Best of Five MCQs for the European Specialty Examination
in Gastroenterology and Hepatology
Second edition
Edited by
Dr Thomas Marjot BSc (Hons), MBBS, MRCP(UK)
Specialist Registrar, Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
Dr Colleen G C McGregor BSc (Hons), MBBS, MRCP(UK)
Specialist Registrar, Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
Dr Tim Ambrose BSc (Hons), MBChB, MRCP(UK), DPhil
Consultant Gastroenterologist, Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
Consultant Editors
Dr Aminda N De Silva BSc (Hons), MBBS, FRCP
Consultant Gastroenterologist, Royal Berkshire NHS Foundation Trust, Reading, UK
Dr Jeremy Cobbold MA, PhD, FRCP
Consultant Hepatologist, Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Professor Simon Travis DPhil, FRCP, MA (Hon)
Professor of Clinical Gastroenterology, Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
3
Great Clarendon Street, Oxford, OX2 6DP, United Kingdom
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First Edition published in 203 Second Edition published in 202
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ISBN 978–0–9–883437–3
DOI: 10.1093/oso/9780198834373.001.0001
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Dedicated to Professor Satish Keshav—clinician, academic, mentor, and friend. He taught us all how to think outside the box.
CONTRIBUTORS
Khansa Adam
LAS Gastroenterology, Royal Berkshire NHS Foundation Trust Reading, UK
Sophie Arndtz
Specialist Registrar, Royal Berkshire NHS Foundation Trust Reading, UK
Homira Ayubi
Clinical Fellow, Milton Keynes University Hospital NHS Foundation Trust Milton Keynes, UK
Vincent T. F. Cheung
Clinical Research Fellow, Translational Gastroenterology Unit, John Radcliffe Hospital Oxford, UK
Emma L. Culver
Consultant Hepatologist, Translational Gastroenterology Unit, John Radcliffe Hospital Oxford, UK
Michael FitzPatrick
Clinical Research Fellow, Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford Oxford, UK
David J. Harman
Specialist Registrar, Oxford University Hospitals NHS Foundation Trust Oxford, UK
Omar Herman
Specialist Registrar, Royal Berkshire NHS Foundation Trust Reading, UK
Arif Hussenbux
Specialist Registrar, Oxford University Hospitals NHS Foundation Trust Oxford, UK
Kate Lynch
Clinical Research Fellow, Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford Oxford, UK
Charis D. Manganis
Specialist Registrar, Oxford University Hospitals NHS Foundation Trust Oxford, UK
Rory Peters
Clinical Research Fellow, Translational Gastroenterology Unit, John Radcliffe Hospital Oxford, UK
Rahul P. Ravindran
Academic Clinical Fellow, Translational Gastroenterology Unit, John Radcliffe Hospital Oxford, UK
Emmanuel A. Selvaraj
Clinical Research Fellow, Oxford University Hospitals NHS Foundation Trust Oxford, UK
Shahana Shahid
Specialist Registrar, Oxford University Hospitals NHS Foundation Trust Oxford, UK
ABBREVIATIONS
5-ASA 5-aminosalicylate
5-HT4 5-hydroxytryptamine type 4 receptor
AATD alpha--antitrypsin deficiency
Ach acetylcholine
ADM adenomyomatosis
AE adverse event
AF atrial fibrillation
AFLP acute fatty liver of pregnancy
AFP alpha-fetoprotein
AH alcoholic hepatitis
AIDS acquired immunodeficiency syndrome
AIN anal intraepithelial neoplasia
AIP autoimmune pancreatitis type
AKI acute kidney injury
ALD alcohol related liver disease
ALF acute liver failure
ALP alkaline phosphatase
ALT alanine aminotransferase
AMA antimitochondrial antibody
AN anorexia nervosa
ANA antinuclear antibody
ANC acute necrotic collection
ANCA anti-neutrophil cytoplasmic antibody
Anti-TNF anti-tumour necrosis factor
Anti-TTG anti-tissue transglutaminase antibody
APC argon plasma coagulation
APFC acute peripancreatic fluid collections
ARM anorectal manometry
AS anastomotic
ASC acute severe colitis
AST aspartate transaminase
ASUC acute severe ulcerative colitis
ATN acute tubular necrosis
AWS alcohol withdrawal syndrome
BAM bile acid malabsorption
BCLC Barcelona clinic liver cancer
BFT biofeedback therapy
BMI body mass index
BTI botulinum toxin injection
BWT bowel wall thickness
BZD benzodiazepine
CA coeliac axis
CACRC colitis-associated colorectal cancer
CASR calcium-sensing receptor
CBD common bile duct
CCK cholecystokinin
CD Crohn’s disease
CDI Clostridioides difficile infection
CE capsule endoscopy
CE cystic echinococcosis
CFTR cystic fibrosis transmembrane conductance regulator
CHB chronic HBV infection
CHD common hepatic duct
CHS cannabis hyperemesis syndrome
CI confidence interval
CLD chronic liver disease
CMV cytomegalovirus
COPD chronic obstructive pulmonary disease
CP chronic pancreatitis
CRC colorectal cancer
CrCl creatinine clearance
CRP C-reactive protein
CSF cerebrospinal fluid
CSPH clinically significant portal hypertension
CTP Child-Turcotte-Pugh (score)
CTZ chemoreceptor trigger zone
CVID common variable immunodeficiency
CYP cytochrome P450
DAA direct-acting antiviral
DCI distal contractile integral
DEXA dual energy x-ray absorptiometry
DILI drug-induced liver injury
DOC dual-operator cholangioscopy
DS dominant strictures
EASL European Association for the Study of the Liver
ECCO European Crohn’s and Colitis Organisation
ECG electrocardiogram
EDS early dumping syndrome
EEG electroencephalography
EEN exclusive enteral nutrition
EIM extra-intestinal manifestation
ELF enhanced liver fibrosis
ELT emergency liver transplantation
EMR endoscopic mucosal resection
EOE eosinophilic oesophagitis
ERCP endoscopic retrograde cholangiopancreatography
ESBGH European Section and Board of Gastroenterology and Hepatology Examination
ESD endoscopic submucosal dissection
ESEGH European Specialty Examination in Gastroenterology & Hepatology
ESGE European Society of Gastrointestinal Endoscopy
ESMO European Society of Medical Oncology
ESWL extracorporeal shockwave lithotripsy
EUS endoscopic ultrasound
EVL endoscopic variceal ligation
FAP familial adenomatous polyposis
FDR first-degree relative
FE faecal elastase
FENa fraction of excreted sodium
FGP fundic gland polyps
FI faecal incontinence
FNA fine-needle aspiration
GAVE gastric antral vascular ectasia
GC gastric cancer
GDH glutamate dehydrogenase
GI gastrointestinal
GIP gastric inhibitory polypeptide
GIST gastrointestinal stromal tumour
GLP-2 glucagon-like peptide 2
GORD gastro-oesophageal reflux disease
GOV gastro-oesophageal varices
GTN topical glyceryl trinitrate
GWAS genome-wide association studies
HA hepatic artery
HAART highly active antiretroviral therapy
HAS hepatic artery stenosis
HAT hepatic artery thrombosis
HBV hepatitis B virus
HCC hepatocellular carcinoma
HCV hepatitis C virus
HDGC hereditary diffuse gastric cancer
HDV hepatitis D
hEDS hypermobile-type Ehlers-Danlos syndrome
HELLP haemolysis, elevated liver enzymes, and low platelets
HFE-HC HFE haemochromatosis
HLA human leukocyte antigen
HNPCC hereditary non-polyposis colorectal cancer
HPS hepatopulmonary syndrome
HPV human papilloma viruses
HR heart rate
HRS–AKI hepatorenal syndrome–acute kidney injury
HVPG hepatic venous pressure gradient
IAP International Association of Pancreatology
IBD inflammatory bowel disease
IBS irritable bowel syndrome
IBS-C irritable bowel syndrome with predominant constipation
ICP intrahepatic cholestasis of pregnancy
IEL intraepithelial lymphocytes
IFX infliximab
IgA TTG immunoglobin A tissue transglutaminase antibody
IgG4-RD IgG4-related disease
IGV isolated gastric varices
IM intestinal metaplasia
IOP interstitial oedematous pancreatitis
IPAA ileal pouch anal anastomosis
IPMN intraductal papillary mucinous neoplasm
IPVD intrapulmonary vascular dilatations
IRP integrated relaxation pressure
ISDE International Society for Diseases of the Esophagus
IUS intestinal ultrasound
JPS juvenile polyposis syndrome
JVP jugular venous pressure
KF Kayser–Fleischer
LDS late dumping syndrome
LG lymphocytic gastritis
LGV chlamydia lymphogranuloma venereum
LHM laparoscopic Heller myotomy
LMWH low molecular weight heparin
LPAC low-phospholipid associated cholelithiasis
LS lynch syndrome
LSM liver stiffness measurement
LT liver transplantation
MAP MUTYH-associated polyposis
MARSIPAN management of really sick patients with anorexia nervosa
MCV mean corpuscular volume
MD Ménétrier’s disease
MDMA 3,4-methyl-enedioxy-methamphetamine
MDT multidisciplinary team
MEN multiple endocrine neoplasia
MMR mismatch repair
MMX multimatrix
MPD main pancreatic duct
MRCP magnetic resonance cholangiopancreatography
MSM men who have sex with men
MUST Malnutrition Universal Screening Tool
MYH MutY human homologue
NA nucleoside analogue
NAFLD non-alcoholic fatty liver disease
NAS non-anastomotic
NASH non-alcoholic steatohepatitis
NKT Natural Killer T
NNRTI non-nucleoside reverse transcriptase inhibitors
NOD2 nucleotide-binding oligomerization domain-containing protein 2
NP necrotizing pancreatitis
NRH nodular regenerative hyperplasia
NRTI nucleoside reverse transcriptase inhibitors
OCA obeticholic acid
OCP contraceptive pill
OR odds ratio
PAS periodic-acid Schiff
PBC primary biliary cholangitis
pCCA perihilar cholangiocarcinoma
PEG polyethylene glycol
PEP post-ERCP pancreatitis
PET positron emission tomography
PG pyoderma gangrenosum
PH potential hydrogen
PHG portal hypertensive gastropathy
PJS Peutz-Jeghers syndrome
PN parenteral nutrition
p-NET pancreatic neuroendocrine tumour
PNR primary non-response
PPI proton pump inhibitor
PPI-REE PPI responsive oesophageal eosinophilia
PSC primary sclerosing cholangitis
PSC-IBD primary sclerosing cholangitis-inflammatory bowel disease
PUD peptic ulcer disease
RAAS renin–angiotensin–aldosterone system
RBL rubber band ligation
RCT randomized controlled trial
RIG radiologically inserted gastrostomy
rPSC recurrent PSC
RR relative risk
RY-GBP Roux-en-Y gastric bypass
SAAG serum-ascites albumin gradient
SBP spontaneous bacterial peritonitis
SCE Specialty Certificate Examination
SCFA short-chain fatty acid enemas
SG sleeve gastrectomy
SSRI selective serotonin reuptake inhibitor
STK serine/threonine kinase
SIBO small intestinal bacterial overgrowth
SIRS systemic inflammatory response syndrome
SMA superior mesenteric artery
SNVA seronegative villous atrophy
SOD sphincter of Oddi dysfunction
SPS serrated polyposis syndrome
SRUS solitary rectal ulcer syndrome
SS somatostatin
SUSS Sit Up Squat Stand
SVR sustained virologic response
TACE transarterial chemoembolization
TE transient elastography
TIPSS transjugular intrahepatic portosystemic shunt
TNF tumour necrosis factor
TPMT thiopurine methyltransferase
TSH thyroid-stimulating hormone
UC ulcerative colitis
UDCA ursodeoxycholic acid
ULN upper limit of normal
VCE video capsule endoscopy
VH variceal haemorrhage
VIP vasoactive intestinal peptide
VTE venous thromboembolism
WCC white cell count
WD Wilson’s disease
WHO World Health Organization
WON walled-off necrosis
ZES Zollinger–Ellison syndrome
NORMAL RANGES
Haematology
haemoglobin
males g/L (30–80)
females g/L (5–65)
red cell count
males × 02/L (4.3–5.9)
females × 02/L (3.5–5.0)
haematocrit
males (0.40–0.52)
females (0.36–0.47)
mean corpuscular volume fL (80–96)
mean corpuscular haemoglobin pg (28–32)
mean corpuscular haemoglobin concentration g/dL (32–35)
white cell count × 09/L (4.0–.0)
neutrophil count × 09/L (.5–7.0)
lymphocyte count × 09/L (.5–4.0)
monocyte count × 09/L (< 0.8)
eosinophil count × 09/L (0.04–0.40)
basophil count × 09/L (< 0.)
platelet count × 09/L (50–400)
reticulocyte count × 09/L (25–85)
reticulocyte count % (0.5–2.4)
CD4 count × 06/L (430–690)
erythrocyte sedimentation rate under 50 years of age:
males mm/st hour (< 5)
females mm/st hour (< 20) over 50 years of age:
males mm/st hour (< 20)
females mm/st hour (< 30)
plasma viscosity (25°C) mPa/second (.50–.72)
Coagulation screen
prothrombin time seconds (.5–5.5)
international normalized ratio (< .4)
activated partial thromboplastin time seconds (30–40) thrombin time seconds (5–9)
Fibrinogen g/L (.8–5.4)
bleeding time minutes (3.0–8.0)
Coagulation factors
factors II, V, VII, VIII, IX, X, XI, XII
IU/dL (50–50) von Willebrand factor antigen
IU/dL (45–50) von Willebrand factor activity
protein C
IU/dL (50–50)
IU/dL (80–35) protein S
Antithrombin
IU/dL (80–20)
IU/dL (80–20) activated protein C resistance (2.2–4.00)
fibrin degradation products
D-dimer
Haematinics
serum iron
serum iron-binding capacity
serum ferritin
serum transferrin
serum vitamin B2
serum folate
mg/L (< 00)
mg/L (< 0.5)
μmol/L (2–30)
μmol/L (45–75)
μg/L (5–300)
g/L (2.0–4.0)
ng/L (60–760)
μg/L (2.0–.0) red cell folate
serum haptoglobin
zinc protoporphyrin:haemoglobin ratio
Haemoglobinopathy screen:
haemoglobin A
haemoglobin A2
haemoglobin F
haemoglobin S
transferrin saturations
methaemoglobin
Chemistry
Blood
μg/L (60–640)
g/L (0.3–.63)
μmol/mol haemoglobin (< 70)
% (> 95)
% (2–3)
% (< 2)
% ( 0)
% (20–50)
% (< )
serum sodium mmol/L (37–44)
serum potassium
serum chloride
serum bicarbonate
anion gap
serum urea
serum creatinine
estimated glomerular filtration rate (MDRD)
serum corrected calcium
serum ionized calcium
serum phosphate
serum total protein
serum albumin
mmol/L (3.5–4.9)
mmol/L (95–07)
mmol/L (20–28)
mmol/L (2–6)
mmol/L (2.5–7.0)
μmol/L (60–0)
mL/minute (> 60)
mmol/L (2.20–2.60)
mmol/L (.3–.32)
mmol/L (0.8–.4)
g/L (6–76)
g/L (37–49)
serum globulin
serum total bilirubin
serum conjugated bilirubin
serum alanine aminotransferase
serum aspartate aminotransferase
serum alkaline phosphatase
serum gamma glutamyl transferase
males
females
serum lactate dehydrogenase
serum acid phosphatase
serum creatine kinase
males
females
serum creatine kinase MB fraction
serum troponin I
serum troponin T
fasting plasma glucose
haemoglobin Ac
serum α-antitrypsin
g/L (24–27)
μmol/L (–22)
μmol/L (< 3.4)
U/L (5–35)
U/L (–3)
U/L (45–05)
U/L (< 50)
U/L (4–35)
U/L (0–250)
U/L (2.6–6.2)
U/L (24–95)
U/L (24–70)
% (< 5)
μg/L (< 0.)
μg/L (< 0.0)
mmol/L (3.0–6.0)
% (4.0–6.0); mmol/mol (20–42)
g/L (.–2.)
serum copper μmol/L (2–26)
serum caeruloplasmin
mg/L (200–350)
serum aluminium μg/L (< 0)
blood lead μmol/L (< 0.5)
serum magnesium mmol/L (0.75–.05)
serum zinc
serum urate
males
females
plasma lactate
plasma ammonia
serum angiotensin-converting enzyme
plasma fructosamine
serum amylase
plasma osmolality
μmol/L (6–25)
mmol/L (0.23–0.46)
mmol/L (0.9–0.36)
mmol/L (0.6–.8)
μmol/L (2–55)
U/L (25–82)
μmol/L (< 285)
U/L (60–80)
mosmol/kg (278–300)
plasma osmolar gap mosmol (< 0)
thiopurine methyltransferase
Urine
glomerular filtration rate
24-hour urinary total protein
24-hour urinary albumin
24-hour urinary creatinine
U/L (> 25)
mL/minute (70–40)
g (< 0.2)
mg (< 30)
mmol (9–8)
24-hour urinary calcium mmol (2.5–7.5)
24-hour urinary copper
24-hour urinary urate
24-hour urinary oxalate
24-hour urinary urobilinogen
24-hour urinary coproporphyrin
μmol (0.2–0.6)
mmol (< 3.6)
mmol (0.4–0.46)
μmol (.7–5.9)
nmol (< 300)
