Please note, the MCQs(Multiple choice questions) on this ppt 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=7k5kba0TNRM https://www.youtube.com/watch?v=kcGi5_xm0Uk https://youtu.be/lSdnQVdLySg

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. 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.

3. Q 11
A 44-year-old shopkeeper has presented with non-bloody diarrhoea but has no blood in
the stool. Further, he has had this loose stools for five weeks and has lost 3 kg weight.
However, he has no history of any acute illness and has not taken any medication recently;
also previously he has had no medical problems. He is a smoker of 10 cigarettes per day
and drinks 21 units of alcohol a week but confesses to having drunk more in the past. On
examination, he was slightly underweight. Apart from this, his chest, cardiovascular
system including heart, BP and pulse. BP was140/86 mmHg. Pulse was 74 bpm with a
regular rhythm. Dipstick urine was normal. Abdominal examination was unremarkable,
and PR examination also was normal.
Plain abdominal x-ray has given.
What would be the most appropriate treatment for this patient's chronic diarrhoea?
A) Co-amoxiclav
B) Creon
C) Metronidazole
D) Octreotide
E) Praziquantel

4. Q 11 – Answer
A 44-year-old shopkeeper has presented with non-bloody diarrhoea but has no blood in the
stool. Further, he has had this loose stools for five weeks and has lost 3 kg weight. However,
he has no history of any acute illness and has not taken any medication recently; also
previously he has had no medical problems. He is a smoker of 10 cigarettes per day and
drinks 21 units of alcohol a week but confesses to having drunk more in the past. On
examination, he was slightly underweight. Apart from this, his chest, cardiovascular system
including heart, BP and pulse. BP was140/86 mmHg. Pulse was 74 bpm with a regular
rhythm. Dipstick urine was normal. Abdominal examination was unremarkable, and PR
examination also was normal. Plain abdominal x-ray has given.
What would be the most appropriate treatment for this patient's chronic diarrhoea?
A) Co-amoxiclav
B) Creon (Correct)
C) Metronidazole
D) Octreotide
E) Praziquantel

5. Q 11
Answer feedback;
Correct answer – B
The x-ray shows calcification in the area of the pancreas, which would support a
diagnosis of diarrhoea secondary to chronic pancreatitis with pancreatic insufficiency.
Hence, the most suitable treatment is CREON, pancreatic enzymes which prevent the
malabsorption associated with pancreatic insufficiency.
Co-amoxiclav therapy would be useful for treating bacterial overgrowth. Metronidazole
can use for the treatment of pseudomembranous colitis caused by Clostridium difficile.
Octreotide (a long-acting synthetic somatostatin analogue) can use in the treatment of
carcinoid syndrome which may present with secretory diarrhoea (in about 83% of
cases).
Praziquantel is the treatment of choice for schistosomiasis. Continuing infection with
Schistosoma may cause granulomatous reactions and fibrosis in the affected organs,
which may result in many clinical manifestations.

6. Q 12
A 16-year-old boy with cystic fibrosis has presented with abdominal pain. However,
he has had no other symptom, including associated nausea and vomiting.
Which of the following is most likely to be the cause?
A) Distal intestinal obstruction syndrome
B) Irritable bowel syndrome
C) Pyelonephritis
D) Renal calculi
E) Ulcerative colitis

7. Q 12 – Answer
A 16-year-old boy with cystic fibrosis has presented with abdominal pain. However,
he has had no other symptom, including associated nausea and vomiting.
Which of the following is most likely to be the cause?
A) Distal intestinal obstruction syndrome (Correct)
B) Irritable bowel syndrome
C) Pyelonephritis
D) Renal calculi
E) Ulcerative colitis

8. Q 12
Answer feedback;
Correct answer – A
Distal intestinal obstruction syndrome occurs in 10-20% of patients with cystic
fibrosis and incidence increases with age, where about 80% of cases present for
the first time in adults. The pathogenesis is partially due to loss of CFTR function
in the intestine which results in deregulation of chloride secretion from the
crypts, bicarbonate secretion from Brunner's glands and sodium transport, which
leads to the accumulation of viscous mucus and faecal material in the terminal
ileum, caecum and ascending colon. The investigation should include a plain
abdominal radiograph which classically shows faecal loading in the right iliac
fossa, dilatation of the ileum and an empty distal colon. Ultrasound may help
identify an obstructive mass but cannot be relied upon to exclude other causes of
pain and bowel obstruction. However, CT can help with diagnosis and shows
dilated small bowel and proximal colon with or without intestinal wall swelling.

9. Q 12
Answer feedback;
Correct answer – A
Treatment for mild and moderate episodes is initially with hydration and full dietetic
review to ensure that the pancreatic enzyme dose correctly titrated to fat intake. As
a part of treatment, regular laxatives should be given, for example, senna and
lactulose. In addition, N-acetylcysteine can use in moderate episodes which loosens
and softens the plugs, presumably by 'opening' the disulphide bonds in the
abnormal intestinal mucus and maintains luminal patency. Severe episodes can treat
with gastrografin or with regularly Klean-Prep enema. If there are signs of peritoneal
irritation or complete bowel obstruction, a surgical review should take. Surgeons will
often treat initially with intravenous fluids and an NG tube while keeping the patient
nil by mouth. In that case, N-acetylcysteine can insert through the NG tube. In
resistant cases, phosphate or gastrograffin enemas can use, or colonoscopy with the
installation of gastrografin.

10. Q 13
An 88-year-old gentleman has brought to the A & E with a 12-hour history of
abdominal pain of sudden onset. On examination, he was pale, cold and clammy. At
that time his pulse was 110bpm and irregular along with blood pressure of 95/64
mmHg. Further, the abdomen was soft and mildly tender; bowel sounds were
absent. The patient's son has mentioned that his father has had three episodes of
passing plum coloured motions during the day. As a part of the diagnosis procedure,
arterial blood gas analysis was performed, which revealed the pH of 7.18 and base
deficit of -16.
Based on the above clinical scenario, what is the most likely diagnosis?
A) Acute pancreatitis
B) Ischaemic bowel
C) Pseudomembranous colitis
D) Ruptured abdominal aortic aneurysm
E) Sigmoid volvulus

11. Q 13 - Answer
An 88-year-old gentleman has brought to the A & E with a 12-hour history of
abdominal pain of sudden onset. On examination, he was pale, cold and clammy. At
that time his pulse was 110bpm and irregular along with blood pressure of 95/64
mmHg. Further, the abdomen was soft and mildly tender; bowel sounds were
absent. The patient's son has mentioned that his father has had three episodes of
passing plum coloured motions during the day. As a part of the diagnosis procedure,
arterial blood gas analysis was performed, which revealed the pH of 7.18 and base
deficit of -16.
Based on the above clinical scenario, what is the most likely diagnosis?
A) Acute pancreatitis
B) Ischaemic bowel (Correct)
C) Pseudomembranous colitis
D) Ruptured abdominal aortic aneurysm
E) Sigmoid volvulus

12. Q 13
Answer feedback;
Correct answer – B
Above clinical scenario is fitting with ischaemic bowel disease, also known as mesenteric
infarction. As we all aware, there are three main blood vessels to supply the gut.
Although any the branches (coeliac, superior and the inferior mesenteric vessels) may
occlude, occlusion of the superior mesenteric artery is more common than the other two.
Though collateral vessels are there to SMA, they may not be able to dilate sufficiently
and quickly to overcome the acute occlusion. The occlusion may be due to a thrombus, or
an embolus which is common in elderly patients who are mainly in atrial fibrillation.
Dissecting aneurysm and vasculitis are other rare causes of infarction. The clinical
features include persistent, severe and generalised abdominal pain. Characteristically, the
pain is out of proportion. Sudden severe pain accompanied by a forceful intestinal
evacuation strongly suggests an acute arterial occlusion.

13. Q 13
Answer feedback;
Correct answer – B
The ischaemic bowel may shed the non-viable mucosa, which mixed with mucus
results in the appearance of plum coloured stools.
The inflammatory markers may elevate, and the blood gas may reveal a metabolic
acidosis like in the above case.
This condition is a surgical emergency as the patient rapidly becomes toxic and may
die from septic shock unless removing the infarcted bowel. Patients those who are
unfit for surgery must be managed with supportive measures such as resting the gut,
intravenous fluids and antibiotics, and monitoring of vital signs in a high dependency
unit.
Unfortunately, the outcome is not that satisfactory in conservative management
without surgical intervention.

14. Q 14
An older woman has presented with severe colicky central abdominal pain, vomiting, and
the passage of abnormal stool mixed with blood which had had the appearance of
redcurrant jelly. On examination, the temperature was 37.9°C along with a pulse of 140/min
with a variable rate. At that time, the abdominal examination has revealed generalized
tenderness. Further noted raised inflammatory markers. As per the ABG, the patient was in
severe metabolic acidosis.
What is the most possible diagnosis ?
A) Acute mesenteric ischaemia
B) Acute exacerbation of Ulcerative colitis
C) Infective colitis
D) Crohn's disease
E) Chronic mesenteric ischaemia
Haemoglobin 126 g/L White cell count 25 ×109/L
Lactate 7 mmol/L pH 7.15

15. Q 14 - Answer
An older woman has presented with severe colicky central abdominal pain,
vomiting, and the passage of abnormal stool mixed with blood which had had the
appearance of redcurrant jelly. On examination, the temperature was 37.9°C along
with a pulse of 140/min with a variable rate. At that time, the abdominal
examination has revealed generalized tenderness. Further noted raised
inflammatory markers. As per the ABG, the patient was in severe metabolic acidosis.
What is the most possible diagnosis ?
A) Acute mesenteric ischaemia (Correct)
B) Acute exacerbation of Ulcerative colitis
C) Infective colitis
D) Crohn's disease
E) Chronic mesenteric ischaemia
Haemoglobin 126 g/L White cell count 25 ×109/L
Lactate 7 mmol/L pH 7.15

16. Q 14
Answer feedback;
Correct answer – A
The clinical picture of the patient mentioned above is going with the
diagnosis of acute mesenteric ischaemia most probably as a result of an
embolic occlusion of the superior mesenteric artery as a complication of
atrial fibrillation that has not diagnosed previously.

17. Q 15
An older man around 60 years of age has presented to gastroenterology clinic with a six-
month history of a burning type central chest discomfort, frequently occurred at night and
was associated with an acidic taste in the mouth.
He has had some relief by taking over-the-counter antacid tablets and had seen his GP
who prescribed a two-month course of omeprazole.
However, the patient has been still getting the symptoms.
His GP had also sent blood for Helicobacter pylori serology which was found to be
negative.
He was otherwise well and did not give a history of any weight loss, vomiting or dysphagia.
There was no other past medical history noted.
On examination, he looked well, not clinically anaemic; pulse was 80bpm and regular
along with a blood pressure of 135/70 mmHg.
His heart sounds were normal, and the chest was clear.
His abdomen was soft and non-tender with no palpable organomegaly or masses. A rectal
examination was unremarkable and normal stool was noted on the examination glove.
An outpatient upper gastrointestinal endoscopy revealed a 10 cm area of non-inflamed
Barrett's epithelium at the lower oesophagus; & multiple biopsies has taken.
The histology came as columnar-lined mucosa with intestinal metaplasia, and dysplasia
was not there.
(Continue to next slide)

18. (For question 15)
How will you manage above patient?
A) Repeat the endoscopy and biopsy in two months
B) Start a proton pump inhibitor & no follow-up needed
C) Start a proton pump inhibitor and repeat the endoscopy and biopsy in two years
D) Start a proton pump inhibitor and repeat the endoscopy in five years
E) Refer the patient to surgery

19. Q 15 – Answer
(Please refer previous two slides for question description)
How will you manage above patient?
A) Repeat the endoscopy and biopsy in two months
B) Start a proton pump inhibitor & no follow-up needed
C) Start a proton pump inhibitor and repeat the endoscopy and biopsy in two years
(Correct)
D) Start a proton pump inhibitor and repeat the endoscopy in five years
E) Refer the patient to surgery

20. Q 15
Answer feedback;
Correct answer – C
Unfortunately, Barrett's oesophagus is a serious complication of GERD. Anyhow, about
10% of people with chronic symptoms of GERD develop Barrett's oesophagus. Please note,
the risks of adenocarcinoma are relatively high (30 × normal), yet the absolute risk is low
as 1% per year to develop adenocarcinoma. This patient has no dysplasia and so at
present, we would start a PPI and re-scope in two years. This management is appropriate
in an otherwise healthy person; the merits of surveillance need to assess on a patient to
patient basis. However, low-grade dysplasia needs six monthly endoscopies & biopsy. On
the other hand, high-grade dysplasia needs further intervention; radiofrequency ablation
(RFA), photodynamic therapy (PDT), cryotherapy, endoscopic mucosal resection (EMR) or
oesophagectomy.

21. https://www.youtube.com/watch?v=7k5kba0TNRM
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