal basal cell carcinoma (c) it is usually associated with abnormal thyroid function tests (d) is caused by globus hystericus in the majority of cases (e) Oesophageal tumours are most commonly adenocarcinoma or squamous cell carcinoma

  3. Regarding dysphagia (a) a barium meal is always the first line investigation (b) patients with Barrett's oesophagus should be screened for lower oesophageal basal cell carcinoma (c) it is usually associated with abnormal thyroid function tests (d) is caused by globus hystericus in the majority of cases (e) Oesophageal tumours are most commonly adenocarcinoma or squamous cell carcinoma - TRUE

  4. In alcohol-related liver disease: (a) chronic disease is usually associated with tender palpable hepatomegaly (b) patients are unlikely to be smokers (c) thiamine has not been proven to prevent memory problems (d) decreased tolerance to alcohol indicates progression of disease (e) benzodiazepines are contraindicated during alcohol detoxification

  5. In alcohol-related liver disease: (a) chronic disease is usually associated with tender palpable hepatomegaly (b) patients are unlikely to be smokers (c) thiamine has not been proven to prevent memory problems (d) decreased tolerance to alcohol indicates progression of disease - TRUE (e) benzodiazepines are contraindicated during alcohol detoxification

  6. In Crohn's disease: (a) there is an association with dermatitis herpetiformis (b) resection of affected segments of bowel is curative (c) Patients are more likely to be smokers than in ulcerative colitis (d) inheritance is autosomal recessive (e) the small bowel is only affected in the setting of backwash ileitis from the colon

  7. In Crohn's disease: (a) there is an association with dermatitis herpetiformis (b) resection of affected segments of bowel is curative (c) Patients are more likely to be smokers than in ulcerative colitis - TRUE (d) inheritance is autosomal recessive (e) the small bowel is only affected in the setting of backwash ileitis from the colon

  8. Coeliac disease: (a) is the most common cause of mal-absorption in developing countries (b) is associated with an increased risk of GI lymphoma (c) patients benefit from a diet high in complex carbohydrates such as bread and pasta (d) is usually diagnosed on CT abdomen (e) patients are at lower risk of osteoporosis than the non-coeliac population

  9. Coeliac disease: (a) is the most common cause of mal-absorption in developing countries (b) is associated with an increased risk of GI lymphoma - TRUE (c) patients benefit from a diet high in complex carbohydrates such as bread and pasta (d) is usually diagnosed on CT abdomen (e) patients are at lower risk of osteoporosis than the non-coeliac population

  10. Helicobacter pylori: (a) is a Gram positive bacterium (b) is associated with over-crowding and lower socio-economic class (c) affects < 1% of the UK population (d) is rarely eradicated by a combination of proton pump inhibitor and antibiotics (e) is a common cause of food poisoning

  11. Helicobacter pylori: (a) is a Gram positive bacterium (b) is associated with over-crowding and lower socio-economic class - TRUE (c) affects < 1% of the UK population (d) is rarely eradicated by a combination of proton pump inhibitor and antibiotics (e) is a common cause of food poisoning

  12. Ulcerative colitis: (a) is more common in smokers than in non-smokers (b) is treated first-line with infliximab (c) commonly involves the jejunum (d) is associated in most patients with psoriasis (e) is associated with HLA B27

  13. Ulcerative colitis: (a) is more common in smokers than in non-smokers (b) is treated first-line with infliximab (c) commonly involves the jejunum (d) is associated in most patients with psoriasis (e) is associated with HLA B27 - TRUE

  14. In irritable bowel syndrome (IBS): (a) mucus may be passed rectally (b) bloody mucoid diarrhoea is common (c) treatment options include 5-ASA compounds (d) symptoms are unrelated to stressful life events (e) a gluten-free diet is first-line treatment

  15. In irritable bowel syndrome (IBS): (a) mucus may be passed rectally - TRUE (b) bloody mucoid diarrhoea is common (c) treatment options include 5-ASA compounds (d) symptoms are unrelated to stressful life events (e) a gluten-free diet is first-line treatment

  16. Colorectal carcinoma: (a) is classified by Breslow's criteria (b) most commonly metastasizes to the liver (c) is most common in those with a high fibre diet (d) is more common in females than in males (e) patients with disease confined to the bowel mucosa have a 40% 5 year survival rate

  17. Colorectal carcinoma: (a) is classified by Breslow's criteria (b) most commonly metastasizes to the liver - TRUE (c) is most common in those with a high fibre diet (d) is more common in females than in males (e) patients with disease confined to the bowel mucosa have a 40% 5 year survival rate

  18. With regards to Peptic Ulcer Disease (PUD): (a) duodenal ulcers are 10 times more common than gastric ulcers (b) the most appropriate initial investigation is testing for Helicobacter pylori (c) this patient requires urgent endoscopy (d) smoking is not a risk factor for its development (e) duodenal ulcers are more common in patients with blood group A

  19. With regards to Peptic Ulcer Disease (PUD): (a) duodenal ulcers are 10 times more common than gastric ulcers - TRUE (b) the most appropriate initial investigation is testing for Helicobacter pylori (c) this patient requires urgent endoscopy (d) smoking is not a risk factor for its development (e) duodenal ulcers are more common in patients with blood group A

  20. Gastric cancer: (a) when shown to be an adenocarcinoma on histology, is associated with Helicobacter pylori (b) is usually a squamous cell carcinoma (c) usually has a good prognosis (d) most commonly presents with haematemesis (e) is usually diagnosed on barium swallow

  21. Gastric cancer: (a) when shown to be an adenocarcinoma on histology, is associated with Helicobacter pylori - TRUE (b) is usually a squamous cell carcinoma (c) usually has a good prognosis (d) most commonly presents with haematemesis (e) is usually diagnosed on barium swallow

  22. Round 2

  23. The best duration of treatment to ensure 90% duodenal ulcer healing with H2 receptor antagonist is: A. 1 weekB. 2 weeksC. 4 weeksD. 8 weeksE. 1 year

  24. The best duration of treatment to ensure 90% duodenal ulcer healing with H2 receptor antagonist is: A. 1 week - FalseB. 2 weeks - FalseC. 4 weeks - FalseD. 8 weeks - TrueE. 1 year - True

  25. Antacid therapy relieves symptoms: A. RapidlyB. By complete neutralisation of gastric acidC. By eradicating Helicobacter pyloriD. IndefinitelyE. By protecting the mucosa from acid

  26. Antacid therapy relieves symptoms: A. Rapidly - TrueB. By complete neutralisation of gastric acid - FalseC. By eradicating Helicobacter pylori - FalseD. Indefinitely - FalseE. By protecting the mucosa from acid - False

  27. Body mass index is measured by: A. Weight / heightB. Weight2 / heightC. Weight / height2 D. Weight2 / height2E. Weight3 / height

  28. Body mass index is measured by: A. Weight / heightB. Weight2 / heightC. Weight / height2 - TrueD. Weight2 / height2E. Weight3 / height

  29. Mouth ulcers are more common in: A. Diverticular disease B. Coeliac disease C. Solitary ulcer of rectum D. Ulcerative colitis E. Crohn’s disease

  30. Mouth ulcers are more common in: A. Diverticular disease - False B. Coeliac disease - True C. Solitary ulcer of rectum - False D. Ulcerative colitis - True E. Crohn’s disease - True

  31. Oral thrush is a frequent finding in: A. Antibiotic therapy B. Oral contraceptive use C. Diabetes mellitus D. HIV infection E. Multiple sclerosis

  32. Oral thrush is a frequent finding in: A. Antibiotic therapy - True B. Oral contraceptive use - False C. Diabetes mellitus - True D. HIV infection - TrueE. Multiple sclerosis - False

  33. Dental caries means increased likelihood of: A. Gout B. Subacute bacterial endocarditis C. Alcoholism D. Peptic ulcer E. Dysphagia

  34. Dental caries means increased likelihood of: A. Gout - FalseB. Subacute bacterial endocarditis - True C. Alcoholism - True D. Peptic ulcer - False E. Dysphagia - True

  35. A high arched palate is seen in: A. Pseudoxanthoma elasticum B. Wegener’s granulomatosis C. Cerebrotendinous xanthomatosis D. Familial hypertriglyceridaemiaE. Marfan’s syndrome

  36. A high arched palate is seen in: A. Pseudoxanthoma elasticum B. Wegener’s granulomatosis C. Cerebrotendinous xanthomatosis D. Familial hypertriglyceridaemiaE. Marfan’s syndrome - True

  37. Crohn’s disease affects the lips: • A. Rarely B. SometimesC. FrequentlyD. NeverE. Invariably

  38. Crohn’s disease affects the lips: • A. Rarely - True B. SometimesC. FrequentlyD. NeverE. Invariably

  39. Parkinson’s disease causes excess dribbling: A. Because of increased salivationB. Because of defective swallowingC. Because patients are tremulousD. Because of festinationE. Because of bradykinesia

  40. Parkinson’s disease causes excess dribbling: A. Because of increased salivationB. Because of defective swallowing - TrueC. Because patients are tremulousD. Because of festinationE. Because of bradykinesia

  41. Gastro-oesophageal reflux can reliably be diagnosed by A. SymptomsB. Biopsy histology of the gastro- oesophageal junctionC. ManometryD. 24 hour pH monitoringE. Bernstein test

  42. Gastro-oesophageal reflux can reliably be diagnosed by A. SymptomsB. Biopsy histology of the gastro- oesophageal junctionC. ManometryD. 24 hour pH monitoring - TrueE. Bernstein test

  43. Round 3

  44. A 40-year-old woman has just returned from a two-week holiday and presents with persistent fatigue, mild right hypochondrial ache and pruritis.  She has a good appetite.  Alcohol intake increased while on holiday to 14 units weekly; but intake had previously been negligible (less then four units weekly).  On examination, she appears to have a slightly enlarged tender liver and palmar erythema.  She also has a few xanthelasma. Liver function tests are found to be deranged with gamma GT 520, AST 61, ALT 85 and Alkaline Phosphatase 386.  FBC shows a mild iron deficiency anaemia with a low MCV.  Ferritin is low.  Antimitochondrial antibody test positive.  Which is the single most likely diagnosis? • a) Alcoholic liver disease • b) Carcinoma head of pancreas • c) Common bile duct gallstone • d) Haemochromatosis • e) Primary biliary cirrhosis

  45. A 40-year-old woman has just returned from a two-week holiday and presents with persistent fatigue, mild right hypochondrial ache and pruritis.  She has a good appetite.  Alcohol intake increased while on holiday to 14 units weekly; but intake had previously been negligible (less then four units weekly).  On examination, she appears to have a slightly enlarged tender liver and palmar erythema.  She also has a few xanthelasma. Liver function tests are found to be deranged with gamma GT 520, AST 61, ALT 85 and Alkaline Phosphatase 386.  FBC shows a mild iron deficiency anaemia with a low MCV.  Ferritin is low.  Antimitochondrial antibody test positive.  Which is the single most likely diagnosis? • a) Alcoholic liver disease • b) Carcinoma head of pancreas • c) Common bile duct gallstone • d) Haemochromatosis • e) Primary biliary cirrhosis - True

  46. A 49-year-old man presents with a five-week history of epigastric pain after meals.  It is sometimes awakening him in the night. He has also been vomiting and is sure he has lost weight. On examination, you find epigastric tenderness, with no mass nor peritonism.  An FBC is normal.  Which is the single most appropriate investigation? • a) Abdominal ultrasound • b) Barium meal • c) Serum amylase estimation • d) Helicobacter pylori test • e) Upper GI endoscopy

  47. A 49-year-old man presents with a five-week history of epigastric pain after meals.  It is sometimes awakening him in the night. He has also been vomiting and is sure he has lost weight. On examination, you find epigastric tenderness, with no mass nor peritonism.  An FBC is normal.  Which is the single most appropriate investigation? • a) Abdominal ultrasound • b) Barium meal • c) Serum amylase estimation • d) Helicobacter pylori test • e) Upper GI endoscopy - True

  48. A 50-year-old man presents with reflux-type symptoms for the first time. On questioning, he has had no haematemesis nor melaena, no weight loss and no difficulty swallowing.  He has taken bendroflumethiazide 2.5mgs daily for hypertension for the last two years and amlodipine was added four months ago.  He states that he drinks less than 10 units of alcohol per week.  His BP today is116/70.  You decide on an intervention strategy and will review him in four weeks.  Which one of the following actions is the most appropriate, at this point in time? • a) Commence triple therapy • b) Commence lansoprazole • c) Cease bendroflumethiazide • d) Commence gaviscon advance • e) Cease amlodipine

  49. A 50-year-old man presents with reflux-type symptoms for the first time. On questioning, he has had no haematemesis nor melaena, no weight loss and no difficulty swallowing.  He has taken bendroflumethiazide 2.5mgs daily for hypertension for the last two years and amlodipine was added four months ago.  He states that he drinks less than 10 units of alcohol per week.  His BP today is116/70.  You decide on an intervention strategy and will review him in four weeks.  Which one of the following actions is the most appropriate, at this point in time? • a) Commence triple therapy • b) Commence lansoprazole • c) Cease bendroflumethiazide • d) Commence gaviscon advance • e) Cease amlodipine - True

  50. A 55-year-old man has had ulcerative colitis for 20 years.  It is usually well controlled on mesalazine 4g daily.  Having developed recent back pain, he has been taking ibuprofen 400mg three times a day (which was prescribed for his wife).  For the past week, he has had an increase in the frequency of his bowel motions which now occur four times a day and are more liquid than usual.  He has had no rectal bleeding or fever.  What is the single most appropriate drug adjustment to make? • a) Add loperamide • b) Add oral prednisolone • c) Add rectal prednisolone • d) Increase mesalazine • e) Stop ibuprofen

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