Gastroenterology1. A 29-year-old librarian has 8 months of cramping abdominal pain relieved by defaecation, bloating and alternating bowel habit. Blood tests including FBC, CRP and coeliac serology are normal. Examination is unremarkable. What is the most appropriate diagnosis pathway? The most appropriate action is: Refer for urgent colonoscopy before making any diagnosis in this NHS general-practice settingTRUE. TrueFALSE. FalseCheck
Gastroenterology2. A 37-year-old hairdresser has symptoms suggestive of coeliac disease. tTG IgA is requested. What additional test must be done at the same time? Select TWO correct statements.Select all that apply.A. Most appropriate: Total IgA level to detect IgA deficiency that can cause false-negative tTGB. The following is not the most appropriate next step: Serum vitamin B12 only in this clinical context for this presentation in this NHS general-practice settingC. Most appropriate: Stool elastase as the paired mandatory testD. Most appropriate: Repeat tTG IgG without any other blood testCheck
Gastroenterology3. A 22-year-old university student has mild jaundice noted during a sports medical. He is well, unconjugated bilirubin is raised with otherwise normal LFTs and no pain. FBC and reticulocytes are normal. What is the most likely diagnosis?A. Obstructive pancreatic cancer requiring immediate 2WW referralB. Acute viral hepatitis needing isolation and urgent admissionC. Gilbert syndrome — benign unconjugated hyperbilirubinaemiaD. Haemolytic crisis requiring emergency transfusionCheck
Gastroenterology4. A 31-year-old teacher with known ulcerative colitis limited to the rectum reports increased blood and urgency for 5 days. She is afebrile, eating normally and has no systemic symptoms. What is appropriate first-line treatment for this mild flare? The most appropriate action is: Topical mesalazine (suppository or enema) as per BNF for mild distal colitisTRUE. TrueFALSE. FalseCheck
Gastroenterology5. A 54-year-old warehouse supervisor reports black vomit like coffee grounds and feels faint. Hb is 78 g/L. What is the most appropriate management?A. Iron tablets and diet advice in primary careB. Emergency hospital admission for suspected upper GI haemorrhageC. Reassure that coffee-ground vomit is usually benign reflux for this presentationD. Outpatient H pylori breath test before any referralCheck
Gastroenterology6. A 39-year-old office manager asks to start a gluten-free diet this week because a friend said it helped bloating. Coeliac disease has not been excluded. What is the most appropriate advice?A. Start gluten-free immediately because testing can be done anytime on any diet for this presentationB. Skip blood tests and proceed directly to colonoscopyC. Gluten-free diet for 2 weeks then test — this is adequate preparationD. Continue eating gluten and arrange serological testing before starting a gluten-free dietCheck
Gastroenterology7. A 46-year-old pharmacist completed H pylori eradication therapy 3 weeks ago and asks when to check eradication. What is the most appropriate timing for a test-of-cure?A. Urea breath test or stool antigen at least 4 weeks after completing eradication and after stopping PPI for 2 weeksB. Serology immediately tomorrow because antibodies disappear within days for this presentation in this NHS general-practice settingC. Breath test during the last week of antibiotics is idealD. No test-of-cure is ever needed after eradicationCheck
Gastroenterology8. A 52-year-old pub manager has ALT 85 U/L on routine bloods. BMI is 28. He drinks approximately 35 units weekly. What is an essential part of the initial assessment? The most appropriate action is: Immediate liver transplant referral from the GPTRUE. TrueFALSE. FalseCheck
Gastroenterology9. A 57-year-old lorry driver has new persistent vomiting and epigastric pain with Hb 98 g/L. He has not improved on omeprazole for 4 weeks. What is the most appropriate action?A. Suspected cancer 2-week-wait upper GI referralB. Double the omeprazole dose and review in 6 monthsC. Switch to antacids only because PPI has been tried onceD. Reassure that anaemia with dyspepsia is usually dietaryCheck
Gastroenterology10. A 30-year-old social worker has chronic diarrhoea. FBC and CRP are normal but faecal calprotectin is 450 mcg/g. What is the most appropriate next step?A. Diagnose IBS and reassure because CRP is normalB. Refer for specialist assessment to exclude inflammatory bowel diseaseC. Repeat calprotectin in 2 years regardless of result for this presentationD. Start loperamide and ignore the calprotectinCheck