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Question 1 of 26
1. Question1 point(s)
A 43 year old alcoholic is admitted with right upper quadrant pain.
Eight hours after his admission you are called to see him because he has become anxious and confused. He has started having visual hallucinations and is quite distressed.
What medication is the most appropriate to help with the symptoms this patient is experiencing?CorrectIncorrect
Question 2 of 26
2. Question1 point(s)
A 53 year old obese man presents to his GP with a dull ache in his right upper quadrant. On examination a smooth liver edge is palpable 2cm below the costal margin.
Liver function tests are as follows:
- Bilirubin 19 (normal range 1-20 µmol/l)
- ALT 76 (normal range 7-55 U/l)
- ALP 56 (normal range 25-110 U/L)
What is the most appropriate next step in investigating and confirming the likely diagnosis?CorrectIncorrect
Question 3 of 26
3. Question1 point(s)
A 43 year old known alcoholic presents to A&E with haematemesis. It started 1 hour ago, and since then he says he has been vomiting about a cupful of fresh red blood every 30 minutes.
What is the most likely cause of this bleeding?CorrectIncorrect
Question 4 of 26
4. Question1 point(s)
Match the viral hepatitis to the description.
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis D
- Hepatitis E
RNA virus transmitted via the faecal-oral route. A vaccine is available.
DNA virus transmitted by blood and bodily fluids.
Transmitted by blood and bodily fluids. 3 in 4 patients become chronically infected.
RNA virus on present in patients with hepatitis B co-infection
RNA virus transmitted by the faecal-oral route. Symptoms are usually very mild and short term. No vaccine is available.
Question 5 of 26
5. Question1 point(s)
46 year old patient is diagnosed with haemochromatosis. He is worried that his only son will inherit the condition. His wife has a genetic test that confirms she is does not have the gene. What is the probability that his son will have haemochromatosis?CorrectIncorrect
Question 6 of 26
6. Question1 point(s)
A 53 year old woman presents to you feeling tired all the time and having significant muscle and joint aches over the last year. These symptoms have been getting progressively worse. She says she went through the menopause at aged 45, but have been having significant mood swings and memory problems in the last 6 months as well.
Examination reveals a bronze discolouration to her skin, but is otherwise unremarkable.
What is the most appropriate initial test to investigate the most likely diagnosis?CorrectIncorrect
Question 7 of 26
7. Question1 point(s)
A 43 year old man is diagnosis with haemochromatosis after complaining of erectile dysfunction and chronic fatigue.
The diagnosis has been confirmed with genetic testing.
He is set to commence a weekly protocol of venesection.
What marker is most helpful in monitoring the success of treatment?CorrectIncorrect
Question 8 of 26
8. Question1 point(s)
An 18 year old is woman is being investigated for Wilson’s disease. Her doctor wants to measure the level of the protein that carries copper around in the blood. What is the name of this protein?CorrectIncorrect
Question 9 of 26
9. Question1 point(s)
Kayser-Fleischer rings are most associated with which condition?CorrectIncorrect
Question 10 of 26
10. Question1 point(s)
Match the gene to the relevant protein.
- Chromosome 14
- Chromosome 6
- Chromosome 13
- Chromosome 7
- Chromosome 4
Human haemochromatosis protein
Wilson disease protein
Cystic Fibrosis Transmembrane Conductance Regulator
Huntingtin protein (associated with Huntington's disease)
Question 11 of 26
11. Question1 point(s)
What is the normal function of alpha-1-antitrypsin in the body?CorrectIncorrect
Question 12 of 26
12. Question1 point(s)
Select the organ systems that are most significantly affected by alpha-1-antitrypsin deficiency.CorrectIncorrect
Question 13 of 26
13. Question1 point(s)
What autoantibody is most sensitive and specific to primary biliary cirrhosis?CorrectIncorrect
Question 14 of 26
14. Question1 point(s)
What condition affecting the liver is most associated with ulcerative colitis?CorrectIncorrect
Question 15 of 26
15. Question1 point(s)
What component of liver biochemistry would you expect the greatest rise in with primary sclerosing cholangitis?CorrectIncorrect
Question 16 of 26
16. Question1 point(s)
Which of the following tumour markers is most associated with hepatocellular carcinoma?CorrectIncorrect
Question 17 of 26
17. Question1 point(s)
What structure is affected in cholangiocarcinoma?CorrectIncorrect
Question 18 of 26
18. Question1 point(s)
A 64 year old lady is booked in to have an endoscopy to investigate reflux symptoms. During the procedure the endoscopist notices that the lower portion of her oesophagus, near the sphincter, has an abnormal appearance.
Biospies are taken, and the results show a histological change to columnar epithelium.
What term is used to describe this process?CorrectIncorrect
Question 19 of 26
19. Question1 point(s)
A 34 year old woman presents to her GP with epigastric discomfort and reflux symptoms. Her GP sends her for a urea breath test, which is positive.
As well as antibiotics, what other medication should be prescribed as part of the treatment for her newly diagnosed infection.CorrectIncorrect
Question 20 of 26
20. Question1 point(s)
A 43 year old with known alcoholic liver disease is brought in by ambulance after vomiting a large amount of fresh blood.
He is unsure of the exact quantity but feel it could have filled more than a cup.
He is haemodynamically stable at present with a blood pressure of 132/87 and a heart rate of 87. His oxygen saturations are 98% on air.
From the list below, select the management options that would be appropriate whilst awaiting blood results and endoscopy.CorrectIncorrect
Question 21 of 26
21. Question1 point(s)
A 56 year old presents to her GP complaining of heartburn. She has had symptoms after eating meals and at night for the last 6 months. She has also experienced 4kg of weight loss.
She puts these symptoms down to stress at work and that for the past 6 months her disabled son has been having several concerning medical problems. Her diet has changed to mostly fatty takeaways and she feels her appetite is less than it used to be due to stress. She also feels the food she is eating doesn’t seem to pass down to her stomach easily.
She has no family history other than her son who has cerebral palsy following a traumatic birth.
She has no past medical history, and went through the menopause at aged 50.
Examination is unremarkable other than mild tenderness in her epigastric region and some mild conjunctival pallor. Her BMI is 20.
What is the most appropriate management for this lady?CorrectIncorrect
Question 22 of 26
22. Question1 point(s)
A 74 year old lady is brought in by ambulance from her care home after vomiting “black fluid” several times after lunch.
She has not vomited since being in hospital.
She cannot give a more detailed description of the quality of quantity of what she vomited, but said that it smelled awful.
She denies any pain, syncope, palpitations or loss of consciousness. She has not opened her bowels for 24 hours and passed a normal stool at that time.
On examination she is haemodynamically stable but does has mild epigastric tenderness. PR reveals an empty rectum with no melaena.
Blood tests are sent.
What scoring system would be useful in predicting this patient’s risk of having an upper GI bleed?CorrectIncorrect
Question 23 of 26
23. Question1 point(s)
A 24 year old lady presents to her GP with irregular bowel movements and crampy abdominal pain.
She normally opens her bowels between 1 and 3 times per day, and this can vary from normal to loose. Occasionally she has mucus in her stools, but denies any PR bleeding. She tends to get generalised crampy pain in her abdomen prior to opening her bowels, which tends to relieve the pain. These symptoms have not changed in the last year. She denies any weight loss or anorexia.
She only drinks limited alcohol on special occasions and does not smoke.
She is worried as her uncle was recently diagnosed with Crohns disease and she is worried that she may have the condition. She has no other family history.
Abdominal and PR examination are normal.
Routine blood tests come back normal.
What would be the most appropriate investigation for reassuring this patient?CorrectIncorrect
Question 24 of 26
24. Question1 point(s)
A 34 year old man with known Ulcerative Colitis presents with a flare. He is opening his bowels with blood and mucus 8-10 times a day for the last 3 days.
He is dehydrated and lethargic on examination. His observations are as follows:
- BP 115/67
- HR 105
- Temp 37.8C
- RR 18
- Sats 98% on room air
What is the most appropriate first line treatment for his flare up?CorrectIncorrect
Question 25 of 26
25. Question1 point(s)
A 29 year old women presents with fatigue, abdominal bloating and pain and loose stools for the past 3 months. She has also been suffering with recurrent aphthous ulcers in her mouth.
She opens her bowels between 2 and 4 times per day, and describes these stools as type 5/6, greasy and difficult to flush.
She has no past medical history and her only family history of note is that her brother has Type 1 Diabetes.
What investigation would most likely lead to a diagnosis?CorrectIncorrect
Question 26 of 26
26. Question1 point(s)
A 31 year old woman is under investigation for chronic diarrhoea.
The results of her endoscopy and biopsy come back and are documented as:
“Biopsy of the duodenal tissue, demonstrating generalised villous atrophy and evidence of crypt hypertrophy.”
What is the most appropriate management of this patient?CorrectIncorrect