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My Masterclass exam #59765
My Masterclass Q1.
Your exam progress
My history A 45 year old male businessman presented to the Gastroenterology clinic with an 0/30
eight week history of bloody diarrhoea. He regularly travelled to South East Asia for 0.0%
My details work purposes. There was no history of inflammatory bowel disease.
Create exam Flexible sigmoidoscopy to the descending colon showed mucosal erythema and
ulceration up to and beyond the point of insertion. Biopsies demonstrated chronic
Website extension offer
inflammatory changes with the presence of inclusion bodies.
PACES screencasts
What is the most appropriate treatment?
A Corticosteroids
B Mesalazine
C Penicillin
D Valganciclovir
E Vancomycin
Submit answer Next question Mark exam

My Masterclass Q1.
Question statistics
My history A 45 year old male businessman presented to the Gastroenterology clinic with an 75.2%
eight week history of bloody diarrhoea. He regularly travelled to South East Asia for of users
My details work purposes. There was no history of inflammatory bowel disease. answered
this
Create exam Flexible sigmoidoscopy to the descending colon showed mucosal erythema and correctly
ulceration up to and beyond the point of insertion. Biopsies demonstrated chronic
inflammatory changes with the presence of inclusion bodies. Your exam progress
PACES screencasts 1/30
What is the most appropriate treatment?
3.3%
A Corticosteroids
B Mesalazine
C Penicillin
D Valganciclovir
E Vancomycin
Answer comments
This man has cytomegalovirus colitis, an important and often missed mimic of
ulcerative colitis. He may have undiagnosed HIV infection given his history, which
would predispose him to this condition.
Next question Mark exam

My Masterclass Q2.
Question statistics
My history An 83-year-old man is about to be discharged home, having spent 3 weeks in hospital 54.2%
being treated for C. difficile diarrhoea associated with pseudomembranous colitis. of users
My details Unfortunately, the nursing staff report that he has had a recurrence of profuse, answered
malodorous, greenish diarrhoea. He has already had one course of oral this
Create exam metronidazole therapy. Which of the following is the most appropriate treatment? correctly
Website extension offer A Intravenous metronidazole Your exam progress

PACES screencasts B Intravenous teicoplanin 2/30
6.7%
C Intravenous vancomycin
D Oral ciprofloxacin
E Oral metronidazole
Answer comments
Approximately 20% of patients with pseudomembranous colitis relapse, usually 2

weeks to 2 months after treatment. This is related to the persistence of C.difficile
spores that are not killed by antibiotic therapy, rather than to metronidazole
resistance, hence recurrence of disease should be treated with a second course of
oral metronidazole.
If he fails to respond to a second course of oral metronidazole the second line agent
would be oral (not intravenous) vancomycin.
Previous question Next question Mark exam

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MyMasterclassexam#59765
MyMasterclass Q3.
Yourexamprogress
Myhistory An18yearoldmanpresentedacutelytotheEmergencyDepartmentwithafoodbolus 2/30
obstructionafterasteakmeal.Onfurtherquestioning,hesaidthathehadsuffered 6.7%
Mydetails similarsymptomsinthepast,buttheyusuallypassedafterafewhours.Apartfrom
eczema,hewasotherwisefitandwell,withnootherpreviousgastrointestinal
Createexam symptoms.
Websiteextensionoffer
Whatisthemostlikelydiagnosis?
PACESscreencasts A Achalasiacardia
B Eosinophilicoesophagitis
C Gastrooesophagealrefluxdisease
D Hiatushernia
E Nutcrackeroesophagus
Submitanswer Previousquestion Nextquestion Markexam

My Masterclass Q3.
Question statistics
My history An 18 year old man presented acutely to the Emergency Department with a food 59.8%
bolus obstruction after a steak meal. On further questioning, he said that he had of users
My details suffered similar symptoms in the past, but they usually passed after a few hours. answered
Apart from eczema, he was otherwise fit and well, with no other previous this
Create exam gastrointestinal symptoms. correctly

What is the most likely diagnosis? Your exam progress
PACES screencasts A Achalasia cardia 3/30
10.0%
B Eosinophilic oesophagitis
C Gastro-oesophageal reflux disease
D Hiatus hernia
E Nutcracker oesophagus
Answer comments
Eosinophilic oesophagitis is increasingly recognized as a cause for intermittent

oesophageal obstruction, especially in young men with a history of atopy. Effective
treatment includes steroid therapy (swallowed rather than inhaled) and dietary
exclusion.

My Masterclass Q4.
Your exam progress
My history Which of the following is true in the investigation of a 30-year-old man with a 2- 3/30
month history of diarrhoea and weight loss? 10.0%
My details
A A normal C-reactive protein (CRP) excludes inflammatory bowel disease
Create exam
B Hydrogen breath testing for small-bowel bacterial overgrowth is a first-
Website extension offer line investigation
PACES screencasts C IgA anti-endomysial antibody determination is mandatory
D Stool examination is most likely to identify a cause
E The absence of a travel history precludes an infectious aetiology
Submit answer Previous question Next question Mark exam

My Masterclass Q4.
Question statistics
My history Which of the following is true in the investigation of a 30-year-old man with a 2- 71.3%
month history of diarrhoea and weight loss? of users
My details answered
A A normal C-reactive protein (CRP) excludes inflammatory bowel disease
this
Create exam
correctly
B Hydrogen breath testing for small-bowel bacterial overgrowth is a first-
Website extension offer line investigation
Your exam progress
PACES screencasts C IgA anti-endomysial antibody determination is mandatory 4/30
13.3%
D Stool examination is most likely to identify a cause
E The absence of a travel history precludes an infectious aetiology
Answer comments
In the investigation of diarrhoea, history is very important. Organic disease is more

likely if the diarrhoea is of less than 3 months duration and nocturnal. It is unusual to
find an infective cause if symptoms have persisted for over 4 months, but untrue to
suggest that the absence of overseas travel precludes an infectious aetiology. Coeliac
disease is extremely common with >0.2% sero-prevalence in Western populations but
can present in subtle ways. Mild diarrhoea associated with a mild anaemia is an
important presentation in adults and serology (for IgA anti-endomysial antibody
against tissue transglutaminase) has a >95% accuracy in diagnosis. Florid ulcerative
colitis can be present without evidence of an on-going acute phase response as
measured by CRP. Small-bowel bacterial overgrowth would be unusual in a young
person in the absence of a structural or functional intestinal disorder (i.e. blind loop
from surgery or diabetes mellitis) but would need to be considered in the elderly.

My Masterclass Q5.
Your exam progress
My history A 75 year old woman was admitted on the acute medical take with a two-day history 4/30
of non-bloody diarrhoea. She had a history of ischaemic heart disease, type 2 13.3%
My details diabetes mellitus, and dyspepsia. Stool analysis was positive for Clostridium difficile
toxin.
Create exam
Which of her medications is most likely to predispose her to this condition?

A Aspirin
PACES screencasts
B Domperidone
C Metformin
D Nicorandil
E Omeprazole

My Masterclass Q5.
Question statistics
My history A 75 year old woman was admitted on the acute medical take with a two-day history 73.6%
of non-bloody diarrhoea. She had a history of ischaemic heart disease, type 2 of users
My details diabetes mellitus, and dyspepsia. Stool analysis was positive for Clostridium difficile answered
toxin. this
Create exam
correctly
Which of her medications is most likely to predispose her to this condition?
Your exam progress
A Aspirin
B Domperidone 16.7%
C Metformin
D Nicorandil
E Omeprazole
Answer comments
Proton pump inhibitors increase the risk of Clostridium difficile diarrhoea by

approximately 4-fold.

My Masterclass Q6.
Your exam progress
My history A 45-year-old man with no previous medical history is found to have oesophageal 5/30
varices when endoscoped to investigate dyspepsia. Which of the following are true: 16.7%
My details
A Beta-blockers do not affect the long term outcome.
Create exam
B If admitted with variceal bleeding, terlipressin may reduce bleeding.
C Variceal banding is indicated.
PACES screencasts
D Variceal bleeding has a 10% mortality rate.
E Variceal sclerotherapy is indicated.

My Masterclass Q6.
Question statistics
My history A 45-year-old man with no previous medical history is found to have oesophageal 71.4%
varices when endoscoped to investigate dyspepsia. Which of the following are true: of users
My details answered
A Beta-blockers do not affect the long term outcome.
this
Create exam
correctly
B If admitted with variceal bleeding, terlipressin may reduce bleeding.
Your exam progress
C Variceal banding is indicated.
D Variceal bleeding has a 10% mortality rate. 20.0%
E Variceal sclerotherapy is indicated.
Answer comments
Beta-blockers are of overall benefit in primary prophylaxis, i.e. in reducing the chance
of a first bleed. Variceal bleeding has a mortality rate of about 30%, and terlipressin
may reduce bleeding when administered acutely.

My Masterclass Q7.
Your exam progress
My history A 28 year old man presented with a three week history of diarrhoea, 6-8 times daily, 6/30
rectal bleeding and weight loss. Stool cultures were negative and blood tests 20.0%
My details demonstrated mild anaemia, raised inflammatory markers and low serum albumen.
Create exam A Abdominal radiograph
Website extension offer B Colonoscopy
PACES screencasts C CT colon
D Serum pANCA
E Sigmoidoscopy

My Masterclass Q7.
Question statistics
My history A 28 year old man presented with a three week history of diarrhoea, 6-8 times daily, 45.4%
rectal bleeding and weight loss. Stool cultures were negative and blood tests of users
My details demonstrated mild anaemia, raised inflammatory markers and low serum albumen. answered
this
Create exam A Abdominal radiograph
correctly
Website extension offer B Colonoscopy

Your exam progress
PACES screencasts C CT colon 7/30
23.3%
D Serum pANCA
E Sigmoidoscopy
Answer comments
The patients story is typical for moderate to severe ulcerative colitis, although
colonic Crohns disease is a possibility. Sigmoidoscopy with rectal biopsy would be the
appropriate investigation.

My Masterclass Q8.
Your exam progress
My history A 39-year-old presents with bilirubin 75 micromol/l, ALT 1850 IU/l, alkaline 7/30
phosphatase 150 IU/l. She has recently returned from a beach holiday in West Africa 23.3%
My details where she suffered from gastroenteritis. Which of the following statements is
correct?
Create exam
A A live-attenuated virus vaccine is available to protect travellers to high-
Website extension offer risk areas for hepatitis A.
PACES screencasts B A positive HAVIgG antibody suggests acute hepatitis A infection.
C Acute hepatitis A has a mortality of 2%.
D Hospital admission is mandatory.
E Pooled human immunoglobulin can be given to close contacts within 2

weeks of exposure.

My Masterclass Q8.
Question statistics
My history A 39-year-old presents with bilirubin 75 micromol/l, ALT 1850 IU/l, alkaline 41.5%
phosphatase 150 IU/l. She has recently returned from a beach holiday in West Africa of users
My details where she suffered from gastroenteritis. Which of the following statements is answered
correct? this
Create exam
correctly
A A live-attenuated virus vaccine is available to protect travellers to high-
Website extension offer risk areas for hepatitis A. Your exam progress
PACES screencasts B A positive HAVIgG antibody suggests acute hepatitis A infection. 8/30
26.7%
C Acute hepatitis A has a mortality of 2%.
D Hospital admission is mandatory.
E Pooled human immunoglobulin can be given to close contacts within 2

weeks of exposure.
Answer comments
Acute hepatitis A is diagnosed on the basis of a positive IgM antibody (IgG is a

marker of previous exposure, which may well have been asymptomatic). Hepatitis A
has a mortality of less than 0.05%. The vaccine is a formalin-inactivated vaccine.
Pooled immunoglobulin prophylaxis is available if less than two weeks from exposure.
Hospital admission is rarely required unless patient has vomiting and/or dehydration.
However, they should be monitored closely as an out-patient. The acute hepatitic
phase is often followed by a prolonged cholestatic phase, and while relapsing disease
is rare, patients should be followed until LFTs normalize.

My Masterclass Q9.
Question statistics
My history A 42 year old woman who had undergone orthotopic liver transplantation 5 years 83.4%
earlier for primary sclerosing cholangitis presented with intermittent abdominal pain of users
My details and bloody diarrhoea. answered
this
Create exam What is the most likely cause for her symptoms? correctly
Website extension offer A Adhesions Your exam progress

PACES screencasts B Recurrent Primary Sclerosing Cholangitis 9/30
30.0%
C Side effects of immunosuppression
D Stomach cancer
E Ulcerative colitis
Answer comments
70% of patients with PSC will have ulcerative colitis, whilst up to 5% of those with UC
will develop PSC. Whilst adhesions may cause abdominal pain, they will not be a
cause for bloody diarrhoea. Colon cancer rather than stomach cancer is associated
with PSC and UC. GI disturbance can occur frequently as a result of certain
immunosuppression regimes, but new symptoms rarely form after this time period,
neither do they cause bloody diarrhoea.

My Masterclass Q10.
Your exam progress
My history In a patient who is jaundiced and HBsAg and HBeAg positive with evidence of 9/30
cirrhosis (ascites) and an albumin of 28g/L and a prothrombin time of 21 sec, the 30.0%
My details best treatment would be:
Create exam A Alpha-interferon.
Website extension offer B Beta-interferon
PACES screencasts C Lamivudine
D Ribavirin
E Ribavirin and alpha-interferon

My Masterclass Q10.
Question statistics
My history In a patient who is jaundiced and HBsAg and HBeAg positive with evidence of 58.0%
cirrhosis (ascites) and an albumin of 28g/L and a prothrombin time of 21 sec, the of users
My details best treatment would be: answered
this
Create exam A Alpha-interferon.
correctly
Website extension offer B Beta-interferon

Your exam progress
PACES screencasts C Lamivudine 10/30
33.3%
D Ribavirin
E Ribavirin and alpha-interferon
Answer comments
Ribavirin has no effect on hepatitis B replication, but used in combination with

interferon is more effective than ribavirin alone in eradicating chronic infection with
hepatitis C.
Interferon was until recently first line treatment for chronic hepatitis B infection
associated with elevated serum transaminases. However, there is often a flare in ALT
(alamine aminotransferase) on starting treatment, which in the presence of end
stage liver disease (elevated PT, bilirubin and ascites here) can lead to liver failure so,
in these circumstances, it is contra-indicated.
Lamivudine suppresses HBV replication and is safe to use in decompensated end-

stage cirrhosis.

My Masterclass Q11.
Your exam progress
My history A 25 year old woman presented with a nocturnal cough. Her chest radiograph 10/30
showed a widened mediastinum which contained a fluid level, and there was no 33.3%
My details gastric air bubble. A barium swallow demonstrated a dilated oesophagus with a tight
stricture at the oesophago-gastric junction.
Create exam
What is the most appropriate management?

A Balloon dilatation of the stricture
PACES screencasts
B Calcium channel blocking agent
C Injection of botulinum toxin into the lower oesophagus
D Laparoscopic myotomy
E Proton pump inhibitor

My Masterclass Q11.
Question statistics
My history A 25 year old woman presented with a nocturnal cough. Her chest radiograph 58.9%
showed a widened mediastinum which contained a fluid level, and there was no of users
My details gastric air bubble. A barium swallow demonstrated a dilated oesophagus with a tight answered
stricture at the oesophago-gastric junction. this
Create exam
correctly
What is the most appropriate management?
Your exam progress
A Balloon dilatation of the stricture
B Calcium channel blocking agent 36.7%
C Injection of botulinum toxin into the lower oesophagus
D Laparoscopic myotomy
E Proton pump inhibitor
Answer comments
This is the classical presentation of severe achalasia, with nocturnal spillover of

retained oesophageal contents leading to cough and the risk of aspiration
pneumonia. Calcium channel blocking agents may relieve lower oesophageal spasm,
but they are relatively ineffective and tachyphylaxis occurs. Botulinum toxin injected
into the lower oesophageal sphincter is effective, but the effect is short lived and
may only last a few months. Laparoscopic Hellers myotomy is the treatment of
choice in a young patient.

My Masterclass Q12.
Your exam progress
My history A 24 yr old man presented with a 6 month history of diarrhoea, with blood mixed in 11/30
with the stool on some occasions. Problems started after he ate a dodgy meal and 36.7%
My details he assumed that they were infective, but matters did not improve and he continued
to open his bowels 3-4 times per day. He had lost some weight, but did not know how
Create exam much. On functional enquiry he admitted to some arthralgia, affecting particularly
his lower back and knees, for which he had been taking occasional ibuprofen. He did
not smoke, and drank little alcohol (<5 units / week). He had been in a long-term
relationship with his female partner, with no other sexual contacts in the preceding
PACES screencasts
year. Physical examination was unremarkable, apart from some slight generalized
abdominal tenderness.
What is the most likely diagnosis?
A Bacterial overgrowth
B Coeliac disease
C Giardiasis
D Idiopathic inflammatory bowel disease
E Non-steroidal anti-inflammatory drug enteropathy

My Masterclass Q12.
Question statistics
My history A 24 yr old man presented with a 6 month history of diarrhoea, with blood mixed in 64.0%
with the stool on some occasions. Problems started after he ate a dodgy meal and of users
My details he assumed that they were infective, but matters did not improve and he continued answered
to open his bowels 3-4 times per day. He had lost some weight, but did not know how this
Create exam much. On functional enquiry he admitted to some arthralgia, affecting particularly correctly
his lower back and knees, for which he had been taking occasional ibuprofen. He did
not smoke, and drank little alcohol (<5 units / week). He had been in a long-term Your exam progress
relationship with his female partner, with no other sexual contacts in the preceding
year. Physical examination was unremarkable, apart from some slight generalized
40.0%
abdominal tenderness.
A Bacterial overgrowth
B Coeliac disease
C Giardiasis
D Idiopathic inflammatory bowel disease
E Non-steroidal anti-inflammatory drug enteropathy
Answer comments
This man is most likely to have idiopathic inflammatory bowel disease, but it would
be important to exclude chronic infection and to consider other causes of chronic
diarrhoea. Some enteric infections such as giardiasis and amoebiasis can produce
prolonged symptoms even in immunocompetent individuals. Coeliac disease is
common and may present with chronic diarrhoea and vague malaise, but blood in
the stool would not be expected and indicates a colitic illness.

My Masterclass Q13.
Your exam progress
My history An 82 year old man with multiple comorbidities was admitted with a 7 week history 12/30
of progressive dysphagia, having been unable to swallow anything except water for 40.0%
My details the past 11 days. Oesophageogastroduodenoscopy (OGD) revealed an almost
occlusive oesophageal lesion that looked suspicious for cancer. An NG tube was
Create exam placed for feeding whilst awaiting the histology results and MDT discussion. Three
days later the patient was found collapsed on the ward. Blood test results included
Hb 11.2g/dl, WCC 4 x109/l, CRP 35 mg/dl, Na 134 mmol/l, K 3.1 mmol/l, Urea
7.5mmol/l, Creatinine 120 ?mol/l, Phosphate 0.4 mmol/l, Corrected calcium 2.0
PACES screencasts
mmol/l, Glucose 4mmol/l
A Dehydration
B Oesophageal perforation
C Refeeding syndrome
D Sepsis
E Vitamin D deficiency

My Masterclass Q13.
Question statistics
My history An 82 year old man with multiple comorbidities was admitted with a 7 week history 91.8%
of progressive dysphagia, having been unable to swallow anything except water for of users
My details the past 11 days. Oesophageogastroduodenoscopy (OGD) revealed an almost answered
occlusive oesophageal lesion that looked suspicious for cancer. An NG tube was this
Create exam placed for feeding whilst awaiting the histology results and MDT discussion. Three correctly
days later the patient was found collapsed on the ward. Blood test results included
Hb 11.2g/dl, WCC 4 x109/l, CRP 35 mg/dl, Na 134 mmol/l, K 3.1 mmol/l, Urea Your exam progress
7.5mmol/l, Creatinine 120 ?mol/l, Phosphate 0.4 mmol/l, Corrected calcium 2.0
mmol/l, Glucose 4mmol/l
43.3%
A Dehydration
B Oesophageal perforation
C Refeeding syndrome
D Sepsis
E Vitamin D deficiency
Answer comments
Given his prolonged history (>10 days) of little or no nutritional intake this man is at
high risk of refeeding syndrome. The phosphate (and indeed the other electrolytes
such as K, Mg, Ur and Ca) should be checked at baseline and then daily given his high
risk status, correcting as necessary.

My Masterclass Q14.
Your exam progress
My history A 38-year-old smoker presents with 4 month's diarrhoea, abdominal pain and weight 13/30
loss. She has noticed uncomfortable red marks on her legs. Which of the following 43.3%
My details statements is true?
Create exam A A stool culture is not necessary in the absence of recent foreign travel.
Website extension offer B Crohns disease is more likely than ulcerative colitis.
PACES screencasts C Dietary restriction an important part of the treatment
D Fistulae require surgical intervention in Crohns disease.
E Nicotine patches may be of therapeutic benefit.

My Masterclass Q14.
Question statistics
My history A 38-year-old smoker presents with 4 month's diarrhoea, abdominal pain and weight 58.7%
loss. She has noticed uncomfortable red marks on her legs. Which of the following of users
My details statements is true? answered
this
Create exam A A stool culture is not necessary in the absence of recent foreign travel.
correctly
Website extension offer B Crohns disease is more likely than ulcerative colitis.
Your exam progress
PACES screencasts C Dietary restriction an important part of the treatment 14/30
46.7%
D Fistulae require surgical intervention in Crohns disease.
E Nicotine patches may be of therapeutic benefit.
Answer comments
The relative risk of Crohns disease is three-fold greater in smokers. A similar

association exists for ulcerative colitis and non-smoking such that nicotine patches
have been used in mild to moderately active disease.
Infectious colitis can present with identical symptoms and macroscopic appearance
as idiopathic inflammatory bowel disease.
Whilst surgery may have an important role, anti-tumour necrosis factor antibody is
licensed for use in both refractory and fistulating Crohns disease.
Malnutrition is a predictor of poor outcome in many conditions, including Crohns

disease. Even if an elemental diet is not the chosen therapeutic modality, nutritional
support should form an important part of management.

My Masterclass Q15.
Your exam progress
My history A 32 year old woman was referred by her General Practitioner to the acute medical 14/30
take with melaena. She had a past history of fibromyalgia, chronic pelvic pain and 46.7%
My details depression.
Create exam Which medication is most likely to contribute to her presentation?
Website extension offer A Amitriptyline
PACES screencasts B Diazepam
C Fluoxetine
D Oxycodone
E St Johns Wort

My Masterclass Q15.
Question statistics
My history A 32 year old woman was referred by her General Practitioner to the acute medical 47.0%
take with melaena. She had a past history of fibromyalgia, chronic pelvic pain and of users
My details depression. answered
this
Create exam Which medication is most likely to contribute to her presentation? correctly
Website extension offer A Amitriptyline Your exam progress

PACES screencasts B Diazepam 15/30
50.0%
C Fluoxetine
D Oxycodone
E St Johns Wort
Answer comments
Selective Serotonin Reuptake Inhibitors (SSRIs) are associated with upper

gastrointestinal bleeding (odds ratio 1.66).

My Masterclass Q16.
Your exam progress
My history A 34-year-old HIV positive man, poorly compliant with treatment, presents to the 15/30
gastroenterologists with diarrhoea. Sigmoidoscopy revealed mucosal inflammation 50.0%
My details with focal haemorrhage, oedematous folds and polypoid lesions. Inclusion bodies
were visible on examination of a biopsy. What is the most likely cause of his
Create exam symptoms and signs?
Website extension offer A Amoebiasis
PACES screencasts B Cryptosporidiosis
C Cytomegalovirus (CMV) colitis
D Disseminated mycobacterium avium intracellulare (MAI)
E Ulcerative colitis.

My Masterclass Q16.
Question statistics
My history A 34-year-old HIV positive man, poorly compliant with treatment, presents to the 79.8%
gastroenterologists with diarrhoea. Sigmoidoscopy revealed mucosal inflammation of users
My details with focal haemorrhage, oedematous folds and polypoid lesions. Inclusion bodies answered
were visible on examination of a biopsy. What is the most likely cause of his this
Create exam symptoms and signs? correctly
Website extension offer A Amoebiasis Your exam progress

PACES screencasts B Cryptosporidiosis 16/30
53.3%
C Cytomegalovirus (CMV) colitis
D Disseminated mycobacterium avium intracellulare (MAI)
E Ulcerative colitis.
Answer comments
The broad differential diagnosis for HIV associated diarrhoea includes:
1. Bacterial infections (Salmonella, Shigella, Campylobacter)

2. Parasitic infections (Cryptosporidium, Isospora, Giardia, Microsporidia,
Entamoeba histolytica)
3. Mycobacterial infections (Mycobacterium avium complex (MAC),
Mycobacterium tuberculosis)
4. Viral infections (Cytomegalovirus)
5. Drug-associated diarrhoea (e.g. nelfinavir)
6. Idiopathic diarrhoea (HIV enteropathy).
CMV colitis is uncommon in patients who are not severely immunocompromized. GI

tract involvement may occur alone or in the setting of disseminated disease. CMV
has three major patterns of infection: primary infection (in the immunocompetent
host causing few or no symptoms; after initial infection, latent viral infection occurs),
secondary reactivation (patients seropositive with latent infection who reactivate
because of immunodeficiency) and superinfection. Within the colon, ulcerative
changes may be seen and watery diarrhoea can develop. As ulcers increase in depth,
erosion into blood vessels may cause profuse bloody diarrhoea. Inflammatory polyps
do develop, which, rarely, obstruct the colon. Severe inflammation and vasculitis
sometimes leads to ischaemia and transmural necrosis, with subsequent perforation
and peritonitis. Classically findings on microscopy include giant cells with large ovoid
or pleomorphic nuclei containing basophilic inclusions (owl's eyes).

My Masterclass Q17.
Your exam progress
My history A 40 year old man had a two year history of intermittent dysphagia, with bolus 16/30
obstruction and choking, particularly after eating bread or steak. He did not give any 53.3%
My details history of reflux symptoms or indigestion.
Create exam What is the likely diagnosis?
Website extension offer A Achalasia of the cardia
PACES screencasts B Eosinophilic oesophagitis
C Hiatus hernia
D Oesophageal cancer
E Peptic oesophageal stricture

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MyMasterclassexam#59765
MyMasterclass Q17.
Questionstatistics
Myhistory A40yearoldmanhadatwoyearhistoryofintermittentdysphagia,withbolus 46.4%
obstructionandchoking,particularlyaftereatingbreadorsteak.Hedidnotgiveany ofusers
Mydetails historyofrefluxsymptomsorindigestion. answered
this
Createexam Whatisthelikelydiagnosis? correctly
Websiteextensionoffer A Achalasiaofthecardia Yourexamprogress

PACESscreencasts B Eosinophilicoesophagitis 17/30
56.7%
C Hiatushernia
D Oesophagealcancer
E Pepticoesophagealstricture
Answercomments
Eosinophilicoesophagitisisarecentlyrecognisedentityleadingtoepisodic
oesophagealspasm,unlikeothercausesofdysphagiawhichtendtobeconstantor
progressive.Whensuspectedonthehistory,endoscopicbiopsiesarenecessaryto
confirmthediagnosis.Thecauseisunknown.Somepatientsmaybeabletomanage
theconditionwithlifestylemeasures,egmasticatemoreslowlyandavoidcertain
foods.Otherwisetheswallowingofinhaledsteroids,egfluticasone,canbebeneficial.
Previousquestion Nextquestion Markexam

My Masterclass Q18.
Your exam progress
My history A 33-year-old injecting drug user with known chronic hepatitis B presented with 17/30
jaundice, pruritus and confusion. Liver function tests suggested a hepatitic picture. 56.7%
My details Ultrasound examination of the liver and biliary system was unremarkable. Which is
the most likely explanation?
Create exam
A Biliary stones
B Hepatitis C
PACES screencasts
C Hepatitis D
D Hepatitis E
E Hepatocellular carcinoma

My Masterclass Q18.
Question statistics
My history A 33-year-old injecting drug user with known chronic hepatitis B presented with 59.3%
jaundice, pruritus and confusion. Liver function tests suggested a hepatitic picture. of users
My details Ultrasound examination of the liver and biliary system was unremarkable. Which is answered
the most likely explanation? this
Create exam
correctly
A Biliary stones
Your exam progress
B Hepatitis C
C Hepatitis D 60.0%
D Hepatitis E
E Hepatocellular carcinoma
Answer comments
Hepatitis D is a RNA virus, structurally unrelated to hepatitis A, B, or C, that causes an

infection requiring the assistance of hepatitis B virus particles in order to replicate.
Disease manifestations include a self-limited acute infection, acute fulminant liver
failure and end stage liver disease from chronic infection. Since hepatitis D virus is
transmitted by blood and blood products, the risk factors for infection are similar to
hepatitis B virus and infection may occur at the same time as hepatitis B or represent
super-infection; the latter scenario should be suspected in a patient with chronic
hepatitis B whose condition suddenly deteriorates. Diagnosis is usually serological
(IgM antibodies indicate acute infection). Clinical manifestations of acute hepatitis C
are extremely rare (usually within 2 months of exposure to HCV).
Acute hepatitis E is most common in the developing world (tropical climates,

inadequate sanitation, and poor personal hygiene).

My Masterclass Q19.
Your exam progress
My history A 50 year old man gave a two year history of painless watery diarrhoea 5-6 times 18/30
daily. He was otherwise in good health, physical examination was normal, and 60.0%
My details routine blood tests including inflammatory markers and tissue transglutaminase
were unremarkable.
Create exam
What is the likely diagnosis?

A Carcinoid syndrome
PACES screencasts
B Idiopathic bile salt malabsorption
C Irritable bowel syndrome
D Laxative abuse
E Microscopic colitis

My Masterclass Q19.
Question statistics
My history A 50 year old man gave a two year history of painless watery diarrhoea 5-6 times 41.0%
daily. He was otherwise in good health, physical examination was normal, and of users
My details routine blood tests including inflammatory markers and tissue transglutaminase answered
were unremarkable. this
Create exam
correctly
What is the likely diagnosis?
Your exam progress
A Carcinoid syndrome
B Idiopathic bile salt malabsorption 63.3%
C Irritable bowel syndrome
D Laxative abuse
E Microscopic colitis
Answer comments
Idiopathic bile salt malabsorption is a poorly understood entity leading to chronic

watery diarrhoea in an otherwise healthy individual. It is probably due to a loss of
ileal bile salt receptors, leading to interruption of the enterohepatic circulation of bile
salts and an increase in their presence in the colon where they act as a laxative.
Treatment with an anion exchange resin such as colestyramine is usually
dramatically effective.

My Masterclass Q20.
Your exam progress
My history A 78-year-old woman was admitted on take because she was unable to cope at 19/30
home. She said that she felt generally weak, but admitted to no other symptoms. On 63.3%
My details examination she looked as though she has lost a lot of weight and was jaundiced,
but there were no other abnormal physical signs. The most likely diagnosis is:
Create exam
A Carcinoma of the pancreas
B Carcinoma of the stomach
PACES screencasts
C Chronic pancreatitis
D Gall stones
E Lymphoma

My Masterclass Q20.
Question statistics
My history A 78-year-old woman was admitted on take because she was unable to cope at 88.9%
home. She said that she felt generally weak, but admitted to no other symptoms. On of users
My details examination she looked as though she has lost a lot of weight and was jaundiced, answered
but there were no other abnormal physical signs. The most likely diagnosis is: this
Create exam
correctly
A Carcinoma of the pancreas
Your exam progress
B Carcinoma of the stomach
C Chronic pancreatitis 66.7%
D Gall stones
E Lymphoma
Answer comments
Pancreatic carcinoma classically causes painless jaundice, but the absence of pain
does not exclude the diagnosis of gallstones. The other diagnoses listed can all cause
jaundice but are much less likely to be the explanation in this case.
If pancreatic cancer is the diagnosis, then liver blood tests are likely to reveal
elevation of alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT).
Elevation of aspartate transaminase (AST) and alanine transaminase (ALT) will be
less marked, and they may be normal. The key investigation is ultrasonography,
which is likely to reveal dilatation of intra- and extra-hepatic bile ducts. Endoscopic
retrograde cholangiopancreatography (ERCP) or CT scanning should confirm the
diagnosis.

My Masterclass Q21.
Your exam progress
My history An 82-year-old lady is admitted from her residential home with an ischaemic stroke. 20/30
Initial examination showed her to be underweight. Her swallowing was impaired and 66.7%
My details she was put on IV fluids for 2 weeks before feeding was introduced via a nasogastric
tube. Subsequent examination revealed further weight loss and a body index of less
Create exam than 18. Which of the following statements is correct?
Website extension offer A Appetite is reduced with age.
PACES screencasts B Lean body mass in older people is usually increased with age.
C Protein energy malnutrition (PEM) does not increase mortality in

patients with stroke.
D Stroke volume is increased in patients with PEM.
E The rate of weight loss is independent of the catabolic state of the

patient.

My Masterclass Q21.
Question statistics
My history An 82-year-old lady is admitted from her residential home with an ischaemic stroke. 55.8%
Initial examination showed her to be underweight. Her swallowing was impaired and of users
My details she was put on IV fluids for 2 weeks before feeding was introduced via a nasogastric answered
tube. Subsequent examination revealed further weight loss and a body index of less this
Create exam than 18. Which of the following statements is correct? correctly
Website extension offer A Appetite is reduced with age. Your exam progress
PACES screencasts B Lean body mass in older people is usually increased with age. 21/30
70.0%
C Protein energy malnutrition (PEM) does not increase mortality in
patients with stroke.
D Stroke volume is increased in patients with PEM.
E The rate of weight loss is independent of the catabolic state of the

patient.
Answer comments
PEM increases morbidity and mortality in older patients but especially those with
congestive cardiac failure and stroke.
The rate of weight loss is increased in patients who are ill with an increased catabolic
state.
Lean body mass in older people is usually decreased with age.
Appetite is reduced with age Heart rate and stroke volume are decreased with PEM
causing an increased circulatory time.

My Masterclass Q22.
Your exam progress
My history A 50-year-old man presented with diarrhoea, fevers and weight loss, associated with 21/30
progressive weakness of his legs and breathlessness on exertion. Initial examination 70.0%
My details in clinic was unremarkable. Blood tests however revealed a CRP of 100mg/l with a
haemoglobin of 10g/dl but a normal MCV. Chest X-ray and upper GI endoscopy was
Create exam normal but CT of his thorax and abdomen demonstrated a transverse colon cancer
associated with pleural and pericardial effusions. In view of his illness he was
admitted and blood cultures grew Streptococcus bovis. Which is the next most
important investigation in this mans management?
PACES screencasts
A Colonoscopy
B Echocardiography
C MRI Spine
D Pleural aspiration
E Urinalyis

My Masterclass Q22.
Question statistics
My history A 50-year-old man presented with diarrhoea, fevers and weight loss, associated with 66.9%
progressive weakness of his legs and breathlessness on exertion. Initial examination of users
My details in clinic was unremarkable. Blood tests however revealed a CRP of 100mg/l with a answered
haemoglobin of 10g/dl but a normal MCV. Chest X-ray and upper GI endoscopy was this
Create exam normal but CT of his thorax and abdomen demonstrated a transverse colon cancer correctly
associated with pleural and pericardial effusions. In view of his illness he was
admitted and blood cultures grew Streptococcus bovis. Which is the next most Your exam progress
important investigation in this mans management?
A Colonoscopy 73.3%
B Echocardiography
C MRI Spine
D Pleural aspiration
E Urinalyis
Answer comments
This gentleman has bacterial endocarditis secondary to translocation of

Streptococcus bovis from his GI tract. The most life-threatening feature is potential
for valve failure and therefore the most important investigation is echocardiography,
which in this case demonstrated severe aortic valve endocarditis with regurgitation.
Colonoscopy confirmed a malignancy whilst his weakness reflected discitis secondary
to septic embolism. Pleural aspiration was not necessary and urinalysis is of
secondary value in his management (looking for haematuria secondary to immune
complex nephritis). He was commenced on antibiotics (benzylpenicillin and
gentamicin) and underwent emergency aortic valve replacement. In due course near
the end of his antibiotic course he will need a transverse colectomy. His prognosis is
potentially very good.

My Masterclass Q23.
Your exam progress
My history A 35-year-old female teacher is referred for investigation of abnormal liver tests, 22/30
which comprise 2-3 fold elevations in the aminotransferase. There is no history of 73.3%
My details liver disease, and a screen for viral hepatitis is negative. In the trawl of autoantibody
tests, a positive anti-tissue transglutaminase antibody test is highlighted. Which of
Create exam the following statements is TRUE?
Website extension offer A Coeliac disease is recognised as a cause of abnormal liver tests, and
may be associated with inflammatory infiltration of the hepatic portal
PACES screencasts tracts, and progressive liver disease
B The most likely diagnosis is autoimmune hepatitis, which is frequently

associated with a raised serum immunoglobulin level, and a variety of
autoantibodies including anti-tissue transglutaminase
C The presence of a positive tissue transglutaminase antibody is highly

suggestive of a diagnosis of coeliac disease in this context
D There is an association of coeliac disease and Primary Biliary cirrhosis

(PBC)
E There is an association of coeliac disease and primary sclerosing

cholangitis (PSC)

My Masterclass Q23.
Question statistics
My history A 35-year-old female teacher is referred for investigation of abnormal liver tests, 45.6%
which comprise 2-3 fold elevations in the aminotransferase. There is no history of of users
My details liver disease, and a screen for viral hepatitis is negative. In the trawl of autoantibody answered
tests, a positive anti-tissue transglutaminase antibody test is highlighted. Which of this
Create exam the following statements is TRUE? correctly
Website extension offer A Coeliac disease is recognised as a cause of abnormal liver tests, and Your exam progress
may be associated with inflammatory infiltration of the hepatic portal
PACES screencasts tracts, and progressive liver disease 23/30
76.7%
B The most likely diagnosis is autoimmune hepatitis, which is frequently
associated with a raised serum immunoglobulin level, and a variety of
autoantibodies including anti-tissue transglutaminase
C The presence of a positive tissue transglutaminase antibody is highly

suggestive of a diagnosis of coeliac disease in this context
D There is an association of coeliac disease and Primary Biliary cirrhosis

(PBC)
E There is an association of coeliac disease and primary sclerosing

cholangitis (PSC)
Answer comments
A positive tissue transglutaminase antibody is highly suggestive of a diagnosis of

coeliac disease in any context. It is well recognised that liver chemistry may be
abnormal in coeliac disease, and pathologically this may be associated with
inflammatory cell infiltrates. There are also recognised associations between coeliac
disease and PBC and PSC, although there are some discrepancies between different
studies. There is no satisfactory explanation for a link between these conditions.
Autoimmune hepatitis typically is associated with a raised serum immunoglobulin
level, and a variety of autoantibodies against hepatic antigens, as well as a positive
antinuclear antibody and frequently positive smooth muscle antibody.

My Masterclass Q24.
Your exam progress
My history A 48-year old man presented with a two-day history of malaena accompanied by a 23/30
drop in his baseline haemoglobin. He underwent a gastroscopy, which was 76.7%
My details completely normal, followed by a colonoscopy where good views were obtained but
only diverticulosis was seen. He remained haemodynamically stable, but continued to
Create exam pass malaena.

Which investigation is the most appropriate next step?
PACES screencasts A Meckel scan
B Mesenteric angiography
C Push enteroscopy
D Repeat colonoscopy
E Video capsule enteroscopy

My Masterclass Q24.
Question statistics
My history A 48-year old man presented with a two-day history of malaena accompanied by a 61.4%
drop in his baseline haemoglobin. He underwent a gastroscopy, which was of users
My details completely normal, followed by a colonoscopy where good views were obtained but answered
only diverticulosis was seen. He remained haemodynamically stable, but continued to this
Create exam pass malaena. correctly

Which investigation is the most appropriate next step? Your exam progress
PACES screencasts A Meckel scan 24/30
80.0%
B Mesenteric angiography
C Push enteroscopy
D Repeat colonoscopy
E Video capsule enteroscopy
Answer comments
The appropriate next step depends on clinical suspicion, and in this context a repeat
gastroscopy (10-30% miss lesions) or a video capsule enteroscopy would be best. A
repeat colonoscopy is less ideal due to invasiveness of procedure and also the fact
that the prior examination had been satisfactory. Mesenteric angiography works best
when patient has a significant bleed (eg. is hypotensive) and is unlikely to reveal a
lesion in this case. A Meckel scan can be considered in children or young adults, but
less so in this age group.

My Masterclass Q25.
Your exam progress
My history A 72 year old man presented to the Emergency Department following an episode of 24/30
haematemesis. Although clinically stable he was concerned as he has been self 80.0%
My details medicating with some over the counter NSAIDs and had read that these could cause
gastric ulceration. Vital signs were all normal and rectal examination revealed normal
Create exam stool. Blood tests including haemoglobin, platelets, urea and coagulation profile were
all normal. The Glasgow Blatchford Score was calculated to be 0 (zero).
How should he be managed?

PACES screencasts
A Admit for overnight observation
B Admit for same day upper GI endoscopy
C Discharge and arrange urgent outpatient upper GI endoscopy
D Discharge with advice to re-present to the Emergency Department if he

has further haematemesis
E Discharge with reassurance

My Masterclass Q25.
Question statistics
My history A 72 year old man presented to the Emergency Department following an episode of 56.6%
haematemesis. Although clinically stable he was concerned as he has been self of users
My details medicating with some over the counter NSAIDs and had read that these could cause answered
gastric ulceration. Vital signs were all normal and rectal examination revealed normal this
Create exam stool. Blood tests including haemoglobin, platelets, urea and coagulation profile were correctly
all normal. The Glasgow Blatchford Score was calculated to be 0 (zero).
Your exam progress
How should he be managed?
A Admit for overnight observation 83.3%
B Admit for same day upper GI endoscopy
C Discharge and arrange urgent outpatient upper GI endoscopy
D Discharge with advice to re-present to the Emergency Department if he

has further haematemesis
E Discharge with reassurance
Answer comments
The absence of malaena and syncope together with normal blood results suggest a
Glasgow Blatchford Score of 0 and hence the patient can be safely discharged for
outpatient investigation.

My Masterclass Q26.
Your exam progress
My history A 45-year-old man with chronic alcoholic liver disease was admitted following a large 25/30
haematemesis. He was treated with intravenous terlipressin, and urgent endoscopy 83.3%
My details was performed after initial fluid resuscitation and correction of a mild coagulopathy
with fresh frozen plasma. This revealed bleeding oesophageal varices, which were
Create exam injected with sclerosant with apparently good effect.
PACES screencasts Six hours later he had a further 500ml haematemesis, and his blood pressure
dropped from 130/90 mmHgto 90/50 mmHg. In addition to fluid resuscitation,
which would be the most appropriate management?
A Administer 10mg vitamin K intravenously
B Change terlipressin to octreotide
C Insert Sengstaken tube
D Repeat endoscopy and sclerotherapy
E Surgical intervention

My Masterclass Q26.
Question statistics
My history A 45-year-old man with chronic alcoholic liver disease was admitted following a large 59.7%
haematemesis. He was treated with intravenous terlipressin, and urgent endoscopy of users
My details was performed after initial fluid resuscitation and correction of a mild coagulopathy answered
with fresh frozen plasma. This revealed bleeding oesophageal varices, which were this
Create exam injected with sclerosant with apparently good effect. correctly
Website extension offer Your exam progress

PACES screencasts Six hours later he had a further 500ml haematemesis, and his blood pressure 26/30
dropped from 130/90 mmHgto 90/50 mmHg. In addition to fluid resuscitation, 86.7%
which would be the most appropriate management?
A Administer 10mg vitamin K intravenously
B Change terlipressin to octreotide
C Insert Sengstaken tube
D Repeat endoscopy and sclerotherapy
E Surgical intervention
Answer comments
Balloon tamponade is the most effective treatment for control of variceal bleeding if
endoscopic therapy has failed. Even though the varices were bleeding from within
the oesophagus, inflation of the gastric balloon with application of traction usually
stops the bleeding by compressing the vessels as they cross the gastrooesophageal
junction. Rarely, inflation of the oesophageal balloon may be required.

My Masterclass Q27.
Your exam progress
My history A 32 year old man had recently been diagnosed with ulcerative colitis, which was 26/30
steroid responsive but frequently relapsed when the dose was reduced. A limited 86.7%
My details flexible sigmoidoscopy showed erythema, friability and ulcers consistent with mild to
moderate colitis. He was started on azathioprine and his colitis appeared to be
Create exam improving when he suddenly developed acute central abdominal pain and was
admitted to hospital.
What is most likely diagnosis?

PACES screencasts
A Acute hepatitis
B Acute pancreatitis
C Colonic perforation
D Fulminant ulcerative colitis
E Renal colic

My Masterclass Q27.
Question statistics
My history A 32 year old man had recently been diagnosed with ulcerative colitis, which was 73.1%
steroid responsive but frequently relapsed when the dose was reduced. A limited of users
My details flexible sigmoidoscopy showed erythema, friability and ulcers consistent with mild to answered
moderate colitis. He was started on azathioprine and his colitis appeared to be this
Create exam improving when he suddenly developed acute central abdominal pain and was correctly
admitted to hospital.
Your exam progress
What is most likely diagnosis?
A Acute hepatitis 90.0%
B Acute pancreatitis
C Colonic perforation
D Fulminant ulcerative colitis
E Renal colic
Answer comments
Side effects of Azathioprine commonly includes nausea, myeloid suppression,

hepatitis and acute pancreatitis. Azathioprine induced hepatitis often causes
nonspecific symptoms and is recognized on blood monitoring, not as an acute
abdomen.

My Masterclass Q28.
Your exam progress
My history A 20 year old woman with extensive colonic Crohns disease responded well to a 27/30
combination of steroids and mesalazine, but she relapsed each time the dose of 90.0%
My details prednisolone was reduced below 7mg daily.
Create exam What should be done?
Website extension offer A Refer for colectomy
PACES screencasts B Start azathioprine
C Start budesonide
D Start infliximab
E Start methotrexate

My Masterclass Q28.
Question statistics
My history A 20 year old woman with extensive colonic Crohns disease responded well to a 69.8%
combination of steroids and mesalazine, but she relapsed each time the dose of of users
My details prednisolone was reduced below 7mg daily. answered
this
Create exam What should be done?
correctly
Website extension offer A Refer for colectomy

Your exam progress
PACES screencasts B Start azathioprine 28/30
93.3%
C Start budesonide
D Start infliximab
E Start methotrexate
Answer comments
Immunosuppressants are effective and appropriate second line drugs and steroid
sparing agents.

My Masterclass Q29.
Your exam progress
My history A 27 year old man with known ulcerative pancolitis diagnosed eight months 28/30
previously was admitted on the acute medical take with a bowel frequency of 15 93.3%
My details times per day, passing bloody stools. His maintenance medications included
azathioprine 125mg OD and mesalazine 2g OD.
Create exam
He was commenced on intravenous steroids, prophylactic low molecular weight

heparin, and intravenous fluids. Biopsies taken at flexible sigmoidoscopy confirmed
active ulcerative colitis with no evidence of cytomegalovirus infection. Stool cultures
PACES screencasts
were negative.
By day three of his admission his bowel frequency had reduced to 8 times per day
and his C-reactive protein was 54mg/dl.
What is the most appropriate next stage in management?
A Continue current therapy
B Give etanercept
C Increase azathioprine
D Increase mesalazine
E Refer for consideration of colectomy

My Masterclass Q29.
Question statistics
My history A 27 year old man with known ulcerative pancolitis diagnosed eight months 48.2%
previously was admitted on the acute medical take with a bowel frequency of 15 of users
My details times per day, passing bloody stools. His maintenance medications included answered
azathioprine 125mg OD and mesalazine 2g OD. this
Create exam
correctly
He was commenced on intravenous steroids, prophylactic low molecular weight
heparin, and intravenous fluids. Biopsies taken at flexible sigmoidoscopy confirmed Your exam progress
active ulcerative colitis with no evidence of cytomegalovirus infection. Stool cultures
were negative.
96.7%
By day three of his admission his bowel frequency had reduced to 8 times per day
and his C-reactive protein was 54mg/dl.
What is the most appropriate next stage in management?
A Continue current therapy
B Give etanercept
C Increase azathioprine
D Increase mesalazine
E Refer for consideration of colectomy
Answer comments
This man has acute severe colitis which is not responding to medical therapy based
on the Travis criteria assessed on day 3 and needs escalation of therapy to
ciclosporin, infliximab or surgery. Referral to the surgeons is the most appropriate
answer here.

My Masterclass Q30.
Your exam progress
My history A 20-year-old man complains of intermittent epigastric pain for 6 months. He has 29/30
lost 5kg in weight. Which of the following statements are true? 96.7%
My details
A H pylori serology is only effective in confirming eradication success if
Create exam performed at least 4 weeks after treatment.
B 50% of 20-year-olds are infected with Helicobacter pylori in the UK.

PACES screencasts C A 13C urea breath test may be falsely negative if the patient is also
taking non-steroidal anti-inflammatory drugs (NSAIDs).
D A 7-day course of a proton pump inhibitor plus amoxycillin would be

appropriate.
E Gastroscopy is the investigation of choice.
Submit answer Previous question Mark exam

My Masterclass Q30.
Question statistics
My history A 20-year-old man complains of intermittent epigastric pain for 6 months. He has 62.8%
lost 5kg in weight. Which of the following statements are true? of users
My details answered
A H pylori serology is only effective in confirming eradication success if
this
Create exam performed at least 4 weeks after treatment.
correctly
B 50% of 20-year-olds are infected with Helicobacter pylori in the UK.
Your exam progress
PACES screencasts C A 13C urea breath test may be falsely negative if the patient is also 30/30
taking non-steroidal anti-inflammatory drugs (NSAIDs). 100.0%
D A 7-day course of a proton pump inhibitor plus amoxycillin would be
appropriate.
E Gastroscopy is the investigation of choice.
Answer comments
Gastroscopy would be appropriate given the presence of the alarm symptom of

weight loss.
Twenty per cent of 20-year-olds and 50% of 50-year-olds are H pylori positive and
the lifetime risk of duodenal ulcer is up to 10% in these individuals. H pylori produces
a urease which release 13C from orally administered 13C urea which can be
measured in exhaled breath 13CO2.
Proton pump inhibitors reduce H pylori load and may result in false negative tests.
Suitable H pylori eradication regimens include proton pump inhibitor based triple
therapies, usually including amoxycillin (or metronidazole) and clarithromycin. H
pylori antibody levels take many months to fall, so ensuring eradication success is
more appropriate with a urea breath test which can be done 4 weeks after
treatment.
Previous question Mark exam

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My Masterclass exam #59765

Submit answer Next question Mark exam

My Masterclass exam #59765

Next question Mark exam

My Masterclass exam #59765

Website extension offer A Intravenous metronidazole Your exam progress

Approximately 20% of patients with pseudomembranous colitis relapse, usually 2

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Submitanswer Previousquestion Nextquestion Markexam

My Masterclass exam #59765

Website extension offer

C Gastro-oesophageal reflux disease

Eosinophilic oesophagitis is increasingly recognized as a cause for intermittent

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My Masterclass exam #59765

PACES screencasts C IgA anti-endomysial antibody determination is mandatory

D Stool examination is most likely to identify a cause

E The absence of a travel history precludes an infectious aetiology

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My Masterclass exam #59765

E The absence of a travel history precludes an infectious aetiology

In the investigation of diarrhoea, history is very important. Organic disease is more

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My Masterclass exam #59765

Which of her medications is most likely to predispose her to this condition?

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My Masterclass exam #59765

Proton pump inhibitors increase the risk of Clostridium difficile diarrhoea by

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My Masterclass exam #59765

E Variceal sclerotherapy is indicated.

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My Masterclass exam #59765

E Variceal sclerotherapy is indicated.

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My Masterclass exam #59765

Create exam A Abdominal radiograph

Website extension offer B Colonoscopy

PACES screencasts C CT colon

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My Masterclass exam #59765

Website extension offer B Colonoscopy

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My Masterclass exam #59765

PACES screencasts B A positive HAVIgG antibody suggests acute hepatitis A infection.

C Acute hepatitis A has a mortality of 2%.

D Hospital admission is mandatory.

E Pooled human immunoglobulin can be given to close contacts within 2

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My Masterclass exam #59765

D Hospital admission is mandatory.

E Pooled human immunoglobulin can be given to close contacts within 2

Acute hepatitis A is diagnosed on the basis of a positive IgM antibody (IgG is a

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My Masterclass exam #59765

Website extension offer A Adhesions Your exam progress

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My Masterclass exam #59765

Create exam A Alpha-interferon.

Website extension offer B Beta-interferon

PACES screencasts C Lamivudine

E Ribavirin and alpha-interferon