scegastrosampleqs

8/2/2019 SCEGastroSampleQs

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Specialty Certificate in Gastroenterology Sample Questions

Question:1

A 50-year-old man presented with haematemesis and melaena. He had a history of

excess alcohol intake for many years. On examination, he was jaundiced with bilateralparotid enlargement, spider naevi and Dupuytrens contracture. His pulse was 100 beatsper minute and his blood pressure was 95/60 mmHg. He had ascites and peripheraloedema.

While awaiting endoscopy, what is the most appropriate management?

A insert a SengstakenBlakemore tubeB intravenous pantoprazoleC intravenous terlipressinD nasogastric tube and aspirationE oral sucralfate


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Question:2

A 67-year-old man with dysphagia was found at endoscopy to have lower oesophagealcarcinoma.

For staging of local invasion in oesophageal cancer, which investigation is most sensitive?

A contrast-enhanced CT scan of oesophagusB laparoscopyC MR scan of chestD PET scanE radial endoscopic ultrasound scan


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Question:4

A 55-year-old man with Crohns disease underwent an ileocaecal resection. The surgicalprocedure was technically straightforward. Three months later, he was reviewed in theclinic. His appetite remained good and the abdominal pain had settled, but he was troubled

by diarrhoea with a daytime stool frequency of six per day. He also experienced faecalurgency 2040 minutes after eating. The stool was watery and there was no blood or pus.

Investigations:

haemoglobin 125 g/L (130180)

white cell count 5.6 109/L (411)

platelet count 256 109/L (150400)erythrocyte sedimentation rate 12 mm/1st h (


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Question:5

A 44-year-old man presented with a 10-year history of ulcerative colitis. He was takingazathioprine 1.5 mg/kg and mesalazine 2.4 g daily. He reported that his bowels openedone to two times per day, with no rectal bleeding.

Investigations:

haemoglobin 106 g/L (130180)MCV 75 fL (8096)

platelet count 164 109/L (150400)

serum total bilirubin 43 mol/L (122)serum alanine aminotransferase 76 U/L (535)serum alkaline phosphatase 328 U/L (45105)serum gamma glutamyl transferase 397 U/L (


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Question:6

A 68-year-old man was found to have positive faecal occult blood tests (FOBT) in anational bowel cancer screening programme. He was offered colonoscopy, but beforemaking his decision he wanted to know what the chances were of actually having a colonic

carcinoma.

What is the likelihood of colonic carcinoma in a patient of this age with a positive FOBT?

A 2%B 8%C 16%D 24%E 48%


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Question:7

A 56-year-old man with established cirrhosis secondary to genetic haemochromatosis wasfound to have a 3-cm focal lesion in the right lobe of his liver at a surveillance ultrasound

scan of his abdomen. When reviewed in the outpatient clinic he was well with no newsymptoms.

Investigations:

international normalised ratio 1.3 (


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Question:8

A 29-year-old woman who was 32 weeks pregnant presented to the accident andemergency department with a 2-week history of malaise, nausea and vomiting.

On examination, there were no stigmata of chronic liver disease, her pulse was 100 beatsper minute and her blood pressure was 160/94 mmHg. She had right upper quadranttenderness and peripheral oedema.

Investigations:





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Question 12

A 60-year-old man with a 35-year history of well-controlled ulcerative colitis was seen forreview. His maintenance treatment comprised sulfasalazine.

On what does the mechanism of action of sulfasalazine depend?

A cleavage of an azo bond by colonic bacteriaB pH-dependent release in the ileocaecal regionC slow release in the small and large intestine through an ethylcellulose coatingD timed-release following alkalinisation in the duodenumE trypsin-mediated release in the distal small bowel


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Question 13

A 61-year-old man with biopsy-proven alcoholic cirrhosis was admitted with increasingbreathlessness, abdominal distension and ankle oedema. He had noticed that he waspassing very little urine.

On examination, his temperature was 38.0C and his blood pressure was 96/45 mmHg.He had signs of chronic liver disease, moderate ascites and peripheral oedema .

Investigations:


white cell count 14.9 109/L (4.011.0)

platelet count 67 109/L (150400)MCV 108 fL (8096)

serum sodium 121 mmol/L (137144)serum potassium 3.1 mmol/L (3.54.9)serum creatinine 387 mol/L (60110)serum albumin 24 g/L (3749)

Following appropriate fluid resuscitation, terlipressin should be given until what end point?

A normalisation of portal pressureB normalisation of serum creatinineC normalisation of serum sodium

D normalisation of urine outputE until discharge


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Question 14

A 28-year-old woman attended a maternity clinic when 37 weeks pregnant with her firstchild. She complained of upper abdominal pain, nausea and vomiting.

On examination, she was drowsy. Her pulse was 105 beats per minute and her bloodpressure was180/125 mmHg. Urinalysis showed protein 3+.

Investigations:





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Question 15

A 45-year-old man with long-standing quiescent ulcerative colitis, who was taking nomedication, asked if there was any medication he should take to reduce his risk ofdeveloping a colitis-associated colorectal cancer.

What treatment is most likely to have a preventive effect?

A 5-aminosalicylatesB azathioprineC low-dose corticosteroidsD none has a proven effectE probiotics


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Question 16

A 30-year-old woman was referred with constipation, which she had experienced since

childhood. She described opening the bowel once a day with a pellet-like stool; if she wasunable to do this, she felt bloated and uncomfortable for the rest of the day. She had ahistory of one previous uncomplicated vaginal delivery. She worked as a teacher and herdietary history was unremarkable. Laxatives and enemas had produced no benefit.Colonic transit study and colonoscopy, performed previously at another hospital, had beennormal.

Clinical examination was normal.

Anorectal manometry confirmed a paradoxical increase in anal sphincter pressure duringattempts at straining.

What is the most appropriate treatment for this condition?

A biofeedbackB cognitive behavioural therapyC dietary fibreD increase fluid intakeE phosphate enemas


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Question 17

A 36-year-old man presented with haematemesis. He was found to have oesophagealvarices at upper gastrointestinal endoscopy. Haemostasis was achieved with three

endoscopically placed band ligations. His past history included no risk factors for acquiredliver disease other than a road traffic accident 12 years previously, following which hereceived a 6-unit blood transfusion.

On examination, there were no stigmata of liver disease. There were a few dilated venulesseen around the lower chest.

The varices were ablated with three further upper gastrointestinal endoscopies andvariceal banding. A right heart and hepatic venous catheterisation was undertaken whichgave the following measurements:

mean right atrial pressure 4 mmHg (3)mean free hepatic venous pressure 6 mmHg (4)mean wedged hepatic venous pressure 19 mmHg (7)

What is the most likely diagnosis?

A BuddChiari syndromeB constrictive pericarditisC nodular regenerative hyperplasiaD portal vein thrombosisE veno-caval web


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Question 18

A 34-year-old man with hepatitis C attended for review after treatment for 12 weeks withpeginterferon and ribavirin co-therapy. He complained of malaise and irritability.Investigations before treatment had confirmed hepatitis C infection with genotype 1a and a

viral load of 1.3 106 IU/mL (lower detection limit 15). There was no evidence of cirrhosis.

Investigations:



neutrophil count 0.72 109/L (1.57.0)

serum albumin 34 g/L (3749)serum total bilirubin 19 mol/L (122)serum alanine aminotransferase 29 U/L (535)serum alkaline phosphatase 95 U/L (45105)

hepatitis C viral load none detected

What is the most appropriate next step in management?

A continue same treatmentB platelet transfusionC reduce peginterferonD reduce ribavirin

E stop treatment


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Question 20

A 64-year-old woman presented with a 3-year history of intermittent diarrhoea. She hadremained well and had not lost weight. She had a past medical history of osteoarthritis,

which had been treated with naproxen. Treatment with loperamide had not improved herbowel symptoms.

On examination, she looked well. She had a body mass index of 34 kg/m2 (1825).

Investigations:

colonoscopy normal

histology from colonic biopsies a mononuclear infiltratewith a few neutrophils and

eosinophils in the lamina propria

Stopping naproxen did not improve her symptoms.

What is the most appropriate next step in management?

A budesonideB colestyramineC octreotideD prednisoloneE sulfasalazine


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Question 22

The portal vein is formed by the confluence of which veins?

A hepatic and superior mesentericB inferior and superior mesentericC splenic and hepaticD splenic and renalE splenic and superior mesenteric


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Question 23

A 61-year-old man with Barretts oesophagus was found to have high-grade dysplasia infour out of eight biopsies taken from the Barretts segment. There was no significant past

medical history. A further upper gastrointestinal endoscopy was arranged and similarhistological features were reported.

Investigations:

CT scan of thorax and abdomen normal

What is the most appropriate management?

A high-dose proton pump inhibitorB intensified endoscopic surveillance

C laser ablation of Barretts segmentD oesophagectomyE photodynamic therapy


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Question 24

A 32-year-old man attended for follow-up 2 months after presenting with a bleeding

duodenal ulcer. As part of his treatment, he had been given a course of Helicobacter pylorieradication therapy, and had continued taking the proton pump inhibitor until 4 weeksbefore his appointment.

Which is the most appropriate test to confirm eradication of Helicobacter pylori infection?

A 13C-urea breath testB gastric antral biopsy for histologyC gastric antral biopsy for rapid urease testD Helicobacter pylori antibody in serumE hydrogen breath test


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Question 25

A 24-year-old woman presented with a 3-month history of lethargy, fatigue and weightloss. She had abdominal bloating and passed loose stools.

On examination, there were no abnormal findings.

Investigations:


platelet count 164 109/L (150400)MCV 70 fL (8096)

white cell count 11.0 109/L (4.011.0)serum ferritin 9 g/L (15300)serum vitamin B12 180 ng/L (160760)red cell folate 86 g/L (160640)

serum albumin 35 g/L (3749)

serum immunoglobulin G 7.2 g/L (6.013.0)serum immunoglobulin A 0.1 g/L (0.83.0)serum immunoglobulin M 0.3 g/L (0.42.5)

anti-tissue transglutaminase antibodies 2 U/mL (


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Question 29

A 64-year-old man was referred from the cardiac clinic. He had presented with increasing

angina and a drug-eluting cardiac stent had been inserted. He had type 2 diabetesmellitus. His investigations had also showed anaemia and he had been treated withferrous sulphate. He was also taking metformin, clopidogrel, metoprolol and nicorandil.

Investigations:

haemoglobin 108 g/L (130180)serum ferritin 15 g/L (15300)

serum C-reactive protein 6 mg/L (


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Question 31

A 35-year-old man with corticosteroid-resistant Crohns disease was treated withazathioprine. After 3 weeks he became severely leucopenic. Subsequent tests revealed an

extremely low concentration of thiopurine methyltransferase (TPMT).

In approximately what proportion of the population does homozygous TPMT deficiencyoccur?

A 1 in 10B 1 in 50C 1 in 100D 1 in 300E 1 in 1000


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23. D

High grade dysplasia in Barretts on two separate endoscopy examinations is best treatedby radiofrequency ablation or oesophagectomy if the patient is fit for surgery. None of the

remaining options is as reliable in achieving a cure.

24. A

The urea breath test or faecal antigen test are the best non-invasive tests for confirmingsuccessful eradication treatment for Helicobacter pylori. Serology may take many monthsor never turn negative and repeat endoscopy is unnecessarily invasive.

25. B

The symptoms together with a combined iron and folate deficiency anaemia would make

celiac disease highly likely. Coeliac disease patients with IgA deficiency will have falsenegative serology as the antibody is of the IgA class.

26. D

The all-cause mortality at 30 days for this patient is approximately 25%, largely owing tothe underlying cerebrovascular accident.

27. B

Enteral nutrition support is important here and recent data suggest nasogastric feeding isas effective as nasojejunal feeding and associated with fewer problems in this situation.Sufficient oral intake is unlikely given his nausea and intravenous nutrition is inappropriate.

28. D

The clinical history is of biliary colic. Given her abnormal LFTs a common bile duct stoneneeds to be considered and this should be done non-invasively with MR imaging.

29. E

Nicorandil is well described to cause colorectal ulceration.

30. C

The short history and normal crypt architecture would favour an infective aetiology.

31. D

0.3% of the population have very low / insignificant levels of TPMT associated withhomozygous gene status.

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