The document discusses the free MCQs for specialty certificate examinations in gastroenterology, addressing cases involving patients with conditions such as peptic ulcer disease, Crohn's disease, elevated gamma GT levels, and Whipple's disease. It provides questions along with feedback and correct answers related to treatment options and diagnostic criteria in these cases. Additionally, it includes information about the importance of Helicobacter pylori eradication therapy and specific diagnostic markers for liver function tests.

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
https://www.youtube.com/watch?v=1o3JdzgBM9g

2. Q 1
A 56-year-old man has attended gastroenterology outpatients for his gastroscopy results.
He has had endoscopy due to a history of dyspepsia of six weeks with associated weight
loss.
Previously, he has been treating with regular ibuprofen for osteoarthritis.
Unfortunately, gastroscopy report describes a 3 cm, clean-based ulcer with flat edges in the
gastric antrum, and rapid urease (CLO/Campylobacter-like organism) test was positive.
Patient keens to know the effect of Helicobacter pylori eradication therapy on peptic ulcer
disease in addition to acid suppression.
What is the most accurate advice he should give?
A) H. pylori eradication therapy increases ulcer healing and significantly decrease ulcer recurrence
B) H. pylori eradication therapy is not indicated for this gentleman
C) H. pylori eradication does not affect either ulcer healing or recurrence
D) H. pylori eradication does not influence ulcer healing but decreases ulcer recurrence
E) H. pylori eradication therapy increases ulcer healing but does not affect the chances of recurrence

3. Q 1 – Answer
A 56-year-old man has attended gastroenterology outpatients for his gastroscopy results.
He has had endoscopy due to a history of dyspepsia of six weeks with associated weight loss.
Previously, he has been treating with regular ibuprofen for osteoarthritis.
Unfortunately, gastroscopy report describes a 3 cm, clean-based ulcer with flat edges in the gastric
antrum, and rapid urease (CLO/Campylobacter-like organism) test was positive.
Patient keens to know the effect of Helicobacter pylori eradication therapy on peptic ulcer disease in
addition to acid suppression.
What is the most accurate advice he should give?
A) H. pylori eradication therapy increases ulcer healing and significantly decrease ulcer recurrence
B) H. pylori eradication therapy is not indicated for this gentleman
C) H. pylori eradication does not affect either ulcer healing or recurrence
D) H. pylori eradication does not affect ulcer healing but decreases ulcer recurrence (Correct)
E) H. pylori eradication therapy increases ulcer healing but does not affect the chances of recurrence

4. Q 1
Answer feedback;
Correct answer – D
In patients taking non-steroidal anti-inflammatory(NSAIDs) drugs,
Helicobacter pylori eradication therapy does not increase the
chances of ulcer healing when compared to acid suppression alone;
however, it does reduce the chances of recurrent peptic ulceration.

5. Q 2
A 35-year-old patient has complained about chronic non-bloody diarrhoea
for a few months associated with noticeable weight loss. Diagnosis has
made as Crohn's Disease with the help of colonoscopy and biopsy. As a
result, he has been treated with steroids and mesalazine.
However, he was unresponsive to the given treatment.
What is the next therapy you would introduce?
A) Infliximab
B) Methotrexate
C) Elemental diet
D) Cholestyramine
E) Azathioprine

6. Q 2 – Answer
A 35-year-old patient has complained about chronic non-bloody diarrhoea for
a few months associated with noticeable weight loss. Diagnosis has made as
Crohn's Disease with the help of colonoscopy and biopsy. As a result, he has
been treated with steroids and mesalazine.
However, he was unresponsive to the given treatment.
What is the next therapy you would introduce?
A) Infliximab
B) Methotrexate
C) Elemental diet
D) Cholestyramine
E) Azathioprine (Correct)

7. Q 2
Answer feedback;
Correct answer – E
If patients failed to respond to steroids and mesalazine, the next recommended
treatment is azathioprine.

8. Q 3
A 47-year-old patient has presented with jaundice. His liver function test has shown
elevated gamma GT.
What is correct regarding gamma GT?
A) In obstructive jaundice isolated increase of GGT is seen
B) Increased GGT levels observed in alcohol excess and fatty liver
C) Not increased in obstructive jaundice
D) Specific to the liver & not found in other tissues
E) Specially used to monitor hepatic disease activity & treatment response

9. Q 3 – Answer
A 47-year-old patient has presented with jaundice. His liver function test has shown
elevated gamma GT.
What is correct regarding gamma GT?
A) In obstructive jaundice isolated increase of GGT is seen
B) Increased GGT levels observed in alcohol excess and fatty liver (Correct)
C) Not increased in obstructive jaundice
D) Specific to the liver & not found in other tissues
E) Specially used to monitor hepatic disease activity & treatment response

10. Q 3
Answer feedback;
Correct answer – B
Gamma-glutamyl transferase or gamma-glutamyl transpeptidase is an enzyme that found
in many tissues, including the liver, pancreas and bone.
However, the most notable one being the liver, and has significance as a diagnostic
marker.
It should be noted that it is increased in the case of alcohol intake and fatty liver disease.
Also, raised GGT with ALP is indicative of obstructive jaundice. Remember that, bilirubin
is typically utilised to monitor response to treatment in liver disease.

11. Q 4
A 55-year-old gentleman has presented to his GP with intermittent abdominal pain
and diarrhoea, which is sometimes difficult to flush away. Also, he has had a cough,
fever and has noticed aches and pains in his joints. As a result, duodenal biopsy has
done, and it reveals periodic acid Schiff stain positive (PAS) macrophages with
intracellular clumps.
Based on the above findings, what is the most likely diagnosis?
A) Coeliac disease
B) Carcinoid Syndrome
C) Whipple's disease
D) Crohn's disease
E) Ulcerative colitis

12. Q 4 - Answer
A 55-year-old gentleman has presented to his GP with intermittent abdominal pain
and diarrhoea, which is sometimes difficult to flush away. Also, he has had a cough,
fever and has noticed aches and pains in his joints. As a result, duodenal biopsy has
done, and it reveals periodic acid Schiff stain positive (PAS) macrophages with
intracellular clumps.
Based on the above findings, what is the most likely diagnosis?
A) Coeliac disease
B) Carcinoid Syndrome
C) Whipple's disease (Correct)
D) Crohn's disease
E) Ulcerative colitis

13. Q 4
Answer feedback;
Correct answer – C
Whipple's disease leads to the above symptoms that mentioned in the question and can also lead to
pericarditis, lymphadenopathy, neurological abnormalities, pleural effusion and hyperpigmentation.
The key to this diagnosis is the evidence on biopsy of PAS-positive macrophages with intracellular
clumps of T. Whipplei.
PAS-positive macrophages with intracellular clumps of T. Whipplei. are characteristic of Whipple's
disease and excludes the other diagnoses.
Treatment of the condition is with penicillin, ampicillin, tetracycline, or co-trimoxazole for one to
two years.

14. Q 5
An 88-year-old male has presented with severe colicky abdominal pain. At that
time, the abdominal examination has revealed minimal generalised tenderness;
however, no evidence of guarding or rigidity. In addition, he gave a history of weight
loss and pain after eating for the last six months. Unfortunately, he has got a
myocardial infarction one year before. Further, blood investigation results revealed
raised inflammatory markers and metabolic acidosis.
What investigation would be most useful for the definitive diagnosis?
A) Angiography
B) CT abdomen
C) Plane abdominal X – ray
D) Serum amylase & USS of the abdomen
E) CT angiogram

15. Q 5 - Answer
An 88-year-old male has presented with severe colicky abdominal pain. At that
time, the abdominal examination has revealed minimal generalised tenderness;
however, no evidence of guarding or rigidity. In addition, he gave a history of weight
loss and pain after eating for the last six months. Unfortunately, he has got a
myocardial infarction one year before. Further, blood investigation results revealed
raised inflammatory markers and metabolic acidosis.
What investigation would be most useful for the definitive diagnosis?
A) Angiography
B) CT abdomen
C) Plane abdominal X – ray
D) Serum amylase & USS of the abdomen
E) CT angiogram (Correct)

16. Q 5
Answer feedback;
Correct answer – E
Whipple's disease leads to the above symptoms that mentioned in the question and can also lead to
pericarditis, lymphadenopathy, neurological abnormalities, pleural effusion and hyperpigmentation.
The key to this diagnosis is the evidence on biopsy of PAS-positive macrophages with intracellular
clumps of T. Whipplei.
PAS-positive macrophages with intracellular clumps of T. Whipplei. are characteristic of Whipple's
disease and excludes the other diagnoses.
Treatment of the condition is with penicillin, ampicillin, tetracycline, or co-trimoxazole for one to
two years.

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