Gi Renal Haem Id1. A 29-year-old florist describes 4 weeks of food sticking behind the sternum, first with meat and now with bread. She has not lost weight. Examination is normal. What is the most appropriate referral? Select TWO correct statements.Select all that apply.A. Most appropriate: Suspected cancer 2-week-wait upper GI referral for dysphagia at any ageB. The following is not the most appropriate next step: Routine gastroscopy in 9 months if symptoms persist in this NHS general-practice settingC. Most appropriate: Eight weeks of high-dose PPI before considering referral in this NHS general-practice settingD. Most appropriate: Reassure that dysphagia under 40 is always functional in this NHS general-practice settingCheck
Gi Renal Haem Id2. A 63-year-old bus driver has 8 weeks of epigastric burning after meals and has lost 4.5 kg without trying. No haematemesis. What is the most appropriate action?A. Omeprazole 40 mg for 12 weeks then reviewB. Suspected cancer 2-week-wait referral for weight loss with dyspepsia aged 55 or overC. H pylori stool antigen only, delaying referral until the result in this NHS general-practice settingD. Ultrasound of the gallbladder as first-line cancer exclusion in this NHS general-practice settingCheck
Gi Renal Haem Id3. A 41-year-old baker has iron deficiency, loose stools and an itchy blistering rash on the elbows. Coeliac disease is suspected. She has already cut gluten for 3 days. What is the most appropriate next testing step?A. Continue a strict gluten-free diet and test antibodies in 6 monthsB. Tissue transglutaminase IgA plus total IgA while she returns to gluten-containing mealsC. HLA typing alone as a community diagnostic test in this NHS general-practice settingD. IgG anti-gliadin as the sole first-line screen in this NHS general-practice settingCheck
Gi Renal Haem Id4. A 66-year-old retired teacher has a positive bowel-screening FIT. Digital rectal examination finds no mass. She feels well. What is the most appropriate action?A. Reassure that screening FIT is often a false positive and repeat in 2 years onlyB. Start mebeverine for presumed IBS in this NHS general-practice setting which is not the safest next step in NHS general practiceC. Request abdominal ultrasound instead of colorectal assessment in this NHS general-practice settingD. Suspected colorectal cancer 2-week-wait referral despite no palpable mass in this NHS general-practice settingCheck
Gi Renal Haem Id5. A 21-year-old student is found to have mild jaundice at a sports medical. He is well. Bilirubin is 38 micromol/L, unconjugated; other LFTs, FBC and reticulocytes are normal. What is the most likely diagnosis?A. Obstructive pancreatic cancer needing immediate 2WWB. Gilbert syndrome — benign unconjugated hyperbilirubinaemiaC. Acute viral hepatitis needing isolation and admission in this NHS general-practice settingD. Haemolytic crisis needing emergency transfusion in this NHS general-practice settingCheck
Gi Renal Haem Id6. A 24-year-old man has 4 months of loose stools without blood, weight loss or nocturnal symptoms. You are considering IBS versus IBD. What is the most appropriate next stool test in primary care? Select TWO correct statements.Select all that apply.A. Most appropriate: Faecal calprotectin to help exclude IBD when cancer is unlikelyB. The following is not the most appropriate next step: Faecal elastase as the first IBD screenC. Most appropriate: FIT as a complete substitute for IBD assessment in this age group in this NHS general-practice settingD. Most appropriate: Stool for pancreatic amylase in this NHS general-practice settingCheck
Gi Renal Haem Id7. A 55-year-old man with NAFLD, ALT 52 U/L (stable), QRISK 22% asks whether he must stop atorvastatin 20 mg because ‘the liver is fatty’. What is the most appropriate advice? The most appropriate action is: Continue the statin; NAFLD with stable LFTs is not a routine contraindicationTRUE. TrueFALSE. FalseCheck
Gi Renal Haem Id8. A 38-year-old woman with IBS has tried diet, exercise and mebeverine. Pain remains dominant. Coeliac serology is negative. What is an appropriate next pharmacological option in NICE NG211?A. Low-dose amitriptyline, explaining it is for pain modulation not depressionB. Immediate high-dose SSRI as first-line for all IBSC. Long-term high-dose hyoscine butylbromide infusion at home in this NHS general-practice settingD. Opioid patches as first-line IBS analgesia in this NHS general-practice settingCheck
Gi Renal Haem Id9. A 54-year-old woman has 8 weeks of looser stools without rectal bleeding. Examination is normal, no mass, no iron deficiency. Local NG12-adjacent pathway uses symptomatic FIT. What is the most appropriate next investigation?A. FIT to triage the lower-GI suspected-cancer pathwayB. Immediate hemicolectomy listing from GP in this NHS general-practice settingC. Ignore symptoms because she is under 60 in this NHS general-practice settingD. High-dose loperamide long term without FIT in this NHS general-practice settingCheck
Gi Renal Haem Id10. A 45-year-old woman has 6 hours of severe right-upper-quadrant pain after a fatty meal, now settling. Temperature 36.7°C, no jaundice, Murphy negative when you see her. What is the most appropriate initial plan?A. Urgent same-day cholecystectomy listing without imagingB. Analgesia, safety-net for cholangitis/cholecystitis, and outpatient ultrasound for suspected biliary colicC. Long-term morphine MR as first-lineD. ERCP in the GP treatment roomCheck