Question 1
Question
BG:
48 year old female with 2 children
Hypertension- well controlled with Amlodipine
-Irritable bowel syndrome (15 year history) on Mebeverine
-Menorrhagia- vaginal hysterectomy 2 years ago
2 month Hx worsening bowels-
Alternating diarrhoea/constipation
Associated lower abdominal pain
Exam:
alert, afebrile, BP 132/70, HR 70, reg
Abdomen: mildly distended but soft non-tender (SNT), no masses, bowel sounds present
FHx: Sister- breast cancer aged 48
Aunt- breast cancer aged 61
What is the next management step would you advise for this patient?
Question 2
Question
BG: 53 year old male, Vetenarian,
MHx – hypertension
PC: Agreed routine review to discuss blood results
Notable results:
Bili 131 (15-73)
GGT 432 (15-73)
ALP 505 (30-130)
ALT 3017 (21-72)
Eventually got hold of him 10 days later- he was on holiday!
Whilst away admitted to a couple days when urine slightly darker and stools paler but since resolved
Approx 5 units/week alcohol
Reviewed in clinic:
No abdo pain, no stigmata liver disease
Exam: obs stable, sclera slightly jaundiced, abdomen soft, nontender, no hepatosplenomegaly
What is(are) the most appropriate next step(s)?
Question 3
Question
Same Patient:
blood tests repeated: Improving LFTs-except ALT still elevated
Liver Screen: all negative but Hepatits Screen:
Hep A: IgG + and IgM -
Hep E: IgG + and IgM +
What is a correct interpretation of these results?
Answer
-
IgM + means that newly exposed to the pathogen
-
IgG+ means that newly exposed to the pathogen
-
IgM- that newly exposed to the pathogen
Question 4
Question
What are possible differential diagnoses of raised ALT?
Question 5
Question
Abdominal Examination findings:
Pain in the foregut ( [blank_start]esophagus[blank_end] to mid-duodenum, liver, [blank_start]gallbladder[blank_end], spleen, 1/2 [blank_start]pancreas[blank_end]) can be felt in the [blank_start]epigastric[blank_end] region.
Pain in the midgut (mid-duodenum to [blank_start]proximal[blank_end] 2/3 transverse colon and 1/2 [blank_start]pancreas[blank_end]) can be felt in the [blank_start]umbilical[blank_end] region.
Pain in the hindgut ([blank_start]distal[blank_end] 2/3 of transverse colon to 1/2 of [blank_start]anal[blank_end] [blank_start]canal[blank_end]) is usually in the [blank_start]pubic[blank_end] region.
Answer
-
esophagus
-
gallbladder
-
pancreas
-
pancreas
-
proximal
-
distal
-
anal
-
canal
-
umbilical
-
epigastric
-
pubic
Question 6
Question
Any gynae problem, always do a pregnancy test first.
Question 7
Question
24 year old presents complaining of a 2 day history of abdominal pain, vomiting and diarrhoea. He had made some stir fried rice for dinner 3 days ago and forgot to put it in the fridge. He has had no recent travel and is otherwise fit and well. A diagnosis of gastroenteritis is made.
What is your most likely causative organism?
Answer
-
Campylobacter
-
Cholera
-
E. Coli
-
Bacillus Cereus
Question 8
Question
Always seek urgent specialist advice whenever a child or elderly are reported to have has a single episode of bloody diarrhoea
Question 9
Question
Management of acute diarrhea and gastroenteritis:
Conservative: Fluids and [blank_start]electrolytes[blank_end]
Medical: [blank_start]Antibiotics[blank_end] (if [blank_start]systematically[blank_end] unwell) and whould be based off of [blank_start]stool[blank_end] culture results
Answer
-
electrolytes
-
Antibiotics
-
systematically
-
stool
Question 10
Question
A 27 year old lady presents to you with a 6 month history of abdominal pain and bloating after meals. Her pain is relieved after defecation. She is also suffering from alternating diarrhoea and constipation and feels like she hasn’t emptied her bowels properly. She is very distressed about her symptoms as it is affecting her personal and work life.
What is your main differential?
Question 11
Question
[blank_start]Irritable[blank_end] [blank_start]bowel[blank_end] [blank_start]syndrome[blank_end] is a common chronic functional disorder of the bowel causing abdominal cramps, bloating, constipation and/or diarrhea. Most common is [blank_start]women[blank_end] in their 20-30s.
Answer
-
women
-
Irritable
-
bowel
-
syndrome
Question 12
Question
What is NOT a potential reason for irritable bowel syndrome?
Answer
-
overactive bowel
-
increased visceral hypersensitivity
-
short chain carbohydrates in diet
-
post-parturition incontinecne
Question 13
Question
Irritable bowel syndrome is diagnosed if there is at least a [blank_start]6[blank_end] month history of abdomen pain, [blank_start]altered[blank_end] bowel habit, and [blank_start]bloating[blank_end]. The diagnosis is official if the abdominal pain is relieved by [blank_start]defecation[blank_end] or linked to altered bowel habit and AT LEAST 2 OF:
passage of [blank_start]mucus[blank_end]
altered stool passage (urgency, frequency, [blank_start]tenesmus[blank_end])
abdominal bloating
symptoms worsened by [blank_start]eating[blank_end]
On examination, the abdomen is usually normal with some generalized [blank_start]tenderness[blank_end]
Answer
-
tenderness
-
6
-
altered
-
bloating
-
defecation
-
mucus
-
tenesmus
-
eating
Question 14
Question
What are ways to generally investigate for irritable bowel syndrome?
Question 15
Question
Main managements of IBS is dietary changes, peppermint old, and (if needed) loperamide
Question 16
Question
Buscapan can be given for irritable bowel syndrome.
Question 17
Question
A 45 year old gentleman presents with 7 month history of abdominal pain and unintentional weight loss. He has been feeling more tired lately and has noticed he has become increasingly paler. He has a PMH of asthma and coeliac disease. He explains that his father and his brother also experienced similar symptoms and were subsequently diagnosed with colorectal cancer.
What is your main differential?
Answer
-
Irritable bowel syndrome
-
Colorectal cancer
-
Crohn's disease
-
Ulcerative Colitis
Question 18
Question
IBD and HNPCC put you at increased risk for colorectal cancer
Question 19
Question
What are these symptomatic of?
Often colicky pain
Rectal bleeding
Bowel obstruction
Tenesmus
Mass in LIF
Early changes in bowel habit
Answer
-
left colon cancers
-
right colon cancers
-
HPNCC
-
small cell colon cancers
-
familial colon cancers
Question 20
Question
What are these symptomatic of:
Weight loss
Anemia
Occult bleeding
Mass in RIF
Answer
-
right colon cancers
-
left colon cancers
-
IBS
-
small cell colon cancer
-
familial colon cancers
Question 21
Question
Most common presentation of colorectal cancer:
[blank_start]rectal[blank_end] [blank_start]bleeding[blank_end]
[blank_start]persisting[blank_end] change in bowel habit
[blank_start]anemia[blank_end]
Answer
-
anemia
-
persisting
-
rectal
-
bleeding
Question 22
Question
Urgent referral for cancer pathway if the patient is aged 40 and over with unexplained weight loss and abdominal pain.
Question 23
Question
How can you NOT investigate colorectal cancer?
Question 24
Question
The earlier the Duke stage (for ex: stage A vs stage B), the lower 5-year survival likelihood.
Question 25
Question
How can you manage colorectal cancer?
Question 26
Question
Bowel Cancer Screening Program:
In England, men and women between the ages of [blank_start]60[blank_end]-74 years take part
A bowel cancer testing kit is sent every [blank_start]2[blank_end] years
2 bowel cancer screening tests:
[blank_start]Fecal[blank_end] [blank_start]occult[blank_end] blood testing – home testing kit
Flexi-[blank_start]sigmoidoscopy[blank_end] – looking for polyps – one at age 55 years
Answer
-
2
-
60
-
Fecal
-
occult
-
sigmoidoscopy
Question 27
Question
Fill in the chart:
Answer
-
4-6
-
salmonella
-
E. coli
-
Bacillus Cereus
-
Campylobacter
Question 28
Question
Which is pelvic pain associated with?
Question 29
Question
What is true regarding Chlamydia trachomatis?
Answer
-
small gram negative
-
infect columnar and transitional epithelium
-
sexually transmitted infection
-
causes infertility
-
more common in younger adults
-
asymptomatic
-
small gram positive
-
febrile
-
affects cognitive functionality
-
lies dormant before manifesting later in life
Question 30
Question
Women with chlamydia present with dysuria and yellowish discharge and irregular bleeding
Question 31
Question
Males with chlamydia present with epididymitis, hematuria, dysuria, discharge, and sudden bursts of weakness
Question 32
Question
Investigations for chlamydia:
Male: [blank_start]first[blank_end]-catch [blank_start]urine[blank_end]
Female: [blank_start]vulvovaginal[blank_end] swab
Both samples are sent for NAATs ([blank_start]nucleic[blank_end] [blank_start]acid[blank_end] [blank_start]amplification[blank_end] test)
Answer
-
first
-
urine
-
vulvovaginal
-
nucleic
-
acid
-
amplification
Question 33
Question
Chlamydia complications:
[blank_start]pelvic[blank_end] inflammatory disease, infertility, [blank_start]ectopic[blank_end] pregnancy
Treatments:
100mg [blank_start]Doxycycline[blank_end] (danger: [blank_start]teratogenic[blank_end]) or 1 gram stat [blank_start]Azithromycin[blank_end]
Answer
-
teratogenic
-
Azithromycin
-
Doxycycline
-
ectopic
-
pelvic
Question 34
Question
Neisseria Gonnorhea is
Gram-[blank_start]negative[blank_end] diplococcus
Infects mucous membranes of the urethra, [blank_start]endocervix[blank_end], rectum, [blank_start]pharynx[blank_end] and conjunctiva
transmitted sexually or [blank_start]perinatally[blank_end]
Presentation:
Women:
[blank_start]Urinary[blank_end] [blank_start]Tract[blank_end] Infection
Discharge
[blank_start]Dysuria[blank_end]
Men:
Discharge: [blank_start]green[blank_end] and thick
[blank_start]dysuria[blank_end]
Answer
-
negative
-
pharynx
-
endocervix
-
perinatally
-
Urinary
-
Tract
-
Dysuria
-
green
-
dysuria
Question 35
Question
Investigation for Gonnorhea:
Women: [blank_start]Pharynx[blank_end], vaginal, rectal swab
Men: Pharynx, [blank_start]urethral[blank_end], rectal swab
Question 36
Question
Ceftriaxone 500mg IM and Azithromycin 3G stat is how to treat gonnorhea.
Question 37
Question
Which of these are complications of gonnorhea?
Question 38
Question
What is the differential diagnosis for these symptoms?
lower abdominal pain
Deep dyspareunia
Abnormal vaginal bleeding and/or discharge
Right upper quadrant pain
Lower abdominal tenderness
Adnexal tenderness, cervical motion tenderness, or uterine tenderness
Abnormal cervical or vaginal mucopurulent discharge
Fever greater than 38°C
Question 39
Question
[blank_start]Peri[blank_end]-[blank_start]hepatitis[blank_end] is the development of adhesions between the liver and the peritoneum, causing right [blank_start]upper[blank_end] quadrant pa
Question 40
Question
How do you manage pelvic inflammatory disease?
Answer
-
screen for STIs
-
paracetamol
-
ibuprofen
-
Oral ofloxacin/levofloxacin + oral metronidazole for 14 days
-
Ceftriaxone as a single IM dose, followed by oral doxycycline + oral metronidazole for 14 days
-
Oral cefixime as a single dose (off-label use), followed by oral doxycycline + oral metronidazole for 14 days.
-
Aspirin
-
Oral ofloxacin/levofloxacin or 14 days
-
Ceftriaxone as a single IV dose, followed by oral doxycycline + oral metronidazole for 14 days
-
Ceftriaxone as a single IM dose, followed by oral doxycycline for 14 days
Question 41
Question
The most common cause of a UTI is E colli
Question 42
Question
Obesity, poor bladder emptying, diabetes, kidney stones, and Vitamin E deficiency all put you at increased risk of a UTI.
Question 43
Question
In a UTI, there will be increased urgency and frequency of urination despite it being painful due to the feeling of incomplete urination.
Question 44
Question
What do you pay special notice for in a urinalysis of a UTI?
Answer
-
leukocytes
-
nitrates
-
blood
-
pH
-
concentration
-
glucose
-
ammonia
Question 45
Question
Which of these is not a possible complication of a UTI?
Question 46
Question
Management of UTI:
[blank_start]Fluids[blank_end] (supportive)
Analgesia
1. [blank_start]Trimethoprim[blank_end]
2. [blank_start]Nitrofurantoin[blank_end]
for:
Women - [blank_start]3[blank_end] days
Men - [blank_start]7[blank_end] days
Answer
-
3
-
7
-
Fluids
-
Trimethoprim
-
Nitrofurantoin
Question 47
Question
While both occur shortly after menarche, there is no underlying pelvic pathology in primary dysmennorea like there is in secondary dysmenorrhea.
Question 48
Question
Which of these may NOT be the reason for secondary dysmenorrhea?
Question 49
Question
[blank_start]Primary[blank_end] dysmennorhea is pain which begins just before menstruation and lasts up to [blank_start]72[blank_end] hours, progressively improving
Question 50
Question
NSAIDS, analgesia and contraceptive pill is how to manage dysmenorrhea.
Question 51
Question
You use ultrasounds and PAP smear tests to investigate for dysmenorrhea.
Question 52
Question
Which of these are emergency findings related to dysmenorrhea?
Question 53
Question
Contraception:
Starting the pill on day [blank_start]5[blank_end] or before protects from pregnancy straight away. Otherwise, patients will need additional contraception until taken for [blank_start]7[blank_end] days.
Question 54
Question
What is NOT true regarding the pill?
Answer
-
not taking it at the same time everyday makes it less effective
-
missing a dose makes it less effective
-
Vomiting makes it less effective
-
Severe diarrhea makes it less effective
-
It is taken every day for 21 days, then stopped for 7 days
-
It is not prescribed for those over the age 40
Question 55
Question
If you forgot to take the pill yesterday, the missed pill should still be taken, even if it means taking two pills in today.