MRCP Part 1 Gastroenterology and Hepatology

Question 1

A 45-year-old woman presents with jaundice, pruritus, and fatigue.
Blood tests show raised ALP (450 U/L), mildly raised ALT (65 U/L), and positive anti-mitochondrial antibodies (AMA).
What is the most likely diagnosis?

Accepted Answer

Primary biliary cholangitis

Answer

Primary sclerosing cholangitis

Answer

Autoimmune hepatitis

Answer

Drug-induced liver injury

Question 2

A 60-year-old man with a history of alcohol excess presents with haematemesis. Endoscopy shows oesophageal varices with active bleeding. After resuscitation, what is the most appropriate acute pharmacological intervention?

Accepted Answer

Intravenous terlipressin

Answer

Oral propranolol

Answer

Intravenous omeprazole

Answer

Oral lactulose

Question 3

Which serological marker is most specific for coeliac disease?

Accepted Answer

Anti-tissue transglutaminase IgA antibodies

Answer

Anti-gliadin IgG antibodies

Answer

Anti-endomysial IgG antibodies

Answer

Anti-nuclear antibodies

Question 4

A patient with ulcerative colitis presents with 8 bloody stools per day, pulse 110 bpm, temperature 38.5 degrees C, and CRP of 85 mg/L. How would you classify this flare according to the Truelove and Witts criteria?

Accepted Answer

Severe

Answer

Mild

Answer

Moderate

Answer

In remission

Question 5

A 35-year-old man presents with epigastric pain and a duodenal ulcer is found on endoscopy. CLO test is positive. What is the recommended first-line eradication therapy in the UK?

Accepted Answer

PPI, amoxicillin, and clarithromycin for 7 days

Answer

PPI and amoxicillin for 14 days

Answer

Bismuth quadruple therapy

Answer

PPI, metronidazole, and levofloxacin

Question 6

Which investigation is the gold standard for diagnosing chronic pancreatitis when cross-sectional imaging is equivocal?

Accepted Answer

Endoscopic ultrasound (EUS)

Answer

Serum amylase

Answer

Faecal elastase

Answer

Plain abdominal X-ray