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CPD
SELF-ASSESSMENT
Self-assessment/CPD This CPD section was prepared by Eric Beck
Questions
We hope you enjoy the CPD section. Let us know your views by email to: [email protected]
FRCP FRCP(Ed) FRCP(Gl)
Select the ONE single best answer from the five alternatives:
1 Regarding the complications of infectious diarrhoea the following condition is CORRECTLY paired with the causative organism: A GuillaineBarre syndrome (GBS) AND Shigella spp. B
Haemolytic uraemic Campylobacter jejuni
C
Haemolytic uraemic syndrome (HUS) AND enterotoxigenic E. coli (ETEC)
D
Reiter’s syndrome AND Clostridium difficile
E
septic arthritis in HLA B27 patients AND Salmonella
syndrome
(HUS)
A
defects in production of immunoglobulin (IgA) increase the risk of developing coeliac disease (CD)
B
in HIV infection intra-epithelial CD8 lymphocyte effect or cells are the first to be destroyed
C
treatment with highly-active antiretroviral therapy (HAART) of HIV positive patients results in recolonization of the gut intra-epithelial lymphocytes
D
organisms causing gut infection in the immunocompromised are more virulent than those found in the immunocompetent
E
searching for cysts in the stools is a more sensitive diagnostic test for Giardia lamblia in the immunocompromised than detection of giardia antigen
C
he should be referred to the dietician to devise an exclusion diet to try and identify foods that might be provoking his symptoms
D
in view of his aversion to allotherapy he should be referred for hypnotherapy
E
he should undergo colonoscopy
4 Regarding small intestinal and colonic motility in various gastrointestinal disorders it is NOT TRUE that:
3 A 51-year-old man had a 10-week history of diarrhoea. He was passing 3e4 loose stools each morning instead of a single formed one. This was associated with urgency and a fear that he might be incontinent travelling on the bus to work. There was no pain but he felt bloated and nauseated at times which was partly relieved by passing flatus or belching. He was aware of borborygmi. There had been no weight loss and his appetite remained good though the hot curries he enjoyed now seemed to provoke his symptoms. He had been well in the past but worried on recalling that his maternal grandmother had died of colon cancer. Four months ago he had been made redundant after 15 years as a computer programmer. He was not on any medication but believed that homoeopathic remedies were best as they did not cause side effects. There were no abnormal findings on general or rectal examination. His GP made a provisional diagnosis of irritable bowel syndrome (IBS) and referred him to the Gastroenterology Clinic. Regarding his management it is TRUE that:
A
a decreased number of interstitial cells of Cajal (ICCs) in the wall of the small bowel has been demonstrated in slow transit constipation (STC)
B
probiotic treatment of IBS alters gut motility by modulation of hydrogen sulphide (H2S) production by gut microbes
C
slowed colonic transit time is an invariable finding in ‘idiopathic’ constipation
D
in systemic sclerosis (SS) involving the small bowel bacterial overgrowth exacerbates the symptoms of chronic intestinal pseudo-obstruction (CIPO)
E
in post operative ileus (POI) delayed dysmotility at sites remote from the manipulated bowel is immunologically mediated
5 Regarding the treatment of ulcerative colitis (UC) it is TRUE that: A
in active proctitis corticosteroid foam is more effective than 5-amino salicyclic acid (5-ASA) suppositories in inducing remission
B
5-amino salicyclic acid (5-ASA) is superior to azathioprine as maintenance therapy in steroid dependent patients
C
successful second-line treatment with ciclosporin needs to be followed by its long term use to prevent relapse
D
the risk of azathioprine induced bone marrow suppression can be predicted by deficiency of thiopurine methyl transferase enzyme (TPMT)
E
when total colectomy is necessary in a young man colectomy with ileo-rectal anastamosis is preferred to proctocolectomy with ileo-anal pouch (IPAA) because of the cumulative risk of pouchitis and pouch failure
For the answers and for more questions and answers, go to:
he fulfils the internationally accepted criteria for the diagnosis of IBS (Rome III 2006)
MEDICINE 39:4
he does not have any alarm features to question the diagnosis of IBS
AND
2 Regarding gut manifestations in immunodeficient states it is TRUE that:
A
B
www.medicinecpd.co.uk
242
.
Self-assessment/CPD This CPD section was prepared by Eric Beck
Questions
We hope you enjoy the CPD section. Let us know your views by email to: [email protected]
FRCP FRCP(Ed) FRCP(Gl)
Select the ONE single best answer from the five alternatives:
1 Regarding the complications of infectious diarrhoea the following condition is CORRECTLY paired with the causative organism: A GuillaineBarre syndrome (GBS) AND Shigella spp. B
Haemolytic uraemic Campylobacter jejuni
C
Haemolytic uraemic syndrome (HUS) AND enterotoxigenic E. coli (ETEC)
D
Reiter’s syndrome AND Clostridium difficile
E
septic arthritis in HLA B27 patients AND Salmonella
syndrome
(HUS)
A
defects in production of immunoglobulin (IgA) increase the risk of developing coeliac disease (CD)
B
in HIV infection intra-epithelial CD8 lymphocyte effect or cells are the first to be destroyed
C
treatment with highly-active antiretroviral therapy (HAART) of HIV positive patients results in recolonization of the gut intra-epithelial lymphocytes
D
organisms causing gut infection in the immunocompromised are more virulent than those found in the immunocompetent
E
searching for cysts in the stools is a more sensitive diagnostic test for Giardia lamblia in the immunocompromised than detection of giardia antigen
C
he should be referred to the dietician to devise an exclusion diet to try and identify foods that might be provoking his symptoms
D
in view of his aversion to allotherapy he should be referred for hypnotherapy
E
he should undergo colonoscopy
4 Regarding small intestinal and colonic motility in various gastrointestinal disorders it is NOT TRUE that:
3 A 51-year-old man had a 10-week history of diarrhoea. He was passing 3e4 loose stools each morning instead of a single formed one. This was associated with urgency and a fear that he might be incontinent travelling on the bus to work. There was no pain but he felt bloated and nauseated at times which was partly relieved by passing flatus or belching. He was aware of borborygmi. There had been no weight loss and his appetite remained good though the hot curries he enjoyed now seemed to provoke his symptoms. He had been well in the past but worried on recalling that his maternal grandmother had died of colon cancer. Four months ago he had been made redundant after 15 years as a computer programmer. He was not on any medication but believed that homoeopathic remedies were best as they did not cause side effects. There were no abnormal findings on general or rectal examination. His GP made a provisional diagnosis of irritable bowel syndrome (IBS) and referred him to the Gastroenterology Clinic. Regarding his management it is TRUE that:
A
a decreased number of interstitial cells of Cajal (ICCs) in the wall of the small bowel has been demonstrated in slow transit constipation (STC)
B
probiotic treatment of IBS alters gut motility by modulation of hydrogen sulphide (H2S) production by gut microbes
C
slowed colonic transit time is an invariable finding in ‘idiopathic’ constipation
D
in systemic sclerosis (SS) involving the small bowel bacterial overgrowth exacerbates the symptoms of chronic intestinal pseudo-obstruction (CIPO)
E
in post operative ileus (POI) delayed dysmotility at sites remote from the manipulated bowel is immunologically mediated
5 Regarding the treatment of ulcerative colitis (UC) it is TRUE that: A
in active proctitis corticosteroid foam is more effective than 5-amino salicyclic acid (5-ASA) suppositories in inducing remission
B
5-amino salicyclic acid (5-ASA) is superior to azathioprine as maintenance therapy in steroid dependent patients
C
successful second-line treatment with ciclosporin needs to be followed by its long term use to prevent relapse
D
the risk of azathioprine induced bone marrow suppression can be predicted by deficiency of thiopurine methyl transferase enzyme (TPMT)
E
when total colectomy is necessary in a young man colectomy with ileo-rectal anastamosis is preferred to proctocolectomy with ileo-anal pouch (IPAA) because of the cumulative risk of pouchitis and pouch failure
For the answers and for more questions and answers, go to:
he fulfils the internationally accepted criteria for the diagnosis of IBS (Rome III 2006)
MEDICINE 39:4
he does not have any alarm features to question the diagnosis of IBS
AND
2 Regarding gut manifestations in immunodeficient states it is TRUE that:
A
B
www.medicinecpd.co.uk
242
.