MRCP Part 1 Gastroenterology & Neurology 1

Question 1

A 45-year-old woman presents with jaundice, pruritus, elevated ALP, and positive anti-mitochondrial antibodies (AMA). What is the diagnosis?

Accepted Answer

Primary biliary cholangitis

Answer

Primary biliary cholangitis (PBC, formerly called primary biliary cirrhosis) is an autoimmune cholestatic liver disease characterised by elevated ALP, positive AMA (especially anti-M2), pruritus, and jaundice. It predominantly affects middle-aged women.

Question 2

Which score is used to assess severity and 30-day mortality in acute upper GI bleeding?

Accepted Answer

Glasgow-Blatchford score

Answer

The Glasgow-Blatchford score (GBS) uses clinical and biochemical parameters (blood urea, haemoglobin, pulse, systolic BP, history of liver disease/heart failure, and syncope/melaena) to assess the need for clinical intervention and risk of mortality in acute upper GI bleeding.

Question 3

A 30-year-old man presents with profuse watery diarrhoea, terminal ileum disease on colonoscopy, and perianal fistulae. What is the most likely diagnosis?

Accepted Answer

Crohn's disease

Answer

Crohn's disease is characterised by transmural, discontinuous ('skip lesions') inflammation that can affect any part of the GI tract from mouth to anus, with predominance for the terminal ileum and colon. Perianal disease (fistulae, abscesses) occurs in up to one-third and is highly characteristic of Crohn's.

Question 4

In a patient with oesophageal varices and acute variceal haemorrhage, which pharmacological agent should be given immediately alongside resuscitation?

Accepted Answer

IV terlipressin

Answer

Terlipressin (or octreotide where terlipressin is unavailable) is a vasoconstrictor that reduces portal hypertension by constricting splanchnic vasculature. It should be given immediately in suspected variceal haemorrhage, before endoscopic confirmation, alongside IV fluids, antibiotics (ciprofloxacin/ceftriaxone), and blood products.

Question 5

A patient with long-standing ulcerative colitis undergoes surveillance colonoscopy. Dysplasia is found in a flat non-polypoid area. What is the recommended management?

Accepted Answer

Colectomy

Answer

The detection of flat (non-polypoid) dysplasia in the context of long-standing ulcerative colitis carries a high risk of synchronous or subsequent colorectal cancer. Current guidelines recommend proctocolectomy (colectomy) when flat dysplasia is confirmed by two independent pathologists.

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Gastroenterology & Neurology 1