MRCP Part 1 Gastroenterology and Hepatology 2

Question 1

A 50-year-old man with known cirrhosis presents with increasing abdominal distension.
Diagnostic ascitic tap shows a serum-ascites albumin gradient (SAAG) of 18 g/L and ascitic fluid neutrophil count of 350 cells/mm3.
What is the most likely diagnosis?

Accepted Answer

Spontaneous bacterial peritonitis

Answer

Portal hypertensive ascites without infection

Answer

Tuberculous peritonitis

Answer

Pancreatic ascites

Question 2

A patient presents with dysphagia to solids and liquids from onset, with a bird's beak appearance on barium swallow. Manometry shows absent peristalsis and failure of LOS relaxation. What is the diagnosis?

Accepted Answer

Achalasia

Answer

Oesophageal carcinoma

Answer

Diffuse oesophageal spasm

Answer

Benign oesophageal stricture

Question 3

Which liver condition is most commonly associated with ulcerative colitis?

Accepted Answer

Primary sclerosing cholangitis

Answer

Primary biliary cholangitis

Answer

Autoimmune hepatitis

Answer

Non-alcoholic fatty liver disease

Question 4

A 40-year-old woman presents with abdominal pain and diarrhoea. Colonoscopy shows skip lesions with cobblestoning and non-caseating granulomas on biopsy. Where else might you expect to find disease?

Accepted Answer

Anywhere from mouth to anus

Answer

Colon and rectum only

Answer

Small bowel only

Answer

Oesophagus only

Question 5

A patient with known hepatitis B has the following serology: HBsAg positive, HBeAg negative, anti-HBe positive, HBV DNA 1500 IU/mL, ALT normal. What phase of hepatitis B is this?

Accepted Answer

Inactive carrier (HBeAg-negative chronic infection)

Answer

Immune tolerant phase

Answer

Immune active phase (HBeAg-positive chronic hepatitis)

Answer

HBeAg-negative chronic hepatitis

Question 6

What is the most appropriate surveillance strategy for a patient with Barrett's oesophagus without dysplasia?

Accepted Answer

Endoscopy with quadrantic biopsies every 2-3 years

Answer

Annual CT scan of the chest

Answer

No surveillance needed

Answer

Endoscopy every 6 months