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 biliary cholangitis (PBC, formerly primary biliary cirrhosis) characteristically presents in middle-aged women with cholestatic liver enzymes (raised ALP) and positive anti-mitochondrial antibodies (AMA), which are present in over 95% of cases. Pruritus and fatigue are common symptoms.

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

Terlipressin (a vasopressin analogue) reduces portal pressure by causing splanchnic vasoconstriction and is the recommended first-line vasoactive drug for acute variceal bleeding. It should be started as soon as variceal bleeding is suspected, even before endoscopy, according to NICE guidelines.

Question 3

Which serological marker is most specific for coeliac disease?

Accepted Answer

Anti-tissue transglutaminase IgA antibodies

Answer

Anti-tissue transglutaminase (anti-tTG) IgA antibodies are the recommended first-line serological test for coeliac disease, with sensitivity >95% and specificity >95%. Total IgA should be checked simultaneously as IgA deficiency is more common in coeliac disease and causes false negatives.

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

Truelove and Witts criteria classify UC flares as severe when patients have 6 or more bloody stools per day PLUS at least one systemic feature: pulse >90 bpm, temperature >37.8 degrees C, Hb <10.5 g/dL, or ESR/CRP >30. This patient meets multiple severe criteria.

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

NICE recommends triple therapy with a PPI, amoxicillin 1g BD, and clarithromycin 500mg BD for 7 days as first-line H. pylori eradication in the UK. If penicillin allergic, metronidazole replaces amoxicillin.

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Gastroenterology and Hepatology