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

Spontaneous bacterial peritonitis (SBP) is diagnosed when ascitic fluid neutrophil count exceeds 250 cells/mm3 in the absence of a surgically treatable intra-abdominal source. The high SAAG (>11 g/L) confirms portal hypertension as the cause of ascites. SBP requires immediate empirical antibiotics (IV cefotaxime).

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

Achalasia presents with dysphagia to both solids and liquids from onset (unlike mechanical obstruction which starts with solids). The bird's beak sign on barium swallow, absent peristalsis, and failure of lower oesophageal sphincter (LOS) relaxation on manometry are diagnostic.

Question 3

Which liver condition is most commonly associated with ulcerative colitis?

Accepted Answer

Primary sclerosing cholangitis

Answer

Primary sclerosing cholangitis (PSC) is strongly associated with ulcerative colitis, with approximately 70-80% of PSC patients having coexisting UC. PSC causes progressive fibrosis and stricturing of intra- and extrahepatic bile ducts, shown by the characteristic beaded appearance on MRCP.

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

Crohn's disease can affect any part of the gastrointestinal tract from mouth to anus, though the terminal ileum and colon are most commonly affected. The skip lesions (normal bowel between affected segments), cobblestoning, and non-caseating granulomas are characteristic histological features.

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

The inactive carrier phase is characterised by HBsAg positive, HBeAg negative, anti-HBe positive, low HBV DNA (<2000 IU/mL), and persistently normal ALT. These patients have low risk of disease progression but require regular monitoring as reactivation can occur.

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Gastroenterology and Hepatology 2