Gastroenterology Medicine 10 Single Best Answer (SBA)
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1. A 50-year-old man with a history of diverticulitis presents with fever, abdominal pain, and leucocytosis. CT abdomen shows a fluid collection in the left lower quadrant. What is the most appropriate next step?
Answer: Start broad-spectrum antibiotics and percutaneous drainage
Intra-abdominal abscesses are typically managed with appropriate antibiotics and image-guided percutaneous drainage as the initial approach.
2. What is the primary pathophysiological mechanism leading to exocrine insufficiency in chronic pancreatitis?
Answer: Progressive fibrosis and atrophy of pancreatic acinar cells
Chronic pancreatitis is characterised by ongoing inflammation and fibrosis, leading to gradual loss of exocrine (and often endocrine) function.
3. A 40-year-old woman presents with severe epigastric pain radiating to the back, nausea, and vomiting. Serum lipase is elevated, and ultrasound shows gallstones. What is the most appropriate initial management?
Answer: Intravenous fluids and analgesia
Initial management of acute pancreatitis includes supportive care with IV fluids, analgesics, and correction of electrolyte imbalances.
4. A 25-year-old man presents with diarrhoea, weight loss, and abdominal pain. Colonoscopy shows segmental colitis with skip lesions. What is the most likely diagnosis?
Answer: Crohn’s disease
Crohn’s disease can involve the entire GI tract and is characterised by non-continuous, “skip” lesions, often involving the terminal ileum.
5. A 70-year-old man presents with painless jaundice, weight loss, and dark urine. What is the most appropriate next investigation?
Answer: CT pancreas with contrast
In painless obstructive jaundice suspicious for pancreatic cancer, a contrast-enhanced CT is typically the best initial imaging test.
6. A 4-week-old infant presents with projectile vomiting after feeding and a palpable “olive” in the epigastrium. What is the most likely ultrasound finding?
Answer: Thickened pyloric muscle
Hypertrophic pyloric stenosis classically presents at 2–8 weeks of age with projectile vomiting, and ultrasound shows a thickened pyloric muscle.
7. Which of the following is the most serious complication of an untreated inguinal hernia?
Answer: Strangulation
Strangulation of the hernia contents leads to vascular compromise, bowel necrosis, and can be life-threatening.
8. What is the most common type of hiatus hernia?
Answer: Sliding hernia
Sliding hiatus hernias are the majority, where the gastroesophageal junction and a portion of the stomach slide into the thorax.
9. A 55-year-old obese man is diagnosed with non-alcoholic fatty liver disease (NAFLD). He asks how he can manage this condition. What is the most appropriate advice?
Answer: Weight loss through diet and exercise
The primary intervention for NAFLD is lifestyle change: weight reduction, diet modification, and regular exercise.
10. A 60-year-old man with cirrhosis develops hepatic encephalopathy. He is started on lactulose. What is the primary mechanism of action of this medication?
Answer: Reduction of ammonia production in the gut
Lactulose is metabolised by gut bacteria, lowering colonic pH and trapping ammonia as ammonium for excretion, improving encephalopathy.
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