Transcript Gastroenterology Quiz - Airedale Gp Training

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
(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
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
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
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
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
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
Coeliac disease:
(a) is the most common cause of malabsorption 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
Coeliac disease:
(a) is the most common cause of malabsorption 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
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
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
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
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
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
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
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
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
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
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
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
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
Round 2
The best duration of treatment to ensure 90% duodenal
ulcer healing with H2 receptor antagonist is:
A. 1 week
B. 2 weeks
C. 4 weeks
D. 8 weeks
E. 1 year
The best duration of treatment to ensure 90% duodenal
ulcer healing with H2 receptor antagonist is:
A. 1 week - False
B. 2 weeks - False
C. 4 weeks - False
D. 8 weeks - True
E. 1 year - True
Antacid therapy relieves
symptoms:
A. Rapidly
B. By complete neutralisation of gastric
acid
C. By eradicating Helicobacter pylori
D. Indefinitely
E. By protecting the mucosa from acid
Antacid therapy relieves
symptoms:
A. Rapidly - True
B. By complete neutralisation of gastric
acid - False
C. By eradicating Helicobacter pylori False
D. Indefinitely - False
E. By protecting the mucosa from acid False
Body mass index is measured
by:
A. Weight / height
B. Weight2 / height
C. Weight / height2
D. Weight2 / height2
E. Weight3 / height
Body mass index is measured
by:
A. Weight / height
B. Weight2 / height
C. Weight / height2 - True
D. Weight2 / height2
E. Weight3 / height
Mouth ulcers are more
common in:
A. Diverticular disease
B. Coeliac disease
C. Solitary ulcer of rectum
D. Ulcerative colitis
E. Crohn’s disease
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
Oral thrush is a frequent
finding in:
A. Antibiotic therapy
B. Oral contraceptive use
C. Diabetes mellitus
D. HIV infection
E. Multiple sclerosis
Oral thrush is a frequent
finding in:
A. Antibiotic therapy - True
B. Oral contraceptive use - False
C. Diabetes mellitus - True
D. HIV infection - True
E. Multiple sclerosis - False
Dental caries means
increased likelihood of:
A. Gout
B. Subacute bacterial endocarditis
C. Alcoholism
D. Peptic ulcer
E. Dysphagia
Dental caries means
increased likelihood of:
A. Gout - False
B. Subacute bacterial endocarditis True
C. Alcoholism - True
D. Peptic ulcer - False
E. Dysphagia - True
A high arched palate is
seen in:
A. Pseudoxanthoma elasticum
B. Wegener’s granulomatosis
C. Cerebrotendinous xanthomatosis
D. Familial hypertriglyceridaemia
E. Marfan’s syndrome
A high arched palate is
seen in:
A. Pseudoxanthoma elasticum
B. Wegener’s granulomatosis
C. Cerebrotendinous xanthomatosis
D. Familial hypertriglyceridaemia
E. Marfan’s syndrome - True
Crohn’s disease affects the
lips:

A. Rarely
B. Sometimes
C. Frequently
D. Never
E. Invariably
Crohn’s disease affects the
lips:

A. Rarely - True
B. Sometimes
C. Frequently
D. Never
E. Invariably
Parkinson’s disease causes
excess dribbling:
A. Because of increased salivation
B. Because of defective swallowing
C. Because patients are tremulous
D. Because of festination
E. Because of bradykinesia
Parkinson’s disease causes
excess dribbling:
A. Because of increased salivation
B. Because of defective swallowing True
C. Because patients are tremulous
D. Because of festination
E. Because of bradykinesia
Gastro-oesophageal reflux can
reliably be diagnosed by
A. Symptoms
B. Biopsy histology of the gastrooesophageal junction
C. Manometry
D. 24 hour pH monitoring
E. Bernstein test
Gastro-oesophageal reflux can
reliably be diagnosed by
A. Symptoms
B. Biopsy histology of the gastrooesophageal junction
C. Manometry
D. 24 hour pH monitoring - True
E. Bernstein test
Round 3
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?
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
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a) Alcoholic liver disease
b) Carcinoma head of pancreas
c) Common bile duct gallstone
d) Haemochromatosis
e) Primary biliary cirrhosis
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?




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a) Alcoholic liver disease
b) Carcinoma head of pancreas
c) Common bile duct gallstone
d) Haemochromatosis
e) Primary biliary cirrhosis - True
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?


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a) Abdominal ultrasound
b) Barium meal
c) Serum amylase estimation
d) Helicobacter pylori test
e) Upper GI endoscopy
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
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?
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a) Commence triple therapy
b) Commence lansoprazole
c) Cease bendroflumethiazide
d) Commence gaviscon advance
e) Cease amlodipine
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
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?
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a) Add loperamide
b) Add oral prednisolone
c) Add rectal prednisolone
d) Increase mesalazine
e) Stop ibuprofen
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 - True
An 18-year-old girl has been amenorrhoeic for six months. She has
lost 5kgs and has developed loose stools, without bleeding, at least
four times a day.
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Carcinoma of colon
Campylobacter
Crohn’s disease
Giardiasis
Irritable bowel syndrome
Laxative abuse
Pseudomembranous colitis
An 18-year-old girl has been amenorrhoeic for six months. She has
lost 5kgs and has developed loose stools, without bleeding, at least
four times a day.
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Carcinoma of colon
Campylobacter
Crohn’s disease
Giardiasis - True
Irritable bowel syndrome
Laxative abuse
Pseudomembranous colitis
A 40-year-old woman presents with intermittent abdominal pain
which she says is totally relieved by defaecation. Which one of the
following symptoms would suggest further investigations are
mandatory?
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a) Loose stools
b) Blood in stools
c) Feeling of incomplete evacuation
d) Increased stool frequency
e) Mucus in stools
A 40-year-old woman presents with intermittent abdominal pain
which she says is totally relieved by defaecation. Which one of the
following symptoms would suggest further investigations are
mandatory?
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

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a) Loose stools
b) Blood in stools - True
c) Feeling of incomplete evacuation
d) Increased stool frequency
e) Mucus in stools
For each of the following patients on a GI drug, select
the side effect that may relate to it from the list
A 75-year-old woman, whose H pylori eradication has
failed, is taking Cimetidine.
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Bezoar formation
Bradycardia
Deafness
Encephalopathy
Glossitis
Hirsutism
Vaginal bleeding
For each of the following patients on a GI drug, select
the side effect that may relate to it from the list
A 75-year-old woman, whose H pylori eradication has
failed, is taking Cimetidine.






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Bezoar formation
Bradycardia - True
Deafness
Encephalopathy
Glossitis
Hirsutism
Vaginal bleeding
An 80-year-old woman, who suffers from GORD, is on
maintenance Lansoprazole.
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Bezoar formation
Bradycardia
Deafness
Encephalopathy
Glossitis
Hirsutism
Vaginal bleeding
An 80-year-old woman, who suffers from GORD, is on
maintenance Lansoprazole.







Bezoar formation
Bradycardia
Deafness
Encephalopathy
Glossitis - True
Hirsutism
Vaginal bleeding
A 70-year-old woman, with arthritis, is on Misoprostol
because Ibuprofen cannot be stopped.




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
Bezoar formation
Bradycardia
Deafness
Encephalopathy
Glossitis
Hirsutism
Vaginal bleeding
A 70-year-old woman, with arthritis, is on Misoprostol
because Ibuprofen cannot be stopped.







Bezoar formation
Bradycardia
Deafness
Encephalopathy
Glossitis
Hirsutism
Vaginal bleeding - Ture

Finish – Well done!