Please note, the MCQs(Multiple choice questions) on this video are according to the specifications and syllabus of Specialty Certificate Examination (SCE) in Gastroenterology and the European Section and Board of Gastroenterology and Hepatology Examination (ESBGHE). However, they provide useful knowledge in the relevant subject area in general. Hence, it is recommended you to go through these videos and gather some information to gain success in future medical and surgical field examinations. https://www.youtube.com/watch?v=1o3JdzgBM9g https://www.youtube.com/watch?v=7k5kba0TNRM https://www.youtube.com/watch?v=kcGi5_xm0Uk

1. Free MCQs for
Specialty Certificate
Examination
in Gastroenterology
Dr Upul Udayaraj Jayasinghe
MBBS, MRCSEd, MRCSI,
Speciality Certificate in Gastroenterology(UK),
Speciality Certificate in Endocrinology & Diabetes(UK),
Diploma in Diabetes Mellitus(India/UK),
Diploma in Human Anatomy and Physiology

2. Q 6
A 55-year-old patient has presented with melaena. Besides, he has been suffering from
hypertension and severe aortic stenosis. On examination, revealed an ejection systolic
murmur; apart from that chest and abdominal examinations were unremarkable. Further, his
blood investigations revealed a microcytic anaemia. Upper GI endoscopy was also
unremarkable.
What is the next best investigation to be performed?
A) Colonoscopy
B) CT abdomen
C) Mesenteric angiography
D) USS abdomen
E) Barium enema

3. Q 6 – Answer
A 55-year-old patient has presented with melaena. Besides, he has been suffering from
hypertension and severe aortic stenosis. On examination, revealed an ejection systolic murmur;
apart from that chest and abdominal examinations were unremarkable. Further, his blood
investigations revealed a microcytic anaemia. Upper GI endoscopy was also unremarkable.
What is the next best investigation to be performed?
A) Colonoscopy
B) CT abdomen
C) Mesenteric angiography (Correct)
D) USS abdomen
E) Barium enema

4. Q 6
Answer feedback;
Correct answer – C
According to the given clinical picture, most probably this patient has angiodysplasia, which
is small vascular malformation of the gut. It is a common cause of otherwise unexplained
gastrointestinal bleeding and anaemia. Lesions are often multiple, and frequently involve
the cecum or ascending colon, although they can occur at other places. In 40% of those
with aortic stenosis has been associated with angiodysplasia of the bowel and therefore GI
bleeding. There are various theories regarding this and it being a connective tissue disorder.
Colonoscopy is useful as it will show any active bleeding points; however, some of the
angiodysplastic lesions can be missed; therefore, mesenteric angiography has a higher
sensitivity.

5. Q 7
A 35-year-old patient with Crohn's disease has presented with right upper abdominal pain,
swinging pyrexia, night sweats and some weight loss. An ultrasound has performed and had
revealed an abscess within the liver, which was thought to be secondary to a bacterial
infection.
What is the empirical antibiotic regimen should start?
A) Vancomycin and metronidazole
B) Vancomycin
C) Clindamycin
D) Amoxicillin and metronidazole
E) Azithromycin

6. Q 7 – Answer
A 35-year-old patient with Crohn's disease has presented with right upper abdominal pain,
swinging pyrexia, night sweats and some weight loss. An ultrasound has performed and had
revealed an abscess within the liver, which was thought to be secondary to a bacterial
infection.
What is the empirical antibiotic regimen should start?
A) Vancomycin and metronidazole
B) Vancomycin
C) Clindamycin
D) Amoxicillin and metronidazole (Correct)
E) Azithromycin

7. Q 7
Answer feedback;
Correct answer – D
According to the given clinical picture, most probably this patient has angiodysplasia, which
is small vascular malformation of the gut. It is a common cause of otherwise unexplained
gastrointestinal bleeding and anaemia. Lesions are often multiple, and frequently involve
the cecum or ascending colon, although they can occur at other places. In 40% of those
with aortic stenosis has been associated with angiodysplasia of the bowel and therefore GI
bleeding. There are various theories regarding this and it being a connective tissue disorder.
Colonoscopy is useful as it will show any active bleeding points; however, some of the
angiodysplastic lesions can be missed; therefore, mesenteric angiography has a higher
sensitivity.

8. Q 8
Cholestyramine was first used to treat hypercholesterolemia; however, since the introduction
of statins, it has only a minor role for this indication. Cholestyramine is used to treat the
pruritus, or itching, that often occur during liver failure, and in other types of cholestasis where
reduced bile acid elimination ability.
Which one of the following drugs will become less effective after a patient starts taking
cholestyramine to relieve intolerable itching as a result of biliary pathology?
A) Warfarin
B) Vitamin D
C) Thiamine
D) Folic acid
E) Erythromycin

9. Q 8 - Answer
Cholestyramine was first used to treat hypercholesterolemia; however, since the introduction
of statins, it has only a minor role for this indication. Cholestyramine is used to treat the
pruritus, or itching, that often occur during liver failure, and in other types of cholestasis where
reduced bile acid elimination ability.
Which one of the following drugs will become less effective after a patient starts taking
cholestyramine to relieve intolerable itching as a result of biliary pathology?
A) Warfarin
B) Vitamin D (Correct)
C) Thiamine
D) Folic acid
E) Erythromycin

10. Q 8
Answer feedback;
Correct answer – B
Cholestyramine is an anion exchange resin and interferes with the absorption of
fat-soluble vitamins.
Thus vitamin D absorption will be reduced, making treatment with this drug less
effective when given with cholestyramine.
Cholestyramine may enhance or reduce the anticoagulant effect of warfarin.

11. Q 9
A 19-year-old student has presented with a 15-week history of non-bloody diarrhoea. Also, he
has lost 2 kg in weight. Apart from this, no abnormalities were found on general and systemic
examination. The patient is a non-smoker as well as non-alcoholic. No significant family history
noted and has had no recent travel abroad. A smear of a duodenal biopsy reveals many
trophozoites.
What is the best treatment option?
A) Gluten free diet
B) Ciprofloxacin
C) Prednisolone
D) Quinine
E) Metronidazole

12. Q 9 - Answer
A 19-year-old student has presented with a 15-week history of non-bloody diarrhoea. Also, he
has lost 2 kg in weight. Apart from this, no abnormalities were found on general and systemic
examination. The patient is a non-smoker as well as non-alcoholic. No significant family history
noted and has had no recent travel abroad. A smear of a duodenal biopsy reveals many
trophozoites.
What is the best treatment option?
A) Gluten free diet
B) Ciprofloxacin
C) Prednisolone
D) Quinine
E) Metronidazole (Correct)

13. Q 9
Answer feedback;
Correct answer – E
According to the given clinical picture and investigation finding, diagnosis here is giardiasis
caused by Giardia lamblia.
Giardia lamblia is a flagellated protozoan parasite that colonizes and reproduces in the
small intestine. Giardiasis does not spread via the bloodstream, nor does it spread to other
parts of the gastrointestinal tract. It remains confined to the lumen of the small intestine
and absorbs nutrients from the lumen of this. In addition, Giardia can cause chronic
diarrhoea.
Luckily, most patients respond to oral metronidazole (250-400 mg tds for five days) as
Giardia is one anaerobic organism.

14. Q 10
A 14-year-old boy presented with a two-day history of right lower quadrant abdominal pain
and passage of bright red blood per rectum. On examination, he was tender in the right iliac
fossa along with bright red blood on rectal examination. As a result, he has been taken to the
operating theatre and has had surgery. The picture shows the pathology specimen.
What is the best investigation should have been done preoperatively to diagnose the specific
cause of patients symptoms?
A) Barium enema
B) Contrast-enhanced CT scan of abdomen
C) Indium 111 radiolabelled white blood cell scan
D) Technetium 99m pertechnetate scintigraphy
E) Transrectal ultrasonography

15. Q 10 - Answer
A 14-year-old boy presented with a two-day history of right lower quadrant abdominal pain and
passage of bright red blood per rectum. On examination, he was tender in the right iliac fossa
along with bright red blood on rectal examination. As a result, he has been taken to the operating
theatre and has had surgery. The picture shows the pathology specimen.
What is the best investigation should have been done preoperatively to diagnose the specific
cause of patients symptoms?
A) Barium enema
B) Contrast-enhanced CT scan of abdomen
C) Indium 111 radiolabelled white blood cell scan
D) Technetium 99m pertechnetate scintigraphy (Correct)
E) Transrectal ultrasonography

16. Q 10
Answer feedback;
Correct answer – E
The picture shows an excised Meckel's diverticulum. Meckel's diverticulum is the vestigial
remnant of the omphalomesenteric duct. The general location of it is terminal ileum within
~60 cm of the ileocaecal valve, and its average length is around 6 cm. About 50% of these
contain ectopic gastric mucosa, commonly leading to clinical presentations of ulceration
and haemorrhage as in this case. Other complications of Meckel's diverticulum include
diverticulitis, intussusception, perforation and obstruction. Although symptoms occur much
more commonly in children, it is a vital differential consideration for gastrointestinal bleed
in adults.
Tc-99m pertechnetate accumulates in gastric mucosa and is the study of choice for
identifying ectopic gastric mucosa in a Meckel's diverticulum.

17. https://www.youtube.com/watch?v=1o3JdzgBM9g
https://www.youtube.com/watch?v=7k5kba0TNRM
https://www.youtube.com/watch?v=kcGi5_xm0Uk
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