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Question 1
Correct
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Which of the following is consistent with a diagnosis of insulinoma?
Your Answer: Low fasting glucose, high insulin, high C peptide
Explanation:Insulinoma is associated with LOW fasting glucose, HIGH insulin level, and HIGH C peptide. Insulin-abuse or overdose will cause HGH insulin levels and a LOW C peptide. If the C peptide is low, be suspicious.
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This question is part of the following fields:
- Gastrointestinal System
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Question 2
Incorrect
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A 30-year-old previously well male presented with dysuria and lower abdominal pain. He also complained of passage of air bubbles when he urinated. His urine sample had faecal matters. The abdomen was soft with mild suprapubic tenderness. Which of the following is the most likely pathology?
Your Answer: Ulcerative Colitis
Correct Answer: Crohn's disease
Explanation:Passage of faecal matters in the urine is suggestive of a fistula. Crohn’s disease is the most common cause of an ileovesical fistula. The diagnostic features of a fistula to the urinary system are pneumaturia, fecaluria, and recurrent or persistent urinary tract infections. Cystoscopy will confirm the diagnosis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 3
Incorrect
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Which of the following stimulates the secretion of gastrin?
Your Answer: High level gastric acid in the stomach
Correct Answer: Amino acids
Explanation:Gastrin is released from G cells in the antrum of the stomach after a meal. It stimulates parietal cells to release HCl. Gastrin is stimulated by a number of things: antrum distention, vagal stimulation, peptides (especially amino acids) in the stomach, hypercalcemia. Gastrin release is inhibited by acid, SST, GIP, VIP, secretin, glucagon, and calcitonin.
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This question is part of the following fields:
- Gastrointestinal System
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Question 4
Incorrect
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Which of the following options is true of patients with oesophageal varices?
Your Answer: Few cases of variceal haemorrhage benefit from betablockers being used routinely
Correct Answer: In spontaneous bacterial peritonitis cefotaxime appears to be a useful antibiotic
Explanation:Spironolactone has been shown to have no effect on the mechanisms of portal hypertension. Also, chronic use of propranolol can reduce the risk of variceal bleeding. The banding of large varices has been shown to be effective, too. Octreotide and terlipressin are also both used to prevent secondary haemorrhage. Cefotaxime is the most commonly used cephalosporin when treating spontaneous bacterial peritonitis. Spironolactone helps to combat secondary hyperaldosteronism which is related to liver failure. It also helps to treat salt and water retention, which both contribute to portal hypertension.
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This question is part of the following fields:
- Gastrointestinal System
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Question 5
Correct
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A 20-year-old girl is presented to the OPD with her mother. Her mother reports that she eats very large portions of food most of the time, but takes diet pills and remains depressed because she thinks she is overweight. However, on general physical examination, she appears to be very thin and her blood pressure is lower than normal. Investigations reveal that she has hypokalaemia. What is this girl most likely suffering from?
Your Answer: Bulimia nervosa
Explanation:Bulimia nervosa is a condition in which a person is involved in binge eating and then purging in an attempt to stay thin despite eating a lot of food. Frequent vomiting can cause electrolyte imbalance that manifests as hyperkalaemia and may lead to hypotension.
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This question is part of the following fields:
- Gastrointestinal System
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Question 6
Incorrect
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A 25-year-old male had an emergency appendicectomy. His doctor prescribed him prophylactic antibiotics to avoid infection after the surgery. Which of the following antibiotics is the best choice for post abdominal surgery?
Your Answer: Metronidazole
Correct Answer: Cefuroxime
Explanation:Cefuroxime is the best choice in the case of gut surgery as it is very effective in preventing infections against gut anaerobes, enterococci and coliforms.
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This question is part of the following fields:
- Gastrointestinal System
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Question 7
Correct
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A 31-year-old woman presents with complaints concerning her bowel habits. She claims that occasionally she sees blood in her stools but she's more concerned about having chronic abdominal and pelvic pain, tenesmus and intermittent diarrhoea. What would be the most probable cause of her condition?
Your Answer: Inflammatory bowel disease
Explanation:Inflammatory bowel disease (IBD) includes both ulcerative colitis and Crohn’s disease. Both of them present with similar symptomatology including diarrhoea, fatigue, abdominal and pelvic pain, blood in the stools, weight loss and occasional fever. In diverticulosis, symptoms are less profound with alternating diarrhoea and constipation.
UTIs might produce abdominal or pelvic pain but they do not interfere with the quality of the stools.
Adenomyosis affects the uterus and presents with mainly menstrual complaints. -
This question is part of the following fields:
- Gastrointestinal System
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Question 8
Incorrect
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A 53-year-old male underwent a partial gastrectomy 15 years ago for a complicated peptic ulcer. Which of the following elements may be deficient in this man?
Your Answer: Thiamine
Correct Answer: Iron
Explanation:The proper gastric acidity is required to transform iron from ferric to ferrous state in order to be absorbable. Even partial gastrectomy may cause dumping syndrome. Malabsorption is rare.
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This question is part of the following fields:
- Gastrointestinal System
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Question 9
Incorrect
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A 28-year-old male was admitted with severe central abdominal pain managed as an acute pancreatitis due to his serum amylase being markedly elevated. He is a known epileptic patient and has been on anti-epileptics. What would be the antiepileptic drug responsible for this clinical presentation?
Your Answer: Phenytoin
Correct Answer: Sodium valproate/Carbamazepine
Explanation:Both Sodium valproate and Carbamazepine are correct. These drugs can cause drug induced pancreatitis however more cases have been reported with Sodium valproate.
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This question is part of the following fields:
- Gastrointestinal System
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Question 10
Incorrect
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A 59-year-old patient presents with altered bowel habits and bleeding per rectum. Exam and sigmoidoscopy showed an ulcer. What is the single most likely diagnosis?
Your Answer: UC
Correct Answer: Colorectal carcinoma
Explanation:The patient’s symptoms along with his age indicates a diagnosis of colorectal cancer. Blood test marker CA-19-9 is a prognostic index for colorectal cancer which confirms the suspicion. Celiac disease is not usually associated with bleeding per rectum and it is associated with a reaction to products containing gliadin. Crohn’s disease and UC are inflammatory bowel diseases and on endoscopy, show many other features of inflammation and not just a single ulcer. A patient with IBS will also have bloating and intermittent diarrhoea with constipation.
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This question is part of the following fields:
- Gastrointestinal System
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Question 11
Incorrect
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A baby born a few days earlier is brought into the emergency with complaints of vomiting, constipation and decreased serum potassium. Which of the following is the most probable cause?
Your Answer: Hirschprung disease
Correct Answer: Pyloric stenosis: hypokalaemic hypochloraemic metabolic alkalosis
Explanation:In pyloric stenosis a new-born baby presents with a history of vomiting, constipation and deranged electrolytes. Excessive vomiting leads to hypokalaemia. Difficulty in food passing from the stomach to the small intestine causes constipation. Hypokalaemia also causes constipation. None of the other disorders mentioned present with the hypokalaemia, vomiting and constipation triad in a new-born.
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This question is part of the following fields:
- Gastrointestinal System
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Question 12
Incorrect
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Which one of the following has no role in increased gastric acid secretion in patients with peptic ulcer disease?
Your Answer: Histamine
Correct Answer: Secretin
Explanation:Secretin is produced in the duodenum in response to a low pH and the presence of carbohydrate and fat. It turns off antral G cell gastrin synthesis. While others that are mentioned such as gastrin, histamine etc. are involved in increased acid secretion.
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This question is part of the following fields:
- Gastrointestinal System
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Question 13
Correct
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A 58-year-old male patient complains of emesis, fatigue, palpitations and weight loss. His blood group is type A. Clinical examination revealed an enlarged liver, ascites and a left supraclavicular lump which is palpable. What is the most probable diagnosis?
Your Answer: Gastric carcinoma
Explanation:Gastric carcinoma may present as atypical general symptoms including emesis, fatigue and weight loss. It may also result in anaemia which might be responsible for the palpitations. The left supraclavicular swelling is referring to Virchow’s node, strongly associated with gastric cancer. Ascites and hepatomegaly generally appear late in the course of the disease and Blood group A has been shown to be associated with gastric cancer.
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This question is part of the following fields:
- Gastrointestinal System
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Question 14
Correct
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A woman complains of diarrhoea, experiencing watery stools 10 daily. She also complains of abdominal bloating, cramps, flatulence, and recent weight loss. She has now developed signs of iron deficiency anaemia. What is the most likely cause of her condition?
Your Answer: Malabsorption
Explanation:Diarrhoea, iron deficiency anaemia and folic acid deficiency are suggestive of malabsorption. Malabsorption leads to a decrease in the solid content of the stools resulting in diarrhoea. Decrease in the absorption of folic acid causes folic acid deficiency, and iron deficiency in the body leads to iron deficiency anaemia.
Jejunal villous atrophy is characterized with pain and weight loss as well, which this patient does not have.
A patient with increased catabolism has sudden weight loss along with deficiencies of nutrients. -
This question is part of the following fields:
- Gastrointestinal System
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Question 15
Incorrect
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Deposition of macrophages containing PAS (Periodic acid-Schiff) granules were found in a jejunal biopsy of a 45-year-old man complaining of indigestion. What is the most likely diagnosis?
Your Answer: Celiac disease
Correct Answer: Whipple's disease
Explanation:Whipple’s disease is a rare, systemic infectious disease caused by the bacterium Tropheryma whipplei. It primarily causes malabsorption but may affect any part of the body including the heart, brain, joints, skin, lungs and the eyes. Weight loss, diarrhoea, joint pain, and arthritis are common presenting symptoms, but the presentation can be highly variable and approximately 15% of patients do not have these classic signs and symptoms. Whipple’s disease is significantly more common in men, with 87% of the patients being male. Diagnosis is made by biopsy, usually by duodenal endoscopy, which reveals PAS-positive (periodic acid schiff) macrophages in the lamina propria containing non-acid-fast gram-positive bacilli.
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This question is part of the following fields:
- Gastrointestinal System
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Question 16
Incorrect
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A 45-year-old male complains of abdominal pain and loose stools. On endoscopy, multiple ulcers were seen from the oesophagus until the stomach. What will be the next best investigation for this patient?
Your Answer: Jejunal biopsy
Correct Answer: Serum gastrin estimation
Explanation:Serum gastrin level will helps in the diagnosis of Zollinger-Ellison syndrome, which is characterised by a history of recurrent and multiple gastric ulcers, due to increase gastrin secretion by the cells.
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This question is part of the following fields:
- Gastrointestinal System
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Question 17
Incorrect
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A 35-year-old alcoholic presented with epigastric pain radiating backward. His pain was relieved with opioid analgesics and anti PUD medications, however after 1 week he developed a fever with a similar kind of abdominal pain to that of his initial presentation. US abdomen shows a fluid collection. The most likely site for the fluid collection would be?
Your Answer: Left paracolic gutter
Correct Answer: Lesser sac
Explanation:The most likely diagnosis in this case is acute pancreatitis, which typically presents with severe abdominal pain and vomiting, along with deranged LFTs and raised serum amylase. It makes a boundary wall for the lesser sac and therefore the most likely site of fluid collection would be in the lesser sac.
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This question is part of the following fields:
- Gastrointestinal System
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Question 18
Correct
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A 75 year male who has been on treatment for joint pain for a long period, presented with vomiting and sudden-onset severe epigastric pain for the past 1 hour. He also complained of shoulder tip pain. On examination his abdomen was rigid. Which of the following is the most appropriate investigation to arrive at a diagnosis at this stage?
Your Answer: Erect CXR
Explanation:The most probable diagnosis is perforated peptic ulcer. History of possible NSAID/steroid use for joint pain, sudden-onset severe epigastric pain, vomiting and shoulder tip pain, support the diagnosis. Erect CXR will show the air under the diaphragm which is diagnostic.
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This question is part of the following fields:
- Gastrointestinal System
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Question 19
Incorrect
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Which is the most common type of inherited colorectal cancer:
Your Answer: Peutz-Jeghers syndrome
Correct Answer: Hereditary non-polyposis colorectal carcinoma
Explanation:Hereditary non-polyposis syndrome (HNPCC) is the most common type of inherited colorectal cancer. It often presents in younger and younger generations down a family. FAP presents with 100’s-1000’s of polyps and is less common. Li-Fraumeni syndrome and Fanconi syndrome are rare. For Peutz-Jeghers syndrome, the thing you will look for in the question stem is discoloured spots on the lips, this is classic.
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This question is part of the following fields:
- Gastrointestinal System
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Question 20
Incorrect
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A 45-year-old female develops profuse watery diarrhoea with lower abdominal pain seven days after undergoing laparoscopic cholecystectomy. What is the most likely diagnosis?
Your Answer: Pseudo-obstruction
Correct Answer: Pseudomembranous colitis
Explanation:Pseudomembranous colitis is caused by a C. difficile infection that causes membranes to form on the colon wall. It is caused most commonly by broad-spectrum antibiotics. This would include cephalosporins, broad-spectrum penicillin, and clindamycin. Macrolides and quinolones have also been reported as potential aetiologies, but much less commonly. This woman would have received antibiotics prophylactically before her surgery, predisposing her to a possible c difficile infection. This is a much better answer choice than pseudo obstruction, abdominal sepsis, bile acid diarrhoea, and campylobacter gastroenteritis simply based on history of present illness.
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This question is part of the following fields:
- Gastrointestinal System
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Question 21
Correct
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A 26-year-old lawyer presents to the gastroenterology clinic with weight loss, intermittent oily diarrhoea and malaise. Blood testing reveals folate and iron deficiency. There is also mild hypocalcaemia on biochemistry screening.
She has type-1 diabetes of 10 years' duration and is stable on a basal bolus insulin regimen, otherwise her past medical history is unremarkable.
Which of these antibody tests is most specific for making a diagnosis?Your Answer: Anti-tissue transglutaminase antibodies
Explanation:The prompt is suggestive of celiac disease as an aetiology. The antibody that is used primarily to suggest this diagnosis is anti-tissue transglutaminase antibody. You can also check anti-gliadin and anti-endomyseal antibodies, although anti-TTG antibodies are now the preferred test. To get an official diagnosis you must have a tissue diagnosis (biopsy). Anti-smooth muscle antibodies would be seen in autoimmune hepatitis. Anti-thyroid antibodies are not at all related to this, and are associated with thyroid. Anti-nuclear antibodies are non-specific.
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This question is part of the following fields:
- Gastrointestinal System
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Question 22
Correct
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A 28-year-old male who has undergone splenectomy for an abdominal trauma presents on the 3rd postoperative day with acute abdominal pain and distension in the upper abdominal area with hypotension. 2 litres of coffee ground fluid was aspirated on insertion of ryles tubes. Which of the following is the most likely diagnosis?
Your Answer: Acute gastric dilatation.
Explanation:Acute gastric dilation leading to ischemia of the stomach is an under-diagnosed and potentially fatal event. Multiple aetiologies can lead to this condition, and all physicians should be aware of it. Acute gastric dilation occurs as a result of eating disorders, trauma resuscitation, volvulus of hiatal hernias, medications, electrolyte abnormalities, psychogenic polyphagia, superior mesenteric artery syndrome, and a myriad of other conditions. Without proper and timely diagnosis and treatment, gastric perforation, haemorrhage, and other serious complications can occur.
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This question is part of the following fields:
- Gastrointestinal System
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Question 23
Correct
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A 55-year-old female presents with complaints of retrosternal chest pain and dysphagia (which is intermittent and unpredictable in nature). When she swallows, food very suddenly 'sticks' in her chest. She is able to clear it when she drinks water, and then can finish the meal without any further incidence. A barium meal shows she has a corkscrew oesophagus. What is the most likely type of dysphagia here?
Your Answer: Oesophageal spasm
Explanation:All of the symptoms observed in this patient are typical of uncoordinated irregular oesophageal peristalsis – this is characteristic of oesophageal spasm. The cork-screw oesophagus is also diagnostic of the condition.
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This question is part of the following fields:
- Gastrointestinal System
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Question 24
Incorrect
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A 70-year-old male patient presents with a history hematochezia and rectal tenesmus for the last six months. What is most probable diagnosis?
Your Answer: Diverticular disease
Correct Answer: Colorectal adenocarcinoma
Explanation:The patient presents with symptoms of possible colorectal adenocarcinoma. When located in the left colon, it typically presents with tenesmus and bleeding. On the right side usually presents with anaemia, weight loss and abdominal pain.
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This question is part of the following fields:
- Gastrointestinal System
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Question 25
Correct
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A 27-year-old patient presents to the OPD with a history of longstanding constipation, blood on the side of stool and extremely painful defecation. Digital rectal examination also results in pain. What is the most likely diagnosis?
Your Answer: Anal fissure
Explanation:An anal fissure is a longitudinal tear of the perianal skin distal to the dentate line, often due to increased anal sphincter tone. Anal fissures are classified according to aetiology (e.g., trauma or underlying disease) or duration of disease (e.g., acute or chronic). They are typically very painful and may present with bright red blood per rectum (haematochezia). Anal fissures are a clinical diagnosis based on history and examination findings. Management is primarily conservative, and includes stool softeners, analgesia, and possible local muscle relaxation; because of the risk of incontinence, surgical intervention is a last resort.
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This question is part of the following fields:
- Gastrointestinal System
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Question 26
Incorrect
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A 22-year-old male presents with loose stools and abdominal pain that is vague in nature. He previously had an episode of lower abdominal pain that was associated with pyrexia which settled on its own. He has also experienced mild weight loss recently. On examination, he is pale and has an ill defined mass in the right iliac fossa. What is the most likely diagnosis?
Your Answer: Appendicular mass
Correct Answer: Crohn's disease
Explanation:Crohn’s Disease (CD) is an inflammatory bowel disease, the pathogenesis of which is not fully understood. The clinical presentation of CD may be similar to ulcerative colitis (UC), the other most common inflammatory bowel disease. CD mostly affects young adults and adolescents between the ages of 15 and 35. It is typically located in the terminal ileum, but can discontinuously affect the entire gastrointestinal tract and commonly leads to complications such as fistulas, abscesses, and stenosis. Clinical features include diarrhoea, weight loss, and abdominal pain in the right lower quadrant (RLQ), as well as extraintestinal manifestations in the eyes, joints, or skin. It is often difficult to diagnose because there is no confirmatory test. Diagnosis is therefore based on the patient’s medical history, physical examination, lab tests, imaging (e.g., MRI), endoscopy, and serological testing. Acute episodes are treated with corticosteroids, and in severe cases, immunosuppressants may be indicated. Antibiotics and surgical intervention may be needed to help treat complications. Because the entire gastrointestinal tract may be affected, Crohn disease cannot be cured (in contrast to ulcerative colitis). The goal of treatment is thus to avoid the progression and recurrence of inflammatory episodes.
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This question is part of the following fields:
- Gastrointestinal System
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Question 27
Correct
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A 74-year-old man presents with left-sided lower abdominal pain. He is obese and admits to a dislike of high fibre foods. The pain has been grumbling for the past couple of weeks and is partially relieved by defecation. He has suffered intermittent diarrhoea.
Blood testing reveals a neutrophilia, and there is also a microcytic anaemia. Barium enema shows multiple diverticula, more marked on the left-hand side of the colon.
Which diagnosis fits best with this clinical picture?Your Answer: Diverticular disease
Explanation:Given that he has diverticula in the clinical scenario combined with his presenting symptoms, it is likely that he has diverticular disease. A low fibre diet would support this diagnosis. Acute diverticulitis would require treatment with antibiotics. Depending on the severity (Hinchey classification) would determine if he needs oral or IV antibiotics, hospital admission or outpatient treatment. Sometimes abscesses or micro perforations occur, which typical require drainage and possibly surgical intervention. Diverticular disease is clearly a better answer than other possible answer choices, simply based on the symptoms presented in the prompt (and mention of low fibre).
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This question is part of the following fields:
- Gastrointestinal System
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Question 28
Incorrect
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A 22-year-old woman has ingested an unknown quantity of paracetamol tablets four hours ago. She now presents with nausea, vomiting, anorexia and right subchondral pain.
Which of the following features suggest that she should be transferred to the liver unit?Your Answer: ALT 800 units/L
Correct Answer: pH 7.25
Explanation:The most widely used prognostic predictors for acetaminophen over-ingestion is King’s College Criteria, which is: arterial PH < 7.3 after fluid resuscitation, Cr level > 3.4, PT > 1.8x control or > 100s, or INR > 6.5, and Grave III or IV encephalopathy.
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This question is part of the following fields:
- Gastrointestinal System
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Question 29
Incorrect
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A 20-year-old female has been referred for investigation of an iron deficiency anaemia. Her mother passed away at age 28, due to colonic carcinoma complicating Peutz-Jegher syndrome. Choose the mode of inheritance of Peutz-Jegher syndrome which is most likely.
Your Answer: Autosomal recessive
Correct Answer: Autosomal dominant
Explanation:Peutz-Jegher syndrome is an autosomal dominant condition which is characterised by perioral pigmentation and hamartomas of the bowel. It was initially assumed that these did not predispose to malignancy, but due to recent studies, the opposite is now believed to be true.
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This question is part of the following fields:
- Gastrointestinal System
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Question 30
Incorrect
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A 50-year-old female was admitted to the emergency department with a moderate fever and productive cough. She commonly experiences central chest pain and regurgitation of undigested food particles. She did not suffer from acid reflux. Solid and liquid diet have both been affected for the last 4 months. A CXR showed an air-fluid level behind a normal sized heart. What is the most likely diagnosis?
Your Answer: Hiatus hernia
Correct Answer: Achalasia
Explanation:The diagnosis is aspiration pneumonia due to the retained food in the oesophagus. This is the case with achalasia. There is no acid reflux in this disease. An air fluid level behind the heart also favours achalasia. In hiatus hernia, GORD is usually present with nausea and vomiting. In the case of a pharyngeal pouch being present, halitosis would be evident.
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This question is part of the following fields:
- Gastrointestinal System
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SESSION STATS - PERFORMANCE PER SPECIALTY
