Free European Specialty Examination in Gastroenterology and Hepatology Practice Questions

Sample Practice Questions

Try these 10 sample questions from the European Specialty Examination in Gastroenterology and Hepatology practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 54-year-old with recurrent biliary pain has never been investigated for common bile duct stones. Which initial investigation pair does BSG recommend?

   1. A.Abdominal CT and serum lipase
   2. B.Transabdominal ultrasound and liver function testsCorrect answer: B
   3. C.MR cholangiopancreatography and serum lipase
   4. D.Endoscopic ultrasound and liver function tests

   Explanation: BSG common bile duct stone guideline states: "Trans-abdominal ultrasound scanning (USS) and liver function tests (LFTs) are recommended for patients with suspected CBDS." These are the initial tests. MRCP or EUS follows when probability remains intermediate; lipase primarily evaluates pancreatic inflammation.

   Reference: BSG common bile duct stone guideline — Summary, Identifying individuals with CBDS

2. 2A patient presents with haematemesis and is now haemodynamically stable after resuscitation. Which bleeding-specific score should be calculated at presentation to guide risk stratification?

   1. A.Full Rockall score
   2. B.Child–Pugh score
   3. C.Glasgow-Blatchford scoreCorrect answer: C
   4. D.MELD score

   Explanation: BSG-led acute upper gastrointestinal bleeding care bundle states: "We recommend GBS is calculated at presentation with AUGIB" GBS is designed for presentation risk assessment. Full Rockall incorporates endoscopic information; Child–Pugh and MELD assess liver disease rather than initial bleeding intervention risk.

   Reference: BSG-led acute upper gastrointestinal bleeding care bundle — Risk stratification

3. 3A newly diagnosed adult has mildly active ulcerative proctitis limited to the rectum. Which treatment is recommended initially?

   1. A.Oral prednisolone
   2. B.Rectal mesalazineCorrect answer: B
   3. C.Oral azathioprine
   4. D.Rectal hydrocortisone

   Explanation: BSG inflammatory bowel disease guideline states: "Mild or moderately active ulcerative proctitis should be treated with 5-ASA suppositories/enemas." Rectal mesalazine directly treats the involved rectum. Rectal steroids are a later option; systemic steroids and azathioprine are not initial treatment of this mild presentation.

   Reference: BSG inflammatory bowel disease guideline — Executive summary, Ulcerative colitis, Proctitis

4. 4An adult with cirrhosis and ascites is admitted with worsening encephalopathy but no fever or abdominal tenderness. What should be done promptly to assess for spontaneous bacterial peritonitis?

   1. A.Diagnostic ascitic paracentesisCorrect answer: A
   2. B.Contrast abdominal CT
   3. C.Serum procalcitonin measurement
   4. D.Repeat liver stiffness measurement

   Explanation: BSG/BASL ascites in cirrhosis guideline states: "Diagnostic paracentesis should be carried out without a delay" All cirrhotic patients with ascites need prompt paracentesis on hospital admission; absence of fever or tenderness does not exclude SBP. CT and blood markers do not replace ascitic analysis.

   Reference: BSG/BASL ascites in cirrhosis guideline — Executive summary, recommendation 2.1

5. 5A 60 kg adult at high risk of refeeding syndrome is starting nutrition support under the NICE-based BAPEN regimen. The patient is not an extreme-risk case. What is the maximum initial daily energy at 10 kcal/kg/day?

   1. A.60 kcal/day
   2. B.300 kcal/day
   3. C.600 kcal/dayCorrect answer: C
   4. D.1500 kcal/day

   Explanation: BAPEN nutritional assessment states: "Start nutrition support at a maximum of 10 kcal/kg/day" 60 kg × 10 kcal/kg/day = 600 kcal/day. 60 omits the factor 10; 300 applies the extreme-case 5 kcal/kg rate; 1500 uses a full-feeding 25 kcal/kg rate too soon.

   Reference: BAPEN nutritional assessment — Clinical assessment, refeeding management

6. 6An adult has a newly identified oesophageal stricture and is being considered for dilatation. What diagnostic step is recommended for all strictures?

   1. A.High-resolution manometry
   2. B.Ambulatory pH monitoring
   3. C.Barium swallow alone
   4. D.Biopsy for histological analysisCorrect answer: D

   Explanation: UK oesophageal dilatation guideline states: "Obtain biopsy specimens from all strictures for histological analysis to exclude malignancy and eosinophilic oesophagitis" Histology addresses malignancy and EoE before treatment. Physiological tests and contrast imaging may answer other questions but do not replace stricture biopsy.

   Reference: UK oesophageal dilatation guideline — Patient preparation, Predilatation investigations 1.1

7. 7A patient with predicted mild acute pancreatitis is hungry and clinically tolerates food, but serum lipase remains elevated. When should oral feeding be offered?

   1. A.Once lipase has fallen below twice normal
   2. B.Once lipase has returned to normal
   3. C.Once a repeat CT confirms resolution
   4. D.As soon as clinically toleratedCorrect answer: D

   Explanation: ESPEN practical pancreatitis nutrition guideline states: "Oral feeding shall be offered as soon as clinically tolerated" Clinical tolerance governs refeeding in mild disease independently of lipase. Normalisation, arbitrary enzyme thresholds or repeat CT are not prerequisites.

   Reference: ESPEN practical pancreatitis nutrition guideline — Recommendation 3

8. 8An adult with suspected coeliac disease is still eating gluten and is about to have diagnostic testing. What dietary advice preserves test sensitivity?

   1. A.Start a strict gluten-free diet now
   2. B.Replace gluten with oats before testing
   3. C.Continue a gluten-containing dietCorrect answer: C
   4. D.Restrict gluten to one meal each week

   Explanation: BSG adult coeliac disease guideline states: "patients consume a gluten-containing diet prior to testing for coeliac disease" Serology and histology detect the immune response to gluten. Removing or markedly restricting it before testing can reduce diagnostic sensitivity.

   Reference: BSG adult coeliac disease guideline — Executive summary, REC 1

9. 9A patient treated for H. pylori is preparing for a urea breath test to confirm eradication. Antibiotics and bismuth were stopped more than four weeks ago. What is the minimum PPI-free interval before testing?

   1. A.3 days
   2. B.7 days
   3. C.10 days
   4. D.14 daysCorrect answer: D

   Explanation: Maastricht VI/Florence H. pylori consensus states: "PPI (for 14 days) must be avoided" PPIs can suppress bacterial detection and cause false-negative testing. The required washout is 14 days; antibiotic and bismuth washout has already been satisfied.

   Reference: Maastricht VI/Florence H. pylori consensus — Working group 2, post-eradication testing

10. 10A patient has recurrent focal swelling under the tongue and intense pain when eating. The swelling settles between meals, and there is no fever. Which diagnosis best fits this obstructive pattern?

    1. A.Aphthous ulceration
    2. B.Salivary duct stoneCorrect answer: B
    3. C.Oral candidiasis
    4. D.Oral lichen planus

    Explanation: NHS salivary gland stones states: "If you feel intense pain during mealtimes, this could mean the stone is completely blocking a saliva gland." Meal-stimulated salivary flow against obstruction produces this pattern. The other oral mucosal disorders do not explain recurrent meal-related gland swelling.

    Reference: NHS salivary gland stones — Symptoms of salivary gland stones