1. A 46-year-old man presents with recurrent heartburn and acid regurgitation after meals. He has no dysphagia, weight loss, vomiting, gastrointestinal bleeding or anaemia. He has tried antacids with limited benefit.
Which ONE of the following is the most appropriate initial management option?
A. Immediate urgent cancer referral.
B. Long-term oral corticosteroids.
C. Trial of a proton pump inhibitor with lifestyle advice.
D. Oral vancomycin.
E. Stop all food intake.
2. A 72-year-old man taking naproxen and warfarin presents with black tarry stools, dizziness and epigastric pain. His blood pressure is 92/58 mmHg and he appears pale.
Which ONE of the following is the most appropriate action?
A. Recommend an antacid and review in one week.
B. Advise taking naproxen with food.
C. Increase warfarin dose.
D. Supply loperamide.
E. Arrange urgent hospital assessment for possible upper gastrointestinal bleeding.
3. A 68-year-old woman with osteoarthritis takes regular ibuprofen. She has a previous history of peptic ulcer disease and now reports recurrent dyspepsia.
Which ONE of the following is the most appropriate medicines optimisation issue?
A. Review NSAID need and consider gastroprotection or an alternative analgesic strategy.
B. Increase ibuprofen dose.
C. Add aspirin for gastric protection.
D. Stop all analgesia permanently.
E. Replace ibuprofen with oral corticosteroids.
4. A 59-year-old man reports progressive difficulty swallowing solids, unintentional weight loss and new persistent indigestion. He has not previously had reflux symptoms.
Which ONE of the following is the most appropriate management?
A. Reassure and supply alginate only.
B. Recommend loperamide.
C. Start peppermint oil.
D. Refer urgently for assessment of possible upper gastrointestinal cancer.
E. Advise avoiding spicy food and review in 6 months.
5. A 36-year-old woman asks for loperamide for diarrhoea. She has had bloody diarrhoea, fever and severe abdominal pain for 24 hours after returning from travel abroad.
Which ONE of the following is the most appropriate advice?
A. Take maximum-dose loperamide and continue travelling.
B. Seek medical assessment because bloody diarrhoea, fever and severe pain are red flags.
C. Take senna.
D. Stop drinking fluids.
E. Treat with omeprazole.
6. A 64-year-old man receiving modified-release morphine for metastatic cancer pain has not opened his bowels for four days. He has no vomiting, no severe abdominal distension and is eating small amounts.
Which ONE of the following is the most appropriate management?
A. Stop all analgesia immediately.
B. Give loperamide.
C. Reassure that opioids do not affect bowel function.
D. Prescribe oral iron.
E. Review bowel regimen and consider regular stimulant and/or osmotic laxative therapy.
7. A 70-year-old woman presents with severe colicky abdominal pain, vomiting, abdominal distension and absolute constipation. She has a history of previous abdominal surgery.
Which ONE of the following is the most appropriate action?
A. Arrange urgent hospital assessment for possible bowel obstruction.
B. Supply high-dose senna.
C. Recommend bulk-forming laxatives immediately.
D. Advise increasing fibre only.
E. Treat as uncomplicated IBS.
8. A 51-year-old man reports a 3-month history of change in bowel habit, intermittent rectal bleeding and unintentional weight loss. He has no previous diagnosis of irritable bowel syndrome.
Which ONE of the following is the most appropriate action?
A. Diagnose IBS and reassure.
B. Supply loperamide indefinitely.
C. Recommend peppermint oil only.
D. Refer for urgent assessment of possible colorectal cancer.
E. Advise eliminating gluten without investigation.
9. A 42-year-old woman has chronic diarrhoea, bloating and iron deficiency anaemia. She has started reducing gluten but has not fully stopped it.
Which ONE of the following is the most appropriate next step?
A. Start lifelong gluten-free diet without testing.
B. Arrange coeliac disease testing while she is still consuming gluten.
C. Prescribe loperamide indefinitely.
D. Treat as acute gastroenteritis.
E. Start high-dose corticosteroids.
10. A 62-year-old man with cirrhosis is prescribed lactulose after an episode of hepatic encephalopathy. He asks why the dose is being adjusted to produce regular soft stools.
Which ONE of the following is the best explanation?
A. Lactulose treats oesophageal varices directly.
B. Lactulose is used to increase blood glucose.
C. Lactulose helps reduce encephalopathy risk by promoting ammonia removal through the bowel.
D. Lactulose prevents all infections in cirrhosis.
E. Lactulose replaces all liver monitoring.
11. A 29-year-old woman with ulcerative colitis reports six episodes of bloody diarrhoea daily, abdominal pain and fever. She feels weak and has a heart rate of 112 bpm.
Which ONE of the following is the most appropriate action?
A. Supply loperamide and review in one month.
B. Reassure that fever is expected in remission.
C. Stop all ulcerative colitis medicines.
D. Arrange urgent clinical assessment for a possible severe flare.
E. Recommend antacids only.
12. A 38-year-old man with Crohn’s disease has needed repeated courses of oral corticosteroids over the past year. The gastroenterology team is considering azathioprine.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Ensure appropriate baseline testing, counselling and blood monitoring are planned.
B. Advise azathioprine works instantly for acute pain relief.
C. Recommend stopping all monitoring after the first dose.
D. Combine with live vaccines routinely.
E. Use azathioprine only as an antacid.
13. A 45-year-old woman taking azathioprine for Crohn’s disease contacts the pharmacy with fever, sore throat and mouth ulcers.
Which ONE of the following is the most appropriate advice?
A. Continue treatment and wait for routine review.
B. Double the azathioprine dose.
C. Take loperamide.
D. Treat as uncomplicated reflux.
E. Seek urgent medical assessment because of possible bone marrow suppression or infection.
14. A 57-year-old man taking mesalazine for ulcerative colitis attends for a medicines review. He asks why periodic blood tests are needed when he feels well.
Which ONE of the following is the most appropriate explanation?
A. Mesalazine commonly causes hypoglycaemia.
B. Monitoring is only needed if he has diarrhoea.
C. Renal function should be monitored because mesalazine can rarely affect the kidneys.
D. Mesalazine replaces colonoscopy surveillance.
E. Blood tests are never needed with mesalazine.
15. A 34-year-old man with ulcerative colitis is prescribed a course of oral prednisolone for a moderate flare. He asks whether he should continue taking it indefinitely to prevent future flares.
Which ONE of the following is the most appropriate advice?
A. Oral corticosteroids are ideal long-term maintenance therapy.
B. Corticosteroid courses should be time-limited and reviewed because of adverse effects.
C. Prednisolone has no long-term risks.
D. Prednisolone should be stopped abruptly after one dose.
E. Prednisolone replaces all maintenance treatment.
16. A 49-year-old man presents with sudden severe epigastric pain radiating to the back, vomiting and abdominal tenderness. He drinks heavily and has a history of gallstones.
Which ONE of the following is the most appropriate action?
A. Supply an antacid only.
B. Treat as constipation.
C. Recommend peppermint oil.
D. Arrange urgent hospital assessment for possible acute pancreatitis.
E. Start loperamide.
17. A 58-year-old woman with chronic pancreatitis reports weight loss, greasy foul-smelling stools and bloating despite eating normally.
Which ONE of the following is the most appropriate treatment consideration?
A. Pancreatic enzyme replacement therapy.
B. Loperamide as sole long-term treatment.
C. High-dose senna.
D. Stop all meals containing protein.
E. Oral vancomycin.
18. A 73-year-old man presents with right upper quadrant pain, fever, jaundice and confusion. He has known gallstones.
Which ONE of the following is the most appropriate management?
A. Reassure and provide antacid.
B. Treat as uncomplicated IBS.
C. Supply peppermint oil.
D. Recommend a gluten-free diet.
E. Arrange urgent hospital assessment for possible ascending cholangitis.
19. A 67-year-old woman with decompensated cirrhosis has increasing abdominal swelling, peripheral oedema and shortness of breath. She has not previously had ascites drained.
Which ONE of the following is the most appropriate action?
A. Supply loperamide.
B. Recommend high-salt diet.
C. Arrange clinical assessment for ascites and possible complications.
D. Stop all monitoring.
E. Treat as uncomplicated dyspepsia.
20. A 55-year-old man with cirrhosis and known oesophageal varices vomits fresh blood at home.
Which ONE of the following is the most appropriate action?
A. Take omeprazole and review next week.
B. Arrange emergency hospital assessment for suspected variceal bleeding.
C. Take loperamide.
D. Drink alcohol to reduce stress.
E. Reassure if bleeding stops.
21. A 48-year-old woman has symptoms consistent with irritable bowel syndrome for several years. She now reports new rectal bleeding and unexplained weight loss.
Which ONE of the following is the most appropriate advice?
A. Treat as routine IBS.
B. Increase peppermint oil.
C. Start loperamide indefinitely.
D. Avoid all investigations.
E. Refer for clinical assessment because red-flag symptoms are present.
22. A 33-year-old man with IBS reports cramping abdominal pain and bloating that are worse after meals. He has no alarm symptoms.
Which ONE of the following may be considered for symptom relief?
A. Long-term oral corticosteroids.
B. Oral vancomycin.
C. An antispasmodic such as mebeverine or peppermint oil.
D. Warfarin.
E. Methotrexate.
23. A 74-year-old woman with chronic constipation has tried lifestyle measures and a bulk-forming laxative but remains constipated. She is drinking adequate fluid and has no symptoms of bowel obstruction.
Which ONE of the following is a reasonable next option?
A. Add or switch to an osmotic laxative such as macrogol.
B. Start loperamide.
C. Stop all fluids.
D. Use oral iron for constipation.
E. Avoid all laxatives permanently.
24. A 79-year-old man with constipation reports overflow diarrhoea, abdominal discomfort and reduced appetite. He is taking opioids and has not opened his bowels properly for 10 days.
Which ONE of the following is the most appropriate concern?
A. Uncomplicated viral gastroenteritis.
B. Faecal impaction.
C. Hyperthyroidism.
D. Acute appendicitis in all cases.
E. Oral candidiasis.
25. A 60-year-old woman is prescribed orlistat for weight management. She asks how it works.
Which ONE of the following counselling points is most appropriate?
A. It increases insulin secretion.
B. It cures obesity without dietary change.
C. It prevents all fat absorption completely.
D. It reduces fat absorption and should be taken with meals containing fat.
E. It treats reflux by neutralising stomach acid.
26. A 44-year-old woman taking orlistat reports oily stools and faecal urgency after eating high-fat takeaway meals.
Which ONE of the following is the most appropriate advice?
A. Reduce dietary fat intake and continue lifestyle measures if treatment remains appropriate.
B. Double the orlistat dose.
C. Take orlistat only when fasting.
D. Add senna to worsen diarrhoea.
E. Stop eating all carbohydrates.
27. A 72-year-old man with reflux symptoms buys omeprazole regularly. He now reports progressive dysphagia and unintentional weight loss.
Which ONE of the following is the most appropriate action?
A. Continue OTC omeprazole indefinitely.
B. Increase antacid use only.
C. Reassure because dysphagia is expected in reflux.
D. Recommend peppermint oil.
E. Refer urgently for assessment because alarm symptoms are present.
28. A 36-year-old woman has dyspepsia and tests positive for Helicobacter pylori. She is prescribed eradication therapy but admits she often stops antibiotics early when symptoms improve.
Which ONE of the following is the most appropriate counselling point?
A. Stop treatment once pain improves.
B. Take only the proton pump inhibitor.
C. Complete the full eradication course to improve cure rates and reduce treatment failure.
D. Use loperamide instead.
E. Avoid telling clinicians about missed doses.
29. A 64-year-old man with a history of peptic ulcer bleeding is prescribed aspirin for secondary prevention after myocardial infarction.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Stop aspirin permanently without discussion.
B. Add ibuprofen for gastroprotection.
C. Reassure that ulcer history is irrelevant.
D. Review need for gastroprotection and bleeding risk with the prescriber.
E. Replace aspirin with senna.
30. A 53-year-old woman with nausea from chemotherapy is prescribed ondansetron. She has a history of constipation and is taking morphine.
Which ONE of the following counselling point is most appropriate?
A. Ondansetron always causes diarrhoea.
B. Constipation risk may increase and bowel regimen should be reviewed.
C. Ondansetron replaces all analgesia.
D. Morphine prevents constipation.
E. Stop fluid intake.
31. A 69-year-old woman with chronic constipation takes senna every night. She develops severe abdominal pain, vomiting and abdominal distension.
Which ONE of the following is the most appropriate advice?
A. Stop self-treatment and seek urgent medical assessment for possible obstruction.
B. Increase senna dose.
C. Add loperamide.
D. Ignore vomiting.
E. Treat as uncomplicated bloating.
32. A 41-year-old man with Crohn’s disease presents with worsening abdominal pain, fever and a tender mass in the right lower abdomen.
Which ONE of the following is the most appropriate action?
A. Supply peppermint oil only.
B. Recommend high-fibre diet immediately.
C. Arrange urgent assessment for possible abscess or complication.
D. Reassure if bowel motions continue.
E. Treat as simple indigestion.
33. A 24-year-old woman with ulcerative colitis asks why she has been advised not to use loperamide during a severe flare with fever and abdominal distension.
Which ONE of the following is the best explanation?
A. Loperamide always causes hyperglycaemia.
B. Loperamide treats inflammation directly.
C. Antimotility medicines may be unsafe in severe colitis due to risk of complications.
D. Loperamide prevents toxic megacolon.
E. Loperamide is a corticosteroid.
34. A 52-year-old man taking methotrexate for Crohn’s disease develops mouth ulcers, sore throat and bruising. His last blood monitoring appointment was missed.
Which ONE of the following is the most appropriate action?
A. Continue methotrexate and wait for routine review.
B. Seek urgent clinical assessment and blood tests because of possible toxicity or bone marrow suppression.
C. Double methotrexate.
D. Treat with loperamide.
E. Take methotrexate daily instead of weekly.
35. A 45-year-old woman prescribed methotrexate for inflammatory bowel disease asks why she must take folic acid.
Which ONE of the following is the most appropriate explanation?
A. Folic acid replaces all monitoring.
B. Folic acid is an antibiotic.
C. Folic acid prevents all infections.
D. Folic acid helps reduce some methotrexate adverse effects.
E. Folic acid increases methotrexate toxicity.
36. A 70-year-old man with cirrhosis is taking spironolactone and furosemide for ascites. He becomes dizzy and his renal function worsens after a dose increase.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Increase both diuretics further.
B. Stop all medicines permanently.
C. Review volume status, renal function and diuretic dosing with the clinical team.
D. Add ibuprofen.
E. Recommend high-salt diet.
37. A 58-year-old man with alcohol-related liver disease asks whether paracetamol is always unsafe for him and whether NSAIDs are a better option.
Which ONE of the following is the most appropriate response?
A. NSAIDs are always safer than paracetamol in cirrhosis.
B. Paracetamol may be used cautiously at appropriate doses, while NSAIDs can be risky in advanced liver disease.
C. Double-dose paracetamol is recommended.
D. Aspirin prevents variceal bleeding.
E. Analgesia choice is unrelated to liver disease.
38. A 47-year-old woman with primary biliary cholangitis is prescribed ursodeoxycholic acid. She asks why treatment is monitored over time.
Which ONE of the following is the most appropriate explanation?
A. It cures all liver disease after one dose.
B. It is used only for constipation.
C. Response is monitored because ongoing liver tests and clinical review guide management.
D. It replaces all cancer surveillance.
E. It prevents all infections.
39. A 67-year-old woman with acute diarrhoea is taking furosemide, ramipril and metformin. She is dehydrated and has reduced urine output.
Which ONE of the following is the most appropriate medicines optimisation issue?
A. Metformin should always be doubled during dehydration.
B. Dehydrating illness may require temporary review of medicines that affect renal function or dehydration risk.
C. Loperamide prevents acute kidney injury.
D. Ramipril treats diarrhoea directly.
E. Furosemide improves dehydration.
40. A 75-year-old man has had watery diarrhoea for 6 weeks with nocturnal symptoms and weight loss. He asks to buy loperamide again.
Which ONE of the following is the most appropriate action?
A. Supply indefinite loperamide without review.
B. Reassure because nocturnal diarrhoea is typical of IBS.
C. Give senna.
D. Refer for medical assessment because chronic diarrhoea with weight loss and nocturnal symptoms is concerning.
E. Recommend antacid only.
41. A 31-year-old woman with known coeliac disease continues to have diarrhoea and bloating despite a gluten-free diet. She admits she occasionally eats foods that may contain gluten.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Explore adherence, hidden gluten exposure and need for dietetic or specialist review.
B. Advise gluten exposure is harmless.
C. Recommend stopping all follow-up.
D. Treat with loperamide only.
E. Start oral steroids without assessment.
42. A patient with a new ileostomy reports a sudden large increase in watery stoma output, dizziness and reduced urine output.
Which ONE of the following is the most appropriate action?
A. Reassure that reduced urine output is expected.
B. Recommend high-fibre bulking without assessment.
C. Seek urgent clinical advice because high-output stoma can cause dehydration and electrolyte disturbance.
D. Stop drinking fluids.
E. Treat as reflux.
43. A 64-year-old woman with a colostomy reports no stoma output for 24 hours, abdominal pain and vomiting.
Which ONE of the following is the most appropriate advice?
A. Take maximum-dose loperamide.
B. Ignore if the stoma looks normal.
C. Increase opioid analgesia.
D. Seek urgent assessment for possible bowel obstruction.
E. Eat more immediately.
44. A 56-year-old man with haemorrhoids reports bright red blood on wiping. He also has recent change in bowel habit and unexplained weight loss.
Which ONE of the following is the most appropriate action?
A. Treat as haemorrhoids only.
B. Supply topical treatment indefinitely.
C. Advise urgent assessment because rectal bleeding with systemic or bowel habit changes requires review.
D. Recommend loperamide.
E. Ignore the weight loss.
45. A 39-year-old woman with severe nausea and vomiting in early pregnancy cannot keep fluids down and has ketones in her urine.
Which ONE of the following is the most appropriate action?
A. Reassure and review after delivery.
B. Recommend alcohol.
C. Stop all fluids.
D. Arrange medical assessment for possible hyperemesis gravidarum and dehydration.
E. Treat with orlistat.
46. A 75-year-old woman taking long-term lansoprazole asks whether she should remain on it indefinitely. She no longer has reflux symptoms and has no documented high-risk indication.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Double the dose.
B. Review ongoing indication and consider step-down or stopping if appropriate.
C. Add another proton pump inhibitor.
D. Continue lifelong without review.
E. Replace with oral steroids.
47. A 60-year-old man taking clopidogrel buys omeprazole for dyspepsia. He has had previous gastrointestinal bleeding.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure that all PPIs are identical with clopidogrel.
B. Tell him to stop clopidogrel.
C. Recommend ibuprofen instead.
D. Review interaction and gastroprotection needs with the prescriber or pharmacist, as PPI choice may matter.
E. Add aspirin.
48. A 50-year-old man presents with sudden severe right upper quadrant pain after fatty meals, nausea and tenderness. He has no fever or jaundice.
Which ONE of the following is the most likely diagnosis?
A. Uncomplicated biliary colic.
B. Crohn’s disease flare.
C. Hepatic encephalopathy.
D. Coeliac disease.
E. Oral candidiasis.
49. A 68-year-old man with chronic pancreatitis is prescribed pancreatic enzyme replacement therapy. He asks how to take it.
Which ONE of the following is the most appropriate advice?
A. Take only at bedtime.
B. Take with meals and snacks to aid digestion.
C. Crush enteric-coated preparations routinely.
D. Take only when constipated.
E. Avoid taking with food.
50. A 33-year-old woman with inflammatory bowel disease is about to start adalimumab. She asks why screening tests are required before treatment.
Which ONE of the following is the most appropriate explanation?
A. Screening is unnecessary before biologics.
B. Biologics cure all infections.
C. Screening is done only for anaemia.
D. Screening replaces all monitoring.
E. Screening helps identify infections such as tuberculosis or hepatitis before immunosuppression.
Gasto-Intestinal Questions
Answers and Rationale
1. C
Uncomplicated reflux symptoms without alarm features can be managed initially with lifestyle advice and a proton pump inhibitor trial. Alarm symptoms such as dysphagia, weight loss or bleeding would require referral.
2. E
Black tarry stools, hypotension, pallor and anticoagulant or NSAID use suggest upper gastrointestinal bleeding. This requires urgent hospital assessment rather than community management.
3. A
NSAIDs increase the risk of peptic ulceration and bleeding, especially in someone with previous ulcer disease. The need for NSAID therapy and gastroprotection should be reviewed.
4. D
Progressive dysphagia and unintentional weight loss are alarm features for possible upper gastrointestinal cancer. Urgent referral is required rather than empirical treatment alone.
5. B
Bloody diarrhoea with fever and severe abdominal pain suggests invasive infection or inflammatory disease. Loperamide may be inappropriate and medical assessment is needed.
6. E
Opioids commonly cause constipation, and patients receiving regular opioids often need a proactive bowel regimen. A stimulant laxative, osmotic laxative or combination may be required depending on symptoms.
7. A
Vomiting, distension, colicky pain and absolute constipation suggest bowel obstruction. Stimulant or bulk-forming laxatives may be unsafe and urgent assessment is required.
8. D
Rectal bleeding, unexplained weight loss and change in bowel habit are red-flag symptoms. These require clinical assessment for possible colorectal cancer rather than treatment as IBS.
9. B
Coeliac testing should be performed while the patient is still consuming gluten, otherwise false-negative results may occur. Iron deficiency anaemia and chronic diarrhoea support investigation.
10. C
Lactulose is used in hepatic encephalopathy to reduce ammonia absorption and promote its removal via the bowel. Doses are often adjusted to achieve regular soft stools.
11. D
Fever, tachycardia and frequent bloody diarrhoea suggest a potentially severe ulcerative colitis flare. This requires urgent clinical assessment.
12. A
Azathioprine requires baseline checks, counselling and ongoing blood monitoring because of risks such as myelosuppression, infection and liver toxicity.
13. E
Fever, sore throat and mouth ulcers in a patient taking azathioprine may indicate infection or bone marrow suppression. Urgent clinical assessment and blood tests are needed.
14. C
Mesalazine can rarely cause renal impairment or interstitial nephritis. Periodic renal function monitoring is therefore important even if symptoms are controlled.
15. B
Corticosteroids can be effective for inducing remission during flares but are not suitable long-term maintenance therapy because of significant adverse effects.
16. D
Severe epigastric pain radiating to the back with vomiting is concerning for acute pancreatitis, particularly with alcohol use or gallstone history. Urgent hospital assessment is needed.
17. A
Chronic pancreatitis can cause pancreatic exocrine insufficiency, leading to steatorrhoea, bloating and weight loss. Pancreatic enzyme replacement therapy may improve digestion and nutrition.
18. E
Right upper quadrant pain, fever, jaundice and confusion suggest ascending cholangitis, which is a medical emergency requiring urgent hospital assessment.
19. C
New or worsening ascites in cirrhosis requires clinical assessment to confirm the cause, assess severity and identify complications such as spontaneous bacterial peritonitis.
20. B
Haematemesis in a patient with cirrhosis and known varices suggests possible variceal bleeding. This is life-threatening and requires emergency hospital treatment.
21. E
New rectal bleeding and weight loss are red flags and should not be attributed to IBS without assessment. Further clinical investigation is required.
22. C
For IBS with cramping abdominal pain and bloating, antispasmodics such as mebeverine or peppermint oil may be considered alongside diet and lifestyle measures.
23. A
If lifestyle measures and bulk-forming laxatives are insufficient, an osmotic laxative such as macrogol is a reasonable next option, provided obstruction is not suspected.
24. B
Overflow diarrhoea with long-standing constipation, opioid use and reduced bowel opening suggests faecal impaction. Assessment and appropriate bowel management are needed.
25. D
Orlistat reduces absorption of dietary fat and is taken with meals containing fat. Gastrointestinal adverse effects are more likely with high-fat meals.
26. A
Oily stools and urgency are recognised effects of orlistat, especially with high dietary fat intake. Dietary counselling is central to improving tolerability.
27. E
Progressive dysphagia and weight loss are alarm symptoms. Ongoing self-treatment with OTC omeprazole is inappropriate without urgent assessment.
28. C
H. pylori eradication requires completion of the full course to maximise eradication and reduce resistance or treatment failure. Symptom improvement alone is not a reason to stop.
29. D
Aspirin may be essential for secondary cardiovascular prevention, but previous ulcer bleeding increases gastrointestinal risk. Gastroprotection and bleeding risk should be reviewed.
30. B
Ondansetron commonly causes constipation. In a patient already taking morphine, bowel regimen should be reviewed proactively to prevent worsening constipation.
31. A
Severe abdominal pain, vomiting and distension may indicate obstruction. Increasing laxatives without assessment could be unsafe.
32. C
Fever, worsening abdominal pain and a tender mass in Crohn’s disease may suggest an abscess or other complication. Urgent assessment is required.
33. C
Antimotility medicines may be unsafe in severe colitis due to risk of toxic megacolon and other complications. Severe flares require urgent clinical management.
34. B
Mouth ulcers, sore throat and bruising in a patient taking methotrexate may indicate toxicity or bone marrow suppression. Missed monitoring increases concern and urgent assessment is needed.
35. D
Folic acid is prescribed with methotrexate to reduce some adverse effects, such as mucosal and gastrointestinal toxicity. It does not replace safety monitoring.
36. C
Diuretics for ascites require careful monitoring of renal function, electrolytes, blood pressure and fluid status. Dizziness and worsening renal function may indicate over-diuresis or dehydration.
37. B
Analgesic choice in liver disease requires caution. NSAIDs can increase risks such as renal impairment and gastrointestinal bleeding in advanced liver disease; paracetamol may be used cautiously at appropriate doses.
38. C
Ursodeoxycholic acid response is monitored using liver tests and clinical review. Ongoing assessment helps guide management and escalation if response is inadequate.
39. B
Dehydration can worsen renal function and increase harm from medicines such as metformin, ACE inhibitors and diuretics. Temporary medicine review may be appropriate during acute illness.
40. D
Chronic diarrhoea with nocturnal symptoms and weight loss is concerning for organic disease. Repeated loperamide supply without investigation would be inappropriate.
41. A
Persistent symptoms in coeliac disease may be due to ongoing gluten exposure, hidden gluten, poor adherence or another diagnosis. Dietetic and specialist review may be needed.
42. C
High-output stoma can rapidly cause dehydration, electrolyte disturbance and acute kidney injury. Dizziness and reduced urine output require urgent clinical advice.
43. D
No stoma output with abdominal pain and vomiting suggests possible obstruction. This requires urgent assessment rather than antimotility treatment.
44. C
Rectal bleeding may be caused by haemorrhoids, but weight loss and change in bowel habit are red flags requiring further assessment.
45. D
Severe vomiting in pregnancy with dehydration or ketones suggests hyperemesis gravidarum. Medical assessment is needed to prevent complications.
46. B
Long-term proton pump inhibitor therapy should be reviewed periodically. If there is no ongoing indication, dose reduction or stopping may be considered.
47. D
Some PPIs may interact with clopidogrel metabolism. In a patient with previous gastrointestinal bleeding, both gastroprotection and interaction risk should be reviewed.
48. A
Right upper quadrant pain after fatty meals without fever or jaundice is consistent with biliary colic. Fever or jaundice would raise concern for cholecystitis or cholangitis.
49. B
Pancreatic enzyme replacement therapy should be taken with meals and snacks to aid digestion and reduce steatorrhoea. Enteric-coated products should not usually be crushed.
50. E
Biologic therapy can increase infection risk. Screening for infections such as tuberculosis and hepatitis helps reduce serious complications before immunosuppression.
Here are 50 multiple-choice questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.