Gastroenterology Medicine 10 Single Best Answer (SBA)
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1. A 65-year-old man presents with a positive FIT test, a 2-month history of rectal bleeding, and a change in bowel habit. He has lost 5 kg unintentionally. What is the most appropriate next step?
Answer: 2WW referral for colonoscopy
With positive FIT and suspicious symptoms for bowel cancer, an urgent ‘two-week wait’ referral for colonoscopy is essential to confirm or exclude malignancy.
2. A 45-year-old woman presents with itching, rectal pain, and small amounts of bright red blood after defecation. Examination confirms internal haemorrhoids. What is the most appropriate initial management?
Answer: Topical hydrocortisone and bulk-forming laxative
Initial treatment for haemorrhoids includes topical anti-inflammatory preparations and laxatives to alleviate straining.
3. A 35-year-old man presents with haematemesis following repeated episodes of vomiting after an alcohol binge. He is haemodynamically stable. What is the most appropriate next step?
Answer: Endoscopy within 24 hours
Mallory-Weiss tears typically present with haematemesis after forceful vomiting. An urgent endoscopy diagnoses and can treat active bleeding if present.
4. A 70-year-old man presents with rectal bleeding and tenesmus. DRE reveals a hard, irregular mass. What is the most appropriate initial investigation?
Answer: Flexible sigmoidoscopy
When rectal cancer is suspected, flexible sigmoidoscopy is typically the initial endoscopic test for diagnostic confirmation and biopsies.
5. A 60-year-old man with a history of peptic ulcer disease presents with sudden severe abdominal pain. Examination shows guarding, rigidity, and absent bowel sounds. What is the most appropriate next step?
Answer: Abdominal CT scan with contrast
In suspected perforation or acute peritonitis, an urgent CT can locate the site of perforation (e.g., perforated ulcer) and guide surgical management.
6. A 68-year-old man presents with progressive dysphagia for solids, weight loss, and hoarseness. What is the most appropriate next step?
Answer: 2WW referral for upper GI endoscopy
Esophageal cancer must be ruled out with urgent endoscopy in patients with progressive dysphagia and significant weight loss.
7. A 55-year-old man with cirrhosis presents with massive haematemesis and haemodynamic instability. What is the most appropriate immediate intervention?
Answer: Administer IV octreotide and volume resuscitation
Variceal bleeding requires prompt haemodynamic support (fluids, blood products) plus medications (octreotide/terlipressin) to reduce portal pressure before endoscopic control.
8. A 30-year-old man presents with severe anal pain during defecation and visible linear tears in the anoderm. What is the most appropriate initial treatment?
Answer: Topical glyceryl trinitrate and stool softeners
An anal fissure is typically treated initially with GTN ointment (to reduce resting anal pressure) and stool softeners to minimise re-injury.
9. A 75-year-old bedridden woman presents with abdominal pain and palpable faecal masses. What is the most appropriate initial treatment?
Answer: Rectal phosphate enema
In faecal impaction, rectal laxatives or enemas are often needed initially. Oral agents or manual evacuation are second-line if enemas fail.
10. A 50-year-old man with peptic ulcer disease is found to have H. pylori infection. What is the most appropriate treatment?
Answer: Amoxicillin, clarithromycin, and omeprazole
H. pylori eradication typically involves triple therapy with a PPI, clarithromycin, and either amoxicillin or metronidazole for 7–14 days.
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