Postgrad MedJ3 1998;74:573-574 C The Fellowship of Postgraduate Medicine, 1998

Postgrad Med J: first published as 10.1136/pgmj.74.875.573 on 1 September 1998. Downloaded from http://pmj.bmj.com/ on September 8, 2019 at Pakistan:BMJ-PG Sponsored. Protected by copyright.
Multiple-choice questions
Multiple-choice questions in gastro-enterology
and hepatology
M C Bateson, R Holden
Are the statements listed beneath each question true or false? Answers are given overleaf.

QUESTION 1 A Nitrates
Which cancers are becoming commoner B Aspirin
in the United Kingdom: C Beta-blockers
A Pancreas D Spironolactone
B Liver E Chenodeoxycholic acid
C Stomach
D Duodenum QUESTION 6
E Gallbladder
A 65-year-old man is admitted as an
QUESTION 2 emergency with severe epigastric pain.
Next day, 'liver function tests' show a
A patient with Crohn's disease presents bilirubin of 38 ZImolIl (normal < 20), alka-
with an exacerbation of diarrhoea. He is line phosphatase 350 IU/l (<100),
toxic with a slight fever, a right iliac fossa y-glutamyl transferase 42 IUll (<50),
mass and right sided loin pain. There are alanine transaminase 87 IU/l (n<60), albu-
no features of intestinal obstruction. min 39 gIl (>35), and globulin 22 gIl (<30).
Which of the following is true: A haemogram was normal with less than
A Ultrasound examination is helpful
B Treatment with steroids should be started 1% reticulocytes:
C Urgent laparotomy is required A This could be biliary colic
D Metronidazole should be added to the B Acute hepatitis is a likely diagnosis
treatment C The bilirubin level may reflect Gilbert's
E Azathioprine is rapidly effective syndrome
D Serum calcium should be checked
QUESTION 3 E Benign intrahepatic cholestasis is a differen-
Characteristic abnormalities of small tial diagnosis
bowel are found on peroral biopsy in
which of the following conditions: QUESTION 7
A Coeliac disease The finding of pigmentation in the colonic
B Alactasia mucosa-melanosis coli-in a patient with
C Amyloidosis diarrhoea suggests which of the following
D Tropical sprue diagnoses:
E Chronic radiation enteritis A Addison's disease
QUESTION 4 B Ulcerative colitis
C Bile salt malabsorption
Acute appendicitis: D Haemochromatosis
A Is diagnosed by pain starting in the right E Laxative abuse
iliac fossa associated with low-grade fever
and leucocytosis QUESTION 8
B Is commoner in young people
C Leads to the commonest abdominal opera- In a patient presenting with abdominal
Bishop Auckland tion pain, weight loss and diarrhoea, which of
General Hospital, D Is linked to severe complications in a the following investigations suggest pan-
Bishop Aukland, minority irrespective of age creatic insufficiency:
County Durham E Is associated with inflammatory bowel A Pancreatic calcification on plain X-ray of
DL14 6AD, UK
M C Bateson disease abdomen
B Serum albumin 23 g/l
Monklands Hospital, QUESTION 5 C Low serum folate
Airdrie, UK
R Holden Which ofthe following drugs reduce portal D Abnormal fluorescein dilaurate test
pressure in patients with portal hyper- E Hypocalcaemia with raised serum alkaline
Accepted 16 December 1997 tension: phosphatase
574 Multiple-choice questions

Postgrad Med J: first published as 10.1136/pgmj.74.875.573 on 1 September 1998. Downloaded from http://pmj.bmj.com/ on September 8, 2019 at Pakistan:BMJ-PG Sponsored. Protected by copyright.
Answers
QUESTION 5
QUESTION 1 A True
A True B False
B True C True
C False D True
D False E False
E False Beta-blockers and nitrates are important
Cancer of the pancreas is commoner than pri- agents for primary and secondary prophylaxis
mary liver cancer but both are increasing in of bleeding from varices. Nitrates used in con-
frequency. Overall gastric cancer frequency has junction with intravenous terlipressin in acute
fallen for many years, though this relates only bleeding increase efficacy and reduce periph-
to antral and pyloric tumours rather than eral side-effects. The clinical utility of the effect
proximal ones. The rate of gallbladder cancer is with spironolactone is uncertain.
probably not changing, but diagnosis will
clearly depend on the rate of cholecystectomy.
Duodenal carcinoma remains very rare. QUESTION 6
A False
QUESTION 2 B False
C True
A True D True
B True E False
C False
D True Although serum biochemistry tests are conven-
E False iently grouped under 'liver function tests' they
may not reflect liver disease. Markedly raised
Ultrasound examination will help in deciding if alkaline phosphatase with normal y-glutamyl
there is abscess present in addition to an transferase suggests a non-hepatic problem and
inflammatory mass due to adherent loops of Paget's disease is a common cause. Similarly, in
inflamed bowel. Hydronephrosis may occur in biliary and pancreatic disease these two
these circumstances and will be seen on ultra- enzymes tend to rise together. Bone disease
sound. Treatment with steroids and metroni- may lead to hypercalcaemia, particularly if the
dazole are appropriate. Azathioprine has no patient The pattern of enzymes
immediate effect in the treatment of acute observedis immobilised.
is unlike acute hepatitis. The electro-
exacerbations of Crohn's disease because of its inferior myocardial
cardiogram showed a
slow onset of action, but long-term treatment infarction which had precipitated
may usefully start in an acute attack. Surgery is unconju-
not indicated urgently. gated hyperbilirubinaemia in a patient with
Gilbert's syndrome and a background of
Paget's disease.
QUESTION 3
A True QUESTION 7
B False
C True A False
D True B False
E False C False
D False
There is no morphological abnormality in E True
alactasia. Chronic radiation enteritis produces
a submucosal endarteritic lesion and will not The finding of melanosis coli, a distinct black-
usually be detected in the more superficial speckled pigmentation of the colonic mucosa,
specimens obtained by peroral biopsy. at sigmoidoscopy indicates regular use of anth-
roquinone laxatives.
QUESTION 4
QUESTION 8
A False
B True A True
C True B False
D True C False
E True D True
Appendicitis pain begins centrally. The peak E False
frequency of appendicectomy is in teenage and Pancreatic calcification, when present, is diag-
the 20s, though perforation, peritonitis and nostic of chronic pancreatitis and indicates a
appendix abscess are distributed throughout disease duration of greater than 10 years. In the
the age range. A history of appendicectomy is fluorescein dilaurate test pancreatic lipase
commoner in Crohn's disease, which might be splits fluorescein from the dilauric acid, and the
explained by confusion of diagnosis. However, fluorescein is absorbed and excreted in the
it is also commoner in ulcerative colitis where urine where it is measured. Other causes of
the association is harder to explain, but might malabsorption are more likely to produce
have an immune basis. hypoproteinamia and vitamin deficiency.