AKT Questions:

Theme – Endoscopy The following patients all have gastrointestinal symptoms. Initial management should include one of the options below. Each option may be used once, more than once or not at all:-

1. A man of 48 who has a history of endoscopically proven duodenal ulceration five years ago for which he received H. Pylori eradication but was lost to follow up. He has recurrent dyspepsia but no red flag symptoms

A. Endoscopy the same day
B. Endoscopy within two weeks
C. Endoscopy routinely (within three months)
D. No need for endoscopy

Answer: D


In these circumstances H. Pylori should be rechecked in the first instance (breath test or Stool antigen) and either PPI or eradication depending on the result.

2. 39 year old female nurse who has typical symptoms of reflux. Her body mass index is 35 and she had an initial response to two months high dose proton pump inhibitor.

A. Endoscopy the same day
B. Endoscopy within two weeks
C. Endoscopy routinely (within three months)
D. No need for endoscopy

Answer: D

This patient should have lifestyle advice, H pylori testing and eradication if positive (even though her symptoms may initially get worse). If negative it would be reasonable to give a proton pump inhibitor as required but review her.

3. A man of 57 with recent onset persistent dyspepsia but no other "red flags".

A. Endoscopy the same day
B. Endoscopy within two weeks
C. Endoscopy routinely (within three months)
D. No need for endoscopy

Answer: C

He should also have a blood screen and helicobacter testing.

4. A woman of 70 with recent onset of difficulty in swallowing

A. Endoscopy the same day
B. Endoscopy within two weeks
C. Endoscopy routinely (within three months)
D. No need for endoscopy

Answer: B

This would be an indication for a "two week" referral.

5. A woman of 70 who takes diclofenac and is found to have a haemoglobin of 9.0 with an iron deficient picture

A. Endoscopy the same day
B. Endoscopy within two weeks
C. Endoscopy routinely (within three months)
D. No need for endoscopy.

Answer: C

If the endoscopy does not explain the anaemia she should have a colonoscopy.