You see an elderly lady with severe abdominal pain on a home visit. She has not opened her bowels for 4 days and reports having vomited last night. Her abdomen is rigid and her blood pressure is 90/50. Which of the following is the LEAST likely cause of this acute presentation?

A 45 year old woman has come to see you in the practice, after seeing her own GP 2 weeks ago, who prescribed Ranitidine for indigestion. She describes episodes of severe epigastric pain, which has been occurring over the last 4 weeks. The pain lasts for up to an hour at a time before settling. The pain was particularly bad last night when she went out and had some Dixy Chicken. Ranitidine has had no impact on her symptoms. On examination: her abdomen is soft and non-tender and her observations are normal.

Which one of the following is the MOST APPROPRIATE management option?

A 20 year old man presents with a 6 week history of very frequent bloody stools. He complains of a lot of pain before he passes stool, which is relieved when he does. He has had to get up in the night to relieve himself and has to run to the toilet. The diagnosis is expected to be ulcerative colitis and various tests are ordered.

Which of the below features is LEAST associated with ulcerative colitis?

A 40 year old man has recently been started on medication for hypertension and GORD as per NICE guidelines. In addition to this, he sometimes takes Diclofenac for intermittent musculoskeletal pain. He is complaining of constipation.

What is the MOST likely cause?

A 46 year old patient presents to her GP with complaints of difficulty in swallowing. She also describes her fingers sometimes going very cold and changing like the colours of the Union flag. What is the MOST likely cause of dysphagia?

A 32 year old male presents with epigastric pain.

He is found to have an elevated amylase and diagnosed with acute pancreatitis. He denies any alcohol. An ultrasound shows no gallstones. He has been unwell over the last few weeks and was told by an out-of-hours GP that he had a viral illness.

Which of the following is NOT a known cause of pancreatitis?

A young lady, not known to you, comes to see you in the GP surgery with tiredness and exertional dyspnoea. You see from her records that she has been in A&E multiple times with blood stained vomiting and was recently admitted for an OGD which showed numerous ulcers from the gastric antrum to the 2nd part of the duodenum.

Select the MOST likely diagnosis.

A 32 year old male has a routine blood test with an insurance company. He attends as they advise him there is a problem with his liver function.

Bilirubin 36umol/L

Alk Phos 104u/L

ALT 15u/L

Albumin 40g/L

You take a detailed history and conduct a thorough examination and find nothing of note in either.

Which of the following is the MOST likely diagnosis?

A 35 year old woman with coeliac disease attends with a 1 month history of pins and needles in her legs. On examination there are signs of peripheral neuropathy and an area of dermatitis around her eyes and nose.

Choose the most likely vitamin deficiency causing the symptoms.

A 25 year old lady with 3 months of intermittent abdominal bloating, pain and diarrhoea attends. There is no history of rectal bleeding, weight loss or family history of bowel disease.

Abdominal exam is normal.

FBC, U&E, CRP, ESR and Coeliac screen have been requested.

Which would be the most useful test to differentiate between IBS and IBD in primary care?

A 40-year-old man has presented to the surgery asking for lifestyle advice following a QRisk score. He is particularly concerned about his alcohol intake. He drinks two pints of 5% lager and one 175ml glass of white wine (abv 14%) each night.

How many more units than recommended does he consume per week? (To nearest whole unit)

What is the MOST common extra-intestinal manifestation of Crohn's disease?

A 23-year-old woman is referred to the neurology clinic after developing a unilateral hand tremor.

Over the past 12 months her family report changes in her behaviour and mood associated with some speech problems. On examination a tremor is noted in the right-hand at rest. There also appears to be paucity of movement and some bradykinesia. Dark circular marks are also noted around the iris. The patient reports that her uncle died of liver cirrhosis at the age of 40 years. What is the most likely diagnosis?

A 34-year-old lady, attends for her emergency appointment slightly late one afternoon. She had declined to give the receptionist the reason for the appointment when she booked it that morning, saying it was personal. She enters the room tearful and says she thinks she has an alcohol problem. She always 'liked a drink' but since she broke with her partner she has been

drinking every night at home. You perform an AUDIT-C assessment which classes her drinking as harmful. You give her the details for the local drug and alcohol services, and arrange some blood tests.

What prescription should you issue her today?

You are the GP trainee doing your morning clinic. You see a 30-year-old woman with coeliac disease.

Which of the following is indicated as part of her management?

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Whilst reviewing an elderly patient, you note the following blood tests.

What is the most likely diagnosis?

At what age does ulcerative colitis most typically present?

A 25-year-old man presents with lethargy and increased skin pigmentation. Blood test reveal deranged liver function tests and impaired glucose tolerance. Given the likely diagnosis of haemochromatosis, what is the most appropriate initial investigation strategy?

You are reviewing a 55-year-old man who has recently been diagnosed with Barrett's oesophagus. This was diagnosed after the patient was referred due to difficult to control symptoms. No evidence of dysplasia was found on biopsies. In terms of risk factor modification, which one of the following has been shown to be most strongly linked to the development of Barrett's oesophagus?