The Specialty certificate in Gastroenterology SCE covers the whole of the curriculum of the specialty training in gastroenterology in the UK. Preparation for this exam requires a wide breadth of knowledge around the curriculum . As knowledge is constantly advancing , awareness of current and updated guidelines is important.This blog is an attempt to pool all resources in one site with regular updates.
Dr Elmuhtady Said
Curriculum for Specialty Certificate Examination in Gastroenterology
A 47-year-old male presents with shortness of breath. He has cirrhosis secondary to Hepatitis C infection. He gives a chronic history of progressive shortness of breath on exertion, and now gets short of breath walking up steps. He gives a history of being more short of breath whilst sitting up, preferring to sleep with no pillows. The blood pressure is 110/70, heart rate 85 beats per minute, and pulse oximetry, breathing room air, shows saturations of 95% lying flat and 87% sitting up. Which of the following tests is the most appropriate to confirm the diagnosis? (Please select 1 option) 1-Contrast echocardiography 2-High resolution CT chest 3-MRI chest 4-Pulmonary angiography 5-V:Q scan This patient has hepatopulmonary syndrome. Platypnoea and orthodexia are typical of this syndrome. A >5% desaturation on sitting up is very suggestive of this condition which complicates liver cirrhosis, and is characterised by pulmonary arteriovenous malformations. Contrast echo is the diagnostic tool of choice. Visualization of late-appearing bubbles in the left atrium following the injection of agitated saline is strongly suggestive of a pulmonary arteriovenous shunt.
A 58-year-old man attends your clinic with irritable bowel syndrome. He has been fully investigated in the past and now he is being managed with lifestyle advice. He has tried reducing the amount of fibre in his diet but this has made his symptoms worse. He lists a range of foods that he enjoys eating. Which of these foods would you advise him to eat more of to increase his fibre intake? (Please select 1 option) 1-Bran 2-Green leafy vegetables 3-Oats 4- Seeds and nuts 5-Whole wheat biscuits
The intake of fibre should be reviewed in people with irritable bowel syndrome, adjusting (usually downwards) and monitoring symptoms. They should be discouraged from eating insoluble fibre. If an increase is advised then this should be in the form of soluble fibre such as oats. The other sources of fibre in the options are all rich in insoluble fibre.
A 60-year-old man has many features of the carcinoid syndrome. You suspect a malignant carcinoid syndrome - most likely of gastrointestinal origin. What is the most likely origin of malignant carcinoid tumours of the gastrointestinal tract? (Please select 1 option) 1-Colon 2-Duodenum 3-Ileum 4-Jejunum 5-Stomach
The ileum is the most likely origin of malignant carcinoid tumours of the gastrointestinal tract.
A 50-year-old man complains of chest pain and dysphagia. Manometry reveals prolonged, repetitive and high amplitude contractions. The lower oesophageal sphincter pressure is increased and there is incomplete relaxation of the sphincter. What is the most likely diagnosis? (Please select 1 option) 1- Achalasia 2- Barrett's oesophagus 3-Diffuse oesophageal spasm 4- Hypertensive lower oesophageal sphincter 5-Scleroderma
This is most likely to be diffuse oesophageal spasm. The manometry findings are typical. Achalasia typically causes absence of peristalsis in the body of the oesophagus.
In hypertensive lower oesophageal sphincter, the lower oesophageal sphincter pressure is high but oesophageal contractions in the body of the oesophagus are normal.
Which of the following stimulates bicarbonate secretion from the pancreas and liver? (Please select 1 option) 1-Cholecystokinin (CCK) 2-Gastrin 3-Motilin 4-Secretin 5-Vasoactive intestinal peptide (VIP)
Secretin is secreted from the small intestine when there is acid in the small intestine. It inhibits gastric motility and acid production, and stimulates bicarbonate secretion from the pancreas and liver.
A patient is referred to hepatology department for possible treatment of hepatitis B. He has stigmata of chronic liver disease. There is portal hypertension and ascites. His INR is 2.2 (<1.4) and albumin 25 g/L (37-49). HBsAg and HBeAg positive. Hepatitis C screen is negative. What will you suggest for treatment? (Please select 1 option) 1-Beta interferon 2-Lamivudine alone 3-Lamivudine plus interferon 4-Ribavarin alone 5-Ribavarin plus interferon
Interferon cannot be used in this case as it can initially worsen hepatic decompensation.
Lamivudine alone is safe in decompensated HBV infection.
Ribavirin is used for hepatitis C infection. Its combination with interferon confers more success in treating HCV infection.
I have long felt a special connection with herbal medicine. First, it's natural, Charlie attended the same small college in Southern California - Claremont Men's College - although he dropped out of school to enroll in the Julliard School of Performing Arts in New York. York. Had he been to Claremont, he would have been senior the year I started there; I often thought that was the reason he was gone when he discovered that I had herpes. So, my life was lonely, all day, I could not stand the pain of the outbreak, and then Tasha introduced me to Dr. Itua who uses her herbal medicines to cure her two weeks of consumption. I place an order for him and he hands it to my post office, then I pick it up and use it for two weeks. All my wound is completely healed no more epidemic. I tell you honestly that this man is a great man, I trust him Herbal medicine so much that I share this to show my gratitude and also to let sick people know that there is hope with Dr. Itua. Herbal Phytotherapy.Dr Itua Contact Email.drituaherbalcenter@gmail.com/Whatsapp ... 2348149277967 He cures. Herpes, Prostate Breast Cancer Brain Cancer CEREBRAL VASCULAR ACCIDENT. ,Endomertil Cancer, cerebrovascular diseases Hepatitis,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease, Dementia.Tach Disease,Shingles, Lung Cancer, Leukemia Lymphoma Cancer, Lung Mesothelioma Asbestos, Ovarian Cervical Uterine Cancer, Skin Cancer, Brain Tumor, H.P.V TYPE 1 TYPE 2 TYPE 3 AND TYPE 4. TYPE 5. HIV,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity Cervical Cancer Colo-rectal Cancer Blood Cancer SYPHILIS. Diabetes Liver / Inflammatory kidney Epilepsy
A 47-year-old male presents with shortness of breath. He has cirrhosis secondary to Hepatitis C infection. He gives a chronic history of progressive shortness of breath on exertion, and now gets short of breath walking up steps. He gives a history of being more short of breath whilst sitting up, preferring to sleep with no pillows. The blood pressure is 110/70, heart rate 85 beats per minute, and pulse oximetry, breathing room air, shows saturations of 95% lying flat and 87% sitting up.
ReplyDeleteWhich of the following tests is the most appropriate to confirm the diagnosis?
(Please select 1 option)
1-Contrast echocardiography
2-High resolution CT chest
3-MRI chest
4-Pulmonary angiography
5-V:Q scan
This patient has hepatopulmonary syndrome. Platypnoea and orthodexia are typical of this syndrome. A >5% desaturation on sitting up is very suggestive of this condition which complicates liver cirrhosis, and is characterised by pulmonary arteriovenous malformations. Contrast echo is the diagnostic tool of choice. Visualization of late-appearing bubbles in the left atrium following the injection of agitated saline is strongly suggestive of a pulmonary arteriovenous shunt.
A 58-year-old man attends your clinic with irritable bowel syndrome. He has been fully investigated in the past and now he is being managed with lifestyle advice.
ReplyDeleteHe has tried reducing the amount of fibre in his diet but this has made his symptoms worse. He lists a range of foods that he enjoys eating. Which of these foods would you advise him to eat more of to increase his fibre intake?
(Please select 1 option)
1-Bran
2-Green leafy vegetables
3-Oats
4- Seeds and nuts
5-Whole wheat biscuits
The intake of fibre should be reviewed in people with irritable bowel syndrome, adjusting (usually downwards) and monitoring symptoms. They should be discouraged from eating insoluble fibre. If an increase is advised then this should be in the form of soluble fibre such as oats. The other sources of fibre in the options are all rich in insoluble fibre.
A 60-year-old man has many features of the carcinoid syndrome. You suspect a malignant carcinoid syndrome - most likely of gastrointestinal origin.
ReplyDeleteWhat is the most likely origin of malignant carcinoid tumours of the gastrointestinal tract?
(Please select 1 option)
1-Colon
2-Duodenum
3-Ileum
4-Jejunum
5-Stomach
The ileum is the most likely origin of malignant carcinoid tumours of the gastrointestinal tract.
A 50-year-old man complains of chest pain and dysphagia. Manometry reveals prolonged, repetitive and high amplitude contractions. The lower oesophageal sphincter pressure is increased and there is incomplete relaxation of the sphincter.
ReplyDeleteWhat is the most likely diagnosis?
(Please select 1 option)
1- Achalasia
2- Barrett's oesophagus
3-Diffuse oesophageal spasm
4- Hypertensive lower oesophageal sphincter
5-Scleroderma
This is most likely to be diffuse oesophageal spasm. The manometry findings are typical. Achalasia typically causes absence of peristalsis in the body of the oesophagus.
In hypertensive lower oesophageal sphincter, the lower oesophageal sphincter pressure is high but oesophageal contractions in the body of the oesophagus are normal.
Which of the following stimulates bicarbonate secretion from the pancreas and liver?
ReplyDelete(Please select 1 option)
1-Cholecystokinin (CCK)
2-Gastrin
3-Motilin
4-Secretin
5-Vasoactive intestinal peptide (VIP)
Secretin is secreted from the small intestine when there is acid in the small intestine. It inhibits gastric motility and acid production, and stimulates bicarbonate secretion from the pancreas and liver.
A patient is referred to hepatology department for possible treatment of hepatitis B.
ReplyDeleteHe has stigmata of chronic liver disease. There is portal hypertension and ascites. His INR is 2.2 (<1.4) and albumin 25 g/L (37-49). HBsAg and HBeAg positive. Hepatitis C screen is negative.
What will you suggest for treatment?
(Please select 1 option)
1-Beta interferon
2-Lamivudine alone
3-Lamivudine plus interferon
4-Ribavarin alone
5-Ribavarin plus interferon
Interferon cannot be used in this case as it can initially worsen hepatic decompensation.
Lamivudine alone is safe in decompensated HBV infection.
Ribavirin is used for hepatitis C infection. Its combination with interferon confers more success in treating HCV infection.
I have long felt a special connection with herbal medicine. First, it's natural, Charlie attended the same small college in Southern California - Claremont Men's College - although he dropped out of school to enroll in the Julliard School of Performing Arts in New York. York. Had he been to Claremont, he would have been senior the year I started there; I often thought that was the reason he was gone when he discovered that I had herpes. So, my life was lonely, all day, I could not stand the pain of the outbreak, and then Tasha introduced me to Dr. Itua who uses her herbal medicines to cure her two weeks of consumption. I place an order for him and he hands it to my post office, then I pick it up and use it for two weeks. All my wound is completely healed no more epidemic. I tell you honestly that this man is a great man, I trust him Herbal medicine so much that I share this to show my gratitude and also to let sick people know that there is hope with Dr. Itua. Herbal Phytotherapy.Dr Itua Contact Email.drituaherbalcenter@gmail.com/Whatsapp ... 2348149277967
ReplyDeleteHe cures.
Herpes,
Prostate
Breast Cancer
Brain Cancer
CEREBRAL VASCULAR ACCIDENT.
,Endomertil Cancer, cerebrovascular diseases
Hepatitis,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,
Dementia.Tach Disease,Shingles,
Lung Cancer, Leukemia Lymphoma Cancer,
Lung Mesothelioma Asbestos,
Ovarian Cervical Uterine Cancer,
Skin Cancer, Brain Tumor,
H.P.V TYPE 1 TYPE 2 TYPE 3 AND TYPE 4. TYPE 5.
HIV,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
Cervical Cancer
Colo-rectal Cancer
Blood Cancer
SYPHILIS.
Diabetes
Liver / Inflammatory kidney
Epilepsy