,Best of Five MCQs for the European
Specialty Examination in Gastroenterology
and Hepatology
,
,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
1
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,Dedicated to Professor Satish Keshav—clinician, academic, mentor,
and friend. He taught us all how to think outside the box.
,
, FOREWORD
For many trainees and colleagues, the European Specialty Examination in Gastroenterology and
Hepatology (ESEGH) will represent the last in a seemingly endless series of formal examinations
required to navigate a career in Medicine. It will also appear a particularly daunting task, with
the ESEGH designed to cover the full range and breadth of gastrointestinal and liver pathology.
Furthermore, the exam’s ‘best of five’ multiple choice questions are notoriously difficult,
pushing candidates to pick the most correct answer from a series of plausible options. To
survive the examination and emerge victorious therefore requires a combination of composure,
experience, clinical problem-solving, and a solid grasp of first principles. Therefore, the value of a
comprehensive, tailor-made resource such as this textbook cannot be overstated.
This book has been compiled by Specialist Registrars affiliated with Oxford University Hospitals NHS
Trust, who are no strangers to the rigors of post-graduate exams. The authors have drawn on this
collective experience to produce the first dedicated textbook to assist candidates in their preparation
for the ESEGH. The book has been meticulously assembled to ensure that all relevant domains of
the curriculum are covered and that the weighting of questions on each topic precisely matches the
proportions found in the examination itself. The questions are engaging, being based on real-life
clinical scenarios which have all required specialist input and decision making. Some questions are
relatively straight forward, but many I found challenging! However, each answer helpfully includes a
summary of the key learning points, alongside a concise explanation that walks the reader through
the necessary background information. In addition, the book has clearly been written for the broad
European audience, with all the answers rooted in the most up-to-date European guidelines.
Writing a textbook is a mammoth undertaking, which is why as a former President both of the
British Society of Gastroenterology and of the Royal College of Physicians, it is particularly satisfying
to see Specialist Registrars work together to produce such a high-quality resource, for the wider
benefit of their trainee colleagues.
I have no doubts that you will find this book an extremely useful and enjoyable read, and I wish you
all the best, both in the examination and in your future careers as Specialists in Gastroenterology
and Hepatology. You will not regret your career choice (or indeed your use of this book!)
Sir Ian Gilmore
Former President of Royal College of Physicians of London
Former President of British Society of Gastroenterology
Director, Liverpool Centre for Alcohol Research
Chairman, Alcohol Health Alliance UK
,
, PREFACE
In 208, the European Specialty Examination in Gastroenterology & Hepatology (ESEGH) came
into force, merging the Specialty Certificate Examination (SCE) in the UK with the European Section
and Board of Gastroenterology and Hepatology Examination (ESBGH). This aimed to unify and
improve standards of practice across Europe, and completing the exam now demonstrates that
sufficient knowledge has been acquired to fulfil the requirements of a specialist in gastroenterology
and hepatology according to a curriculum agreed upon across the continent. The exam involves
200 ‘Best of Five’ multiple-choice questions, meaning that several of the choices may be plausible
but only one is the best answer. Successfully answering this type of question is challenging and
requires synthesis of basic knowledge, experience, data analysis, and clinical problem solving.
Practice, as always, is crucial and we therefore aimed to produce a valuable tool for all trainees
revising for the exam, as well as international reference material for other professionals working in
gastroenterology and hepatology.
This is the first question book specifically designed to help prepare for the ESEGH. It contains 300
original ‘Best of Five’ multiple-choice questions covering the breath of the European curriculum.
Furthermore, the composition of the book exactly matches the proportion of questions for
each curriculum area found in the exam. For example, the ESEGH contains 20% questions on
hepatology, 0% on small intestinal disorders, 8% on pancreatic disorders, and so on, and therefore
the same proportions of questions for each topic area are reflected in the book. Each question
is accompanied by an answer, a set of succinct bullet points of key ‘take-home’ messages and a
short summary of the relevant background, evidence base and up-to-date European guidelines.
The book ends with a chapter of 50 questions designed to act as a mock examination for use in
the final stages of preparation. Questions have been contributed by 5 UK specialty trainees in
Oxford, many of whom have successfully passed the former UK Specialty Certificate Examination
or the ESEGH itself. All questions were scrutinized by senior editors, Professor Simon Travis,
Dr Aminda de Silva, and Dr Jeremy Cobbold who deserve particular thanks for their invaluable
advice and guidance throughout the writing and editing process. We would also like to thank the
broader gastroenterology and hepatology consultant body at the John Radcliffe Hospital who have
supported trainees in their question contributions, and the radiology and histology department
team who have sourced many of the images included in the book.
We sincerely hope that you find reading this book and answering the questions both interesting and
helpful in your exam preparations. Good luck!
Dr Thomas Marjot
Dr Colleen McGregor
Dr Tim Ambrose
