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year 3 conditions > gastrointestinal > Flashcards

gastrointestinal Flashcards

1
Q

if a pt has primary sclerosing cholangitis, what would indicate a decrease in the synthetic function of the liver and the need for a liver transplant

A

prolonged PT

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2
Q

which demographic and syndrome is primary biliary cholangitis associated with

A

middle aged females
sjogrens syndrome

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3
Q

what is Wilsons disease and what is it characterised by

A

hepatic jaundice due to excessive copper deposition in liver / brain / cornea
characterised by
- reduced serum caeruloplasmin
- reduced total serum copper
causes psychiatric problems - speech/swallowing/physical coordination

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4
Q

which clinical sign is associated with raised oestrogen in cirrhosis

A

palmar erythema

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5
Q

which clinical sign is associated with portal hypertension in cirrhosis

A

caput medusae

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6
Q

what is terlipressin used for

A

treatment of bleeding oesophageal varicies

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7
Q

what is the cause of jaundice in the presence of deranged liver function tests and anti mitochondrial antibodies

A

primary biliary cholangitis

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8
Q

what is given before the administration of glucose in wernickes encepahlopathy

A

IV thiamine

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9
Q

what is used when there’s reduced consciousness due to cerebral oedema in hepatic encephalopathy

A

IV mannitol

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10
Q

what helps to reduce encephalopathy by facilitating nitrogenous waste loss through the intestines

A

lactulose

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11
Q

what is used to reduce oedema or ascites in liver cirrhosis

A

spironolactone

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12
Q

what are the most common bacteria associated with spontaneous bacterial peritonitis

A

e coli
k pneumoniae

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13
Q

prophylactic treatment for spontaneous bacterial peritonitis

A

Abx: ciprofloxacin or norfloxacin

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14
Q

what s the initial investigation if see someone unstable and confused, smelling of alcohol and has signs of liver failure

A

blood glucose - to rule out hypoglycaemia
then do LFTs

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15
Q
A
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16
Q

What is disulfiram used for

A

Is an aldehyde dehydrogenase inhibitor used in patients with alcohol dependency
Causes unpleasant symptoms on alcohol consumption which helps them abstain from drinking

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17
Q

If a patient has hepatic encephalopathy which medication can reduce confusion

A

Lactulose
- chlordiazepoxide is for pts at risk of alcohol withdrawal and is CONTRAINDICATED in pts with hepatic encephalopathy

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18
Q

what is Gilbert’s disease

A

benign condition (no treatment needed) in which there is decreased activity of the enzyme that conjugates bilirubin
this means you get unconjugated hyperbilirubinaemia during fasting, stress, exercise, illness

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19
Q

likely diagnosis if someone gets jaundice in ramadan

A

gilbert’s disease

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20
Q

what is the most common complication of acute liver failure

A

bacterial infection

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21
Q

which antibiotics should be avoided when treating HAP in a pt with acute liver failure and why

A

gentamicin - can cause renal failure

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22
Q

which resp condition requires needle decompression

A

tension pneumothorax

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23
Q

when would you give FFP

A

if there is evidence of haemorrhage / bleeding

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24
Q

when is IV mannitol given

A

if suspected raised intracranial pressure

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25
Q

treatment if pt has bibasal crepitations on inspiration

A

IV furosemide - as they have pulmonary oedema

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26
Q

which symptom specifically indicates primary biliary cirrhosis

A

pruritus

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27
Q

which antibiotic can cause jaundice

A

co amoxiclav

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28
Q

what does dry cough and red nodules on shin indicate

A

sarcoidosis

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29
Q

what does the triad of abdominal pain, ascites, tender hepatomegaly indicate

A

Budd Chiai syndrome - thrombosis of hepatic vein

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30
Q

what is the most likely diagnosis for an older pt presenting with anaemia, dyspnoea, palpitations, headaches, easy bruising, bone pain, splenomegaly

A

myelofibrosis

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31
Q

main treatment for confusion due to hepatic encephalopethy

A

ORAL lactulose

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32
Q

what is given for symptomatic relief of alcohol withdrawal

A

chlordiazepoxide

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33
Q

what is given to prevent wernickes encephalopathy

A

IV thiamine

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34
Q

what does a cloudy ascitic fluid tap indicate

A

infection

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35
Q

an INR over which number is indicative alone for urgent liver transplant

A

INR > 6.5

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36
Q

what is the triad of acute liver failure

A

encephalopathy
jaundice
coagulopathy

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37
Q

what causes leuchonychia in chronic liver disease

A

hypoalbuminaemia

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38
Q

what causes excoriations/pruritis in chronic liver disease

A

raised serum bilirubin

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39
Q

what ammonia levels are seen in liver failure

A

high

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40
Q

medication used to reduce recurrence of hepatic encephalopathy

A

rifaximin

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41
Q

3 meds for hepatic encephalopathy and what they’re used for

A

oral lactulose - for confusion, causes loss of toxins via gut
IV mannitol - for reduced consciousness, reduces ICP
rifaximin - for prevention of recurrence

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42
Q

pruritus + pale stool + dark urine = what kind of jaundice

A

obstructive jaundice

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43
Q

iif a pt has jaundice and breathlessness (but no smoking history and bronchodilators are ineffective) what os the most likely cause

A

low serum alpha 1 antitrypsin

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44
Q

describe the microscopy results of ascitic tap for SBP

A

neutrophil count > 250 /uL

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45
Q

treatment for SBP

A

IV ceftriaxone / ciprofloxacine / cefotaxime

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46
Q

how many hours after abstinence from alcohol does delirium terms occur

A

48 - 72 hrs

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47
Q

what are the LFTs and other blood results for alcoholic hepatitis

A

AST>ALT (2:1)
elevated GGT
non megaloblastic macrocytic anaemia
increased ALP (but less than ALT and AST)
increased bilirubin
decreased albumin
increased PT

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48
Q

if have a pt who smells of alcohol, has signs of chronic liver disease and seems very confused, what’s the first investigation

A

blood glucose to rule out hypoglycaemia , then do LFTs

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49
Q

symptomatic relief of alcohol withdrawal

A

chlordiazepoxide
vitamin C

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50
Q

prevention of wernickes encephalopathy

A

pabrinex (IV thiamine)

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51
Q

what medications are given following successful alcohol withdrawal

A

Acamprosate - for abstinence
Disulfiram
Naltrexone

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52
Q

which autoimmune hepatitis occurs in children only

A

type 2

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53
Q

what is the most common type of autoimmune hepatitis

A

type 1

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54
Q

antibodies for type 1 A.I hepatitis

A

anti smooth muscle antibodies (ASMA)
anti nuclear antibodies (ANA)

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55
Q

antibodies for type 2 A.I hepatitis

A

anti liver kidney microsomal 1 antibodies
(anti LKM1)

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56
Q

antibodies for type 3 A.I hepatitis

A

anti soluble liver antigen

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57
Q

what is a sensitive markers for ischaemic hepatitis

A

significant rise in LDH

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58
Q

what is the highest LFT in viral hepatitis

A

ALT (ALT >AST)

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59
Q

describe the serology results in AI hepatitis

A

high IgG (hypergammaglobulinaemia)
ANA / ASMA / A-LKM1 / anti-solube liver antigen antibodies

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60
Q

which hepatitis is characterised by high IgG

A

auto immune hepatitis

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61
Q

treatment for AI hepatitis

A

Induction therapy : prednisolone (corticosteroid)
Maintenance therapy : azatioprine (immunosuppressant)

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62
Q

which hepatitis present predominantly in young/midddle aged women

A

autoimmune hepatitis

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63
Q

with class of antibody indicates previous or chronic infection

A

IgG

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64
Q

which class of antibody indicates current / acute infection

A

IgM

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65
Q

most common viral hep in developing countries

A

hep A

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66
Q

most common viral hep globally

A

hep B

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67
Q

causes of viral hepatitis

A

ABCDE ACE

Hep A
Hep B
Hep C
Hep D
Hep E

Adenovirus
CMV
EBV

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68
Q

what virus causes hep a / b /c / e

A

Hep A = RNA picarnovirus
Hep B = hepadnavirus
Hep C = RNA flavivirus
Hep E = calcivirus

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69
Q

which hep virus is asymptomatic

A

hep c

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70
Q

with which hep virus do most people develop chronic infection

A

hep c

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71
Q

hep a / b / c mode of transmission

A

a = faecal - oral
b = blood/body fluids
c = blood/body fluids

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72
Q

with which hep virus do most people develop jaundice

A

hep a
(some adults do with hep b, hep c is usually asymptomatic)

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73
Q

what is the serology of someone with chronic hep b infection with high viral replication

A

positive anti HBcIgG antibodies
positive hepB antigen
positive HBeAg
positive HBsAg

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74
Q

which Hep B antibody indicates previous vaccination

A

antibody against HbsAg

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75
Q

which Hep B antibody indicates previous infection

A

IgG antibody against HbcAg

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76
Q

which Hep B antigen indicates high infectivity / high viral replication

A

HbeAg

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77
Q

1st and 2nd line treatment for hep B

A

1st = Peginterferon, alpha 2a
(interferon alpha)
2nd = Tenofovir, Entecavir

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78
Q

treatment for hep c

A

DAAT
nucleoside analogues eg sofosbuvir+ ribavirin

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79
Q

characteristic symptoms of ascending cholangitis

A

charcots triad
RUQ pain
Fever
Jaundice

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80
Q

what is fibrosis

A

fibrosis of liver tissue into regenerative nodules

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81
Q

what causes palmar erythema in cirrhosis

A

increased oestrogen

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82
Q

what causes leuchonychia in cirrhosis

A

low albumin

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83
Q

what causes caput medusae in cirrhosis

A

portal HTN

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84
Q

what is fetor hepaticus and what is it a sign of

A

rotten eggs/garlic smelling breath
sign of liver cirrhosis

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85
Q

clinical signs of liver cirrhosis

A

palmar erythema
dupuytren contracture
caput medusae
spider naevi
fetor hepaticus
pruritus
plantar erythema
gynaecomastia
jaundice
oesophageal varices
oedema
ascites
splenomegaly
smaller liver

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86
Q

what is the most specific and sensitive test for liver cirrhosis

A

liver biopsy

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87
Q

what is done in liver cirrhosis every 6 months to screen for hepetocellular cancer

A

liver ultrasound
AFP levels

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88
Q

what is done to check for varicies in pts with liver cirrhosis

A

upper GI endoscopy

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89
Q

how to mange ascites due to liver cirrhosis

A

sodium restriction
spironolactone
paracentesis

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90
Q

what surgical procedure can treat portal hypertension to reduce the risk of oesophageal varices

A

TIPS (transoesophageal intrehepatic porto systemic shunt)

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91
Q

what treatments are required if a pt with liver cirrhosis has haematemesis / malaena

A

terlipressin (vasopressin analogue)
IV Abx
Vit K / FFP (PT>20) / blood or platelet transfusion

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92
Q

what med is used as a prevention to reduce recurrence of hepatic encephalopathy

A

rifaximin

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93
Q

triad of liver failure

A

coagulopathy (INR > 1.5)
jaundice
encephalopathy

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94
Q

what treatment is given for paracetamol overdose leading to liver failure

A

N -acetylcysteine

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95
Q

what does asterixis in liver failure indicate

A

hepatic encephalopathy

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96
Q

prophylactic Abx for SBP

A

ciprofloxacin or norfloxacin

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97
Q

how long after last drink does delirium tremens occur

A

48-96 hours

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98
Q

which tumour marker is used for hepatocellular carcinoma

A

AFP

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99
Q

what is the most likely diagnosis of someone with COPD and liver cirrhosis

A

alpha - 1 - antitrypsin deficiency

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100
Q

what is the number of units per day and the audit score baseline for recommending assisted alcohol withdrawal (eg chlordiazepoxide)

A

over 15 units per day
AUDIT score of over 20

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101
Q

what type of bilirubin is high in gilbert’s syndrome

A

unconjugated bilirubin

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102
Q

what do you measure to confirm diagnosis of Wilsons disease

A

ceruloplasmin levels

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103
Q

likely diagnosis in a 22 year old with jaundice, tremor, affected speech

A

Wilsons disease

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104
Q

what is a subacute history with tender hepatomegaly and ascites suggestive of (pt has had no recent travel and doesn’t drink)

A

liver ischaemia due to budd chiari syndrome

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105
Q

investigation for Budd chair syndrome / liver ischaemia

A

US liver with Doppler flows

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106
Q

what is the serum copper level in Wilsons disease

A

LOW - bc copper is deposited the tissues

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107
Q

what vitamin deficiency causes wernickes encephalopathy

A

vitamin B1 (thiamine)

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108
Q

triad of werncikes encephalopathy

A

ataxia
confusion
opthalmoplegia

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109
Q

first line treatment for Wilsons disease

A

penicillamine
(remember like “copper Penny”)

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110
Q

what is the LFT results for AI hep

A

raised ALT and AST compared with ALP

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111
Q

which type of bilirubin can be found in the urine

A

conjugated bilirubin - as this is water soluble

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112
Q

which type of bilirubin is high in Gilberts syndrome

A

unconjugated bilirubin - only yellow skin and sclera not poo/pee

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113
Q

which gene mutation is responsible for Gilberts syndrome

A

UGT1A1 gene

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114
Q

initial step if pt took paracetamol overdose more than 15 hours ago

A

start N acetyl cysteine immediately

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115
Q

initial step if pt took paracetamol overdose 4 - 15 hours ago

A

check blood paracetamol conc and commence treatment accordingly

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116
Q

what are the 3 situations where you should start N acetyl cysteine immediately for paracetamol overdose

A
  • staggered overdose
  • if ingestion was more than 15 hours ago
  • if there is uncertainty about timing
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117
Q

pathophysiology of delirium tremens

A

unopposed glutamate activity

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118
Q

what is the LFT results in non alcoholic fatty liver disease

A

mild increase in AST and ALT

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119
Q

how do you diagnose non alcoholic fatty liver disease

A

liver biopsy

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120
Q

what is Budd chiari syndrome

A

obstruction of hepatic veins (often by thrombosis)
- hepatomegaly
- ascites
- abdo pain

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121
Q

for paracetamol ingestion, what Ph would indicate immediate liver transplant

A

pH < 7.3 at 24hrs post ingestion

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122
Q

what is naloxone used for

A

to treat and reverse opioid toxicity

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123
Q

how do you reduce risk of renal impairment in pts with SBP

A

give HAS (human albumin solution)

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124
Q

give 2 contraindications to performing an ascitic tap

A

infection on skin overlying area intended to insert needle into
disseminated intravascular coagulopathy

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125
Q

how do you calculate SAAG (serum-ascites albumin gradient)

A

serum albumin - ascites albumin

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126
Q

what are the causes of ascites if SAAG > 11 g/L and what type of ascites is it

A

ascites is transudative (low albumin)
causes:
portal HTN
liver cirrhosis
alcoholic liver disease
liver failure
Budd-Chiari syndrome
congestive heart failure

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127
Q

what are the causes of ascites if SAAG < 11 g/L and what type of ascites is it

A

ascites is exudative (high protein)
causes:
MIPN
- malignancy / malnutrition
- infection (eg TB)
- pancreatitis
- nephrotic syndrome

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128
Q

treatment for ascites

A

dietary sodium restriction
spironolactone
ascitic tap / paracentesis (give Iv albumin when doing large volume paracentesis)
AbX for SBP prophylaxis (ciprofloxacin / norfloxacin)

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129
Q

2 main side effects of spironolactone

A

gynaecomastia and hyperkalemia

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130
Q

wheat do you give for ascites if the max dose of spironolactone isn’t working

A

add furosemide to the spironolactone

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131
Q

what to give during large volume paracentesis

A

IV albumin

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132
Q

initial investigation of ascites

A

abdo USS

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133
Q

sign on examination suggesting ascites

A

shifting dullness

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134
Q

treatment of oesophageal varices due to portal HTN

A

terlipressin + IV Abx
consider TIPS (transjugular intrahepatic portosystemic shunt)
Prophylactic Beta blockers

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135
Q

what is raised in ascitic tap for SBP

A

neutrophils

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136
Q

what suggests SBP in an ascitic tap

A

ascitic fluid white cells > 250/mm3 which are predominantly neutrophils (PMN - polymorphonuclear neutrophils)
or
ascitic fluid contains neutrophils > 250/mm3 neutrophils

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137
Q

what is raised in ascitic tap for intra abdominal malignancy

A

lymphocytes

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138
Q

what is constipation defined as

A

irregular bowel movements
=< 3 bowel movements per week

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139
Q

give 3 groups of medication that cause consitpation

A

CCBs
antipsychotics
opiates

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140
Q

what is primary and secondary constipation

A

primary = due to dehydration, low fibre diet, lack of exercise
secondary = due to diverticulosis, diverticulitis, haemorrhoids, bowel obstruction, IBS etc

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141
Q

treatments for consitaption

A

1st: dietary and lifestyle modifications (more fluids, fibre exercise)

Bulk laxatives and tool softeners
Osmotic laxatives - eg lactulose
stimulant laxatives - eg senna
prunes - natural laxatives

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142
Q

what are the 4 main types of laxatives

A

bulk laxatives
osmotic laxatives
simulant laxatives
stool softener laxatives

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143
Q

when might constipation cause confusion

A

faecal impactation

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144
Q

bristol stool chart (type 1 -7)

A

1 - hard lumps, like nuts
2 - sausage shape but lumpy
3 - sausage shape with cracks on surface
4 - smooth sausage
5 - soft blobs, clear cut edges
6 - fluffy pieces, ragged edges, mushy
7 - watery, no solid pieces

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145
Q

investigations for constipation

A

anal manometry
FBC - ion deficiency anaemia
TFTs - hypo thyroidism
AXR - rectal mass, faecal impactation

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146
Q

Rome IV diagnostic criteria for functional constipation in adults

A
  • at least 2
  • in the past 1/4 or more of defections
  • in past 12 weeks
  • with symptoms ongoing for 6+ months
  • 3 or less bowel movements per week
  • sensation of incomplete evacuation
  • sensation of anorectal obstruction / blockage
  • manual aid to evacuate stool
  • straining attempts to defecate
  • hard/lumpy stool
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147
Q

constipation red flags in children

A

meconium passage delayed (over 48 hours)
consitpation within first month of life
bilious vomiting
blood in stool
fever
family history of related disease
severe abdo distention

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148
Q

constipation red flags in adults

A

family history
iron deficiency anaemia
blood in stool
palpable ado mass
reduced stool caliber
weight loss
recall prolapse
sudden onset
unresponsive to medication
>50 years

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149
Q

what counts as chronic anal fissure

A

over 6 weeks

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150
Q

primary vs secondary anal fissure

A

primary - due to local trauma
secondary - due to underlying disease eg previous anal surgery, IBD, infections

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151
Q

acute anal fissure management (<1 week)

A

conservative
- fluids
- diet modifications
- bulk forming laxatives and stool softeners
- lubricant / petroleum jelly application prior to defacation
- sitz bath

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152
Q

chronic anal fissure (>6 weeks)

A

analgesia
- topical GTN
- topical diltiazem

for persistent fissures
- botox
or surgical sphincterectomy

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153
Q

grades I - IV for internal fissures

A

I - bleeding, no prolapse
II - prolapse, reduces spontaneously
III - prolapse, can be technically reduced
IV - prolapse, cannot be reduced

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154
Q

internal vs external sphincter

A

internal - above denate line, painlesss
external - below denate line, can be painful and prone to thrombosis

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155
Q

how can you tell if a haemorrhoid is thrombosed

A

v painful
purple
oedematous

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156
Q

1st line diagnostic investigation for haemorrhoid

A

anoscopic examination (protoscopy)

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157
Q

1st line management for all haemorrhoid patients

A

dietary and lifestyle modifications

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158
Q

management for haemorrhoid grades I - IV

A

I = topical corticosteroids (relives pruritis)
II-III = Rubber band ligation
IV = surgical haemorrhoidectomy

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159
Q

which class of proteins triggers coeliac disease

A

gliadin

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160
Q

which skin manifestation is seen in coeliac disease

A

dermatitis herpetiformis
(itchy papulovesicular lesions on extensor surfaces of skin esp elbows)

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161
Q

1st line and gold standard diagnostic investigations for coeliac disease

A

1st line : serology
- increased IgA tTG / anti-endomysial / anti-gliadin antibodies

after that do Endoscopy + biopsy (diagnostic, gold standard)
- crypt hyperplasia / villous atrophy / increased intraepithelial lymphocytes

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162
Q

treatment for coeliac disease

A

avoid gluten - eat alternatives
vitamin and mineral supplements (as coeliac disease causes malabsorption)

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163
Q

which vaccination is give to those with coeliac disease and why

A

pneumococcal vaccination
they get functional hyposplenism

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164
Q

FBC finding for coeliac disease

A

iron deficiency anaemia

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165
Q

Blood smear finding for coeliac disease and what does this indicate

A

target cells
Howell-jolly bodies
indicates functional hyposplenism

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166
Q

what effect does coeliac disease have on the spleen

A

causes functional hyposplenism

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167
Q

most important sign suggestive of IBS

A

pain relieved by defecation

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168
Q

which extra intestinal manifestation runs its course independent of IBD activity (active luminal disease)

A

primary sclerosing cholangitis

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169
Q

what medication is used to maintain remission in UC in those who’s remission is not maintained by 5 ASA

A

mercatopurine or azothioprine

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170
Q

what investigation is done to monitor for complications of coeliac disease

A

DEXA scan –> monitors for osteoporosis / osteopenia

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171
Q

which area is always affected in UC but often spared in crohns

A

rectum

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172
Q

what type of laxative is macrogol

A

osmotic

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173
Q

what is the first line investigation for coeliac disease in a pt who his IgA deficient

A

blood test for anti tTG IgG antibodies
(normally its for anti tTG IgA antibodies)

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174
Q

first lien med for crohns flare up

A

IV hydrocortisone

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175
Q

pt with crohns presents with pain and fresh red bleeding on defecation. what is the most likely diagnosis

A

anal fissure

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176
Q

which part of the intestine is affected by crohns disease and contributes to the formation of gallstones

A

terminal ileum

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177
Q

what is imatinib used to treat and what is its mechanism of action

A

chronic myeloid leukaemia
GI stromal tumours

inhibition of tyrosine kinase

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178
Q

which investigation differentiates IBS from IBD

A

faecal calprotein

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179
Q

what does positive faecal elastase indicate

A

chronic pancreatitis

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180
Q

what do cysts on stool microscopy indicate

A

parasitic infection eg giardiasis

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181
Q

what type of condition does high ALP compared to ALT/AST indicate

A

obstruction

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182
Q

what does jaundice, pruritis and an obstructive LFT pattern in a pt with UC indicate

A

primary sclerosis cholangitis

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183
Q

LFT results in PSC

A

obstructive pattern
- v high ALP compared to AST/ALT

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184
Q

MRCP results in PSC

A

multiple beaded biliary structures

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185
Q

what do you need to rule out if someone with coeliac disease presents with weight loss / recurrent diarrhoea / recurrent abdominal pain

A

enteropathy associated T cell lymphoma

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186
Q

treatment for PSC

A
  • supportive
  • liver transplant, is potentially curative but PSC can recur
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187
Q

which condition does pain relieve by defecation indicate

A

IBS

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188
Q

pt with opiate - induced constipation has been taking movicol (osmotic laxative) to no effect. what is next step in management

A

ADD Senna

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189
Q

best treatment for opiate-induced constipation

A

a combination of an osmotic and a stimulant laxative

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190
Q

in which pts should stimulant laxatives be avoided

A

pts with
- small bowel obstruction
- IBD
- pregnant

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191
Q

initial management in a euvolemic pt with toxic megacolon

A

urgent decompression with an NG tube

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192
Q

which conditions is hcg raised in

A

hydatidiform moles
choriocarcinoma
gestational trophoblastic tumours

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193
Q

what is VMA (vanillylmandelic acid) raised in

A

phaechromocytoma

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194
Q

which condition is CA19-9 raised in

A

cholangiocarcinoma

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195
Q

which condition is CA125 raised in

A

ovarian cancer

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196
Q

what do raised faecal leukocytes indicate

A

bacterial infective colitis

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197
Q

what is a common defecation problem in enterally fed pts

A

diarrhoea

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198
Q

what is the likely diagnosis if a pt with long-standing UC develops abnormal liver enzymes and weight loss

A

cholangiocarcinoma / biliary tract carcinoma

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199
Q

crohns pt is on steroid therapy, which med should she be put on to prevent crohns flare

A

azothioprine

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200
Q

pt underwent a bowel resection for their crohns and is now suffering with pale coloured and difficult to flush diarrhoea. what is most likely diagnosis

A

short bowel syndrome

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201
Q

what is blepharitis and what is it most commonly caused by

A

inflammation of eyelid - red, crusty
caused by staph aureus infection

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202
Q

when is tacrolimus used to treat UC

A

when pt is resistant to aminosalicylates and steroids

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203
Q

what is used to maintain remission in UC pts

A

azathioprine

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204
Q

if pt has an acute uC flare up and topical +oral mesalazine is not improving symptoms what do you add

A

add prednisolone

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205
Q

what medication is used to maintain remission in both uc and crohns

A

azathioprine

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206
Q

if colonscopy is normal in a pt with crohns, whats the next step in investigation

A

investigate the small bowel:
- small bowel MRI or small bowel capsule endoscopy

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207
Q

what is loperamide used for

A

to treat diarrrhoea
so don’t give in constipation !!

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208
Q

give some iatrogenic causes of diarrhoea

A

oral magnesium replacement, penicillin, omeprazole, metformin, chemotherapy, NSAIDs

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209
Q

most likely cause of hairy-looking white lesion on side of tongue

A

epstein barr virus

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210
Q

likely diagnosis if a pt presents with weight loss, bloody diarrhoea, high ALP and positive p-ANCA and ANA

A

primary sclerosing cholangitis (secondary to UC)

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211
Q

what are sore swollen tongue (glossitis), bleeding gums and peripheral neuropathy a sign of

A

B12 deficiency

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212
Q

order of treatments for UC flare up

A
  1. IV hydrocortisone
  2. cyclosporin
  3. infliximab
  4. colectomy
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213
Q

first line test for coeliac disease suspicion

A

total IgA + IgA tTG

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214
Q

if crohns pt presents with sepsis secondary to a perineal abscess, what is first line of investigation

A

urgent MRI pelvis
(if delay - urgent CT, if not possible - examination under anaesthetic)

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215
Q

what kind of laxative is ispaghula husk

A

bulk forming

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216
Q

what kind of laxative is macrogol

A

osmotic laxative

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217
Q

what kind of laxative is bisacodyl

A

stimulant laxative

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218
Q

what is a likely diagnosis for abdominal pain, explosive diarrhoea, bloating and flatulence after tropical travel

A

giardia

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219
Q

what do pale stools (steatorrhea) indicate

A

malabsorption

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220
Q

if a pt meets IBS criteria, what is the most appropriate next investigation

A

tTG antibodies, to rue out coeliac disease

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221
Q

what indicates surgery with toxic megacolon

A

not responds to steroids within 48-72 hrs

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222
Q

toxic megacolon treatment

A

NBM
IV fluids
IV hydrocortisone

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223
Q

which cause if diarrhoea shows ancathocytes, target cells and Howell jolly bodies on a a blood film

A

coeliac disease

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224
Q

in which conditions should pts also be tested for coeliac disease

A

graves disease
T1DM

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225
Q

first line treatment for flare up in crohns

A

prednisolone

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226
Q

what is shilling test used for

A

evaluates whether or not vit B12 deficiency is caused by pernicious anaemia

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227
Q

treatment for dermatitis herpetiformis

A

dapsone

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228
Q

what do aphthous ulcers in the context of weight loss and abdo pain indicate

A

crohns

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229
Q

if pt is in an acute condition/having a flare up and was suspected to have IBD (blood in stool is already seen), what is the best diagnostic investigation

A

flexible sigmoidoscopy
(colonoscopy can cause perforation in flare up)

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230
Q

what is chlorhexidine used to treat

A

oral ulcers

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231
Q

what is fluconazole used to treat

A

oral thrush , candidiasis

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232
Q

what is the ABC of IBS

A

abdominal pain, bloating, change in bowel habit for at least 6 months

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233
Q

rome IV criteria for IBS

A

on average at least 1 day/week, during past 3 months, 2 of the following
- pair related to defecation
- change in stool frequency
- change in stool form/appearance

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234
Q

according to NICE, those who meet criteria for IBS should be tested to rule out which other condition

A

coeliac disease - test for anti tTG antibodies

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235
Q

management for cramps/pains associated with IBS

A

antispasmodics

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236
Q

management for constipation dominant IBS

A

bulk forming laxatives (ispagula husk / Fybogel)
avoid lactulose

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237
Q

management for diarrhoea dominant IBS

A

Loperamide (antidiarrhoeals)

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238
Q

where is the pain in UC

A

left lower abdomen

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239
Q

where is the pain in crohns

A

right lower abdomen

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240
Q

contrast the diarrhoea in UC vs crohns

A

UC: bloody, mucus
Crohns: non bloody, watery

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241
Q

contrast the main symptoms a right vs left sided colorectal carcinoma

A

right: melena, diarrhoea
left: constipation

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242
Q

contrast colon layer involvement in UC vs crohns

A

crohns: transmural
UC: mucosa

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243
Q

contrast the most commonly affected parts of gut in UC vs crohns

A

Crohns: terminal ileum
UC: rectum

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244
Q

contrast granuloma involvement in UC vs crohns

A

crohns: non caseating granulomas
UC: no granulomas

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245
Q

contrast involvement pattern in UC vs crohns

A

crohns: skip lesions
UC: continuous

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246
Q

contrast smoking effects in UC vs crohns

A

crohns: smoking = Risk factor
UC: smoking = protection

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247
Q

contrast joint involvement in UC vs crohns

A

crohns: arthropathy (joint pain)
UC: ankylosing spondyliis, pyoderma gangernosum

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248
Q

what are the effects on the skin and eyes in UC and crohns

A

skin:
erythema nodosum (erythema on shins)
pyoderma gangrenosum (ulcers on legs)
mouth ulcers

eyes:
anterior uveitis (painful red eye with loss of vision and photophobia)
episcleritis (painless red eye)

(in UC, episcleritis>anterior uveitis)

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249
Q

what shows on a barium enema in crohns

A

kantor’s string sign
rose thorn ulcers

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250
Q

what does a biopsy show in crohns

A

skip lesions
deep ulcers
cobblestone appliance
transmural inflammation
non caveating granulomas
increased goblet cells

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251
Q

1st line treatment for crohns flare up

A

predinsiolone

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252
Q

treatment in crohns

A

induce remission:
prednisone / budesonide

maintain remission:
1st line: azathioprine (may cause myelosuppresion, reducing WCC)
2nd line: methotrexate

Bioogics

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253
Q

side effect of azothioprine

A

myelosuppression, may cause WCC reduction

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254
Q

next steps if crohns colonsoscipy is normal

A

investigate small bowwel by either
- small bowel capsule endoscopy
- MRI small bowel

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255
Q

what is proctitis

A

UC involving only rectum

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256
Q

what is pancolitis

A

UC involving entire colon

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257
Q

which parts of the gut can UC be found in

A

uptown the ileocaecal valve - never spreads proximally to this

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258
Q

does crohns or UC have genetic element, and what is the genetic element

A

UC
genetic predisposition - HLA-B27

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259
Q

rectal involvement in UC vs crohns

A

rectum is always involved in UC but often spared in crohns

260
Q

what shows on a biopsy in UC

A

continuous inflammation
crypt abscesses
no granulomas
depletion of goblet cells

261
Q

goblet cells in UC vs crohns

A

crohns: increase
UC: depletion

262
Q

what shows on barium enema in UC

A

lead pipe appearance

263
Q

AXR in UC

A

thumb printing
loss of haustra
pseudopolyps
toxic megacolon

264
Q

toxic megacolon treatment

A

IV fluids
NBM
NGT
IV hydrocortisone –> surgery if don’t respond in 48-72 hrs

265
Q

why do you need to monitor a pt on mesalazine with FBC

A

mesalazine causes agranulocytosis

266
Q

no. of bowel movements in mild, moderate, severe UC

A

mild <4
moderate 4-6 (4 or 5)
severe 6 or more

267
Q

treatment for UC

A

mild/moderate
- 5 -ASA (Mesalazine)
- topical for proctitis or proctosigmoiditis
- oral for more extensive disease or if topical doesn’t help

moderate flare up:
oral steroids

severe flare up
- 1st: IV hydrocortisone
- 2nd: IV cyclosporin
- 3rd: inflixamab
- 4th: colectomy

268
Q

treatment for maintaining remision UC

A

1st: mesalazine
2nd: mercatopurine / azothioprine

269
Q

what does MRCP show in primary sclerosing cholangitis

A

multiple beaded biliary structures

270
Q

Tx for primary sclerosing cholangitis

A

supportive
liver transplant, but it can recur

271
Q

antibodies shown in primary sclerosing cholangitis

A

ANA
p-ANCA
anti-SMA

272
Q

what do LFTS indicate in primary sclerosing cholangitis

A

obstruction (v high ALP compared to ALT/AST)

273
Q

what should symptoms of cholestasis (jaundice/ pruritis) in a pt with UC indicate

A

primary sclerosing cholangitis

274
Q

first line / gold standard step of management for GORD
then following that what are the next steps

A

1) 8 week PPI trial

if this doesn’t work, or pt displays any ALARM symptoms (>55yrs, weight loss, dysphagia)
Do endoscopy

if endoscopy is negative
Do oesophageal manometry with pH monitoring

275
Q

medication for GORD

A

PPI, can add H2 blocker (ranitidine) to this

276
Q

Symptom relief med for GORD

A

antacids

277
Q

PPI side effects

A

hypomagnesaemia
hyponatraemia (SIASH)
increased risk of C diff
osteoperosis + increased risk of fractures

278
Q

what is the surgery for GORD

A

nissens fundoplication

279
Q

2 types of oesophageal cancer

A

upper 2/3: squamous cell carcinoma
lower 1/3: adenocarcinoma

280
Q

causes of squamous cell carcinoma of oesophagus

A

alcohol
smoking
HPV
hot beverages
diet low in fruit and veg

281
Q

causes of adenocarcinoma of oesophagus

A

GORD
male sex
obesity
barrets oesophagus
hiatus hernia

282
Q

first line gold standard investigation for oesophageal cancer

A

endoscopy and biopsy

283
Q

investigation for oesophageal cancer

A

endoscopy + biopsy
CAP CT/MRI
(CAP = chest abdo pelvis)

284
Q

treatment for oesophageal cancer

A

oesophagectomy + chemo
or
chemoradiotherapy

285
Q

what is achalasia

A

decreased relaxation of LOS

286
Q

gold standard investigation for achalasia

A

oesophageal manometry - shows increased LOS pressure

287
Q

findings of barium enema in achalasia

A

birds beak appearance

288
Q

how to stage oesphegal cancer

A

CAP CT / MRI

289
Q

findings on CXR for achalasia

A

widened mediastinum

290
Q

treatment for achalasia

A

pneumatic dilatation
hellers cardiomyotomy

291
Q

2 signs of advanced disease in oesophageal cancer

A

hoarseness: compression of recurrent laryngeal nerve
horners syndrome: miosis, ptosis, anhidrosis

292
Q

signs of upper GI bleed

A

haematemesis, meleana, raised urea

293
Q

what is appendicitis caused by

A

obstruction of lumen of appendix, by faecolith, infective agents or lymphoid hyperplasia

294
Q

what is mcburneys point of tenderness and what does it indicate

A

1/3 of distance from right ASIS to umbilicus
indicates appendicitis

295
Q

what is rosvings sign and what does it indicate

A

deep palpation in LLQ elicits pain in RLQ
appendicitis

296
Q

what is obturator sign and what does it indicate

A

pain on internal rotation of flexed hip
appendicitis

297
Q

what is psoas sign and what does it indicate

A

pain on extension of hip
appendicitis or psoas abscess –> do CT abdo to check

298
Q

what is blumberg sign and what does it indicate

A

rebound tenderness in RLQ
appendicitis

299
Q

investigation for appendicitis

A

1st: FBC
CRP
abdo US
abdo CT (if US is inconclusive)

300
Q

best imaging if appendix perforation is suspected

A

erect CXR

301
Q

main FBC result in appendicitis

A

neutrophil associated leukocytosis
raised CRP

302
Q

appendicitis treatment

A

laparoscopic appendicetocmy
give prophylactic ABx before surgery (metronidazole / cefuroxime)

303
Q

2 main complications of appendicectomy

A

perforation –> peritonitis
pelvic abscess —> pain, fever, sweats, mucus diarrhoea

304
Q

causes of acute pancreatitis

A

I GET SMASHED

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion poison
Hypercalcaemia, Hypertriglyceridaemia
ERCP
Drugs

305
Q

most common cause of acute pancreatitis in females

A

gallstones

306
Q

most common cause of acute pancreatitis in males

A

alcohol

307
Q

2 skin signs of severe pancreatitis

A

Cullens sign (periumbilical bruising)
Grey-turner sign (flank bruising)

308
Q

describe the pain in acute pancreatitis

A

severe epigastric pain that radiates towards the back
sudden onset
worse with movement

309
Q

what is the pH of body in acute pancreatitis

A

hypokalaemia metabolic alkalosis
(nausea and vomiting causes dehydration)

310
Q

which enzyme do you test for in acute pancreatitis

A

lipase(more senssitive than lipase)

311
Q

if suspect gallstones in acute pancreatitis what is the best imaging

A

ultrasound

312
Q

leukocyte levels/results in acute pancreatitis

A

leukocytosis with left shift

313
Q

what does elevated haematocrit (>44%) indicate in acute pancreatitis

A

poor prognosis

314
Q

what does elevated ALT in acute pancreatitis indicate

A

suggests that gallstones is the cause

315
Q

treatment for acute pancreatitis

A

Fluid resus
analgesia (IV morphine)
enteral feeding

316
Q

treatment for gallstones pancreatitis

A

ERCP

317
Q

what needs to be monitored very 6 months in chronic pancreatitis pts

A

HbA1c needs to be monitored very 6 months
as DM develops in majority of pts

318
Q

faeces in chronic pancreatitis

A

steatorrhea

319
Q

most sensitive test at detecting pancreatic calcification in chronic pancreatitis

A

CT

320
Q

which enzyme is measured in chronic pancreatitis

A

faecal elastase

321
Q

treatment for chronic pancreatitis

A

pancreatic enzyme supplements

322
Q

most common form of pancreatic cancer

A

primary pancreatic ductal adenocarcinoma

323
Q

signs and symptoms of pancreatic cancer

A

painless jaundice - suggests obstruction
dark urine and pale stools
pruritus
palpable mass in RUQ
non specific upper abdominal pain
weight loss and anorexia

324
Q

which part of the pancreas is the cancer if it causes obstruction to bile flow

A

head of pancreas

325
Q

cause of pruritic in pancreatic cancer

A

bile salts in circulation

326
Q

cause of pale stool and dark urine in pancreatic cancer

A

pale stool: reduced stercobilinogen
dark urine: reduced urobilinogen, increased conjugated bilirubin

327
Q

what does persistent back pain in pancreatic cancer suggest

A

retroperitoneal metastases

328
Q

what is Courvoisier’s law

A

palpable gallbladder + obstructive jaundice –> malignancy, esp pancreatic malignancy

329
Q

1st line investigation for pancreatic cancer and what does it show
and 2nd line

A

HRCT - shows “double duct sign” = dilation pancreatic and common bile ducts
if HRCT unavailable: abdo ultrasound

330
Q

LFTs in pancreatic cancer

A

high
- bilirubin
- ALP
- GGT

normal
- ALT

331
Q

biomarker for pancreatic cancer

A

CA 19-9

332
Q

treatment for pancreatic cancer

A

whipple’s resection (pancreaticoduodenectomy)
–> for lesions at head of pancreas
+ adjuvant chemotherapy

333
Q

side effects of Whipple’s resection

A

dumping syndrome
peptic ulcer disease

334
Q

surgical treatment for pancreatic cancer that is just for palliation

A

ERCP with stunting

335
Q

what is acute cholangitis

A

bacterial infection of biliary tract

336
Q

what is the organism that most commonly causes acute cholngitis

A

E coli

337
Q

2 main causes of cholangitis

A

choledocholelithiasis (gallstones in common bile duct)
Biliary strictures

338
Q

what is Reynolds pentad

A

indicates obstrcutive ascending cholangitis:

RUQ pain
jaundice
fever
hypotension
altered mental state

339
Q

what is charcots triad

A

RUQ pain
jaundice
fever

340
Q

first line investigation for acute cholangitis

A

US scan
then first intervention is ERCP: helps to observe bile duct stone and can remove it too

341
Q

how can LFTs differentiate between cholangitis and cholecystitis

A

high ALP+ALT suggest cholangitis rather than cholecystitis

342
Q

ABG in sepsis

A

low bicarbonate
raised lactate
metabolic acidosis

343
Q

MRCP vs ERCP

A

MRCP: just imaging
ERCP: imaging and therapeutic

344
Q

possible side effect of ERCP

A

ERCP can cause pancreatitis

345
Q

cholangitis vs cholecystitis

A

cholangitis = inflammation of bile duct
cholecystitis = inflammation of gallbladder

346
Q

first line treatment for acute cholangitis

A

1st: IV antibiotics
2nd: ERCP drainage after 24-48 hrs
3rd: elective cholecystectomy (when pt is well to prevent further episodes)

347
Q

factors for poor prognosis for acute cholangitis

A

hyperbilirubinaemia
high fever
leukocytosis
older age
hypoalbuminaemia

348
Q

cause of cholecytitis

A

cystic duct obstruction caused by gallstones

349
Q

cholecystitis risk factors

A

diabetes
TPN
gall bladder

350
Q

signs and symptoms of cheolcytitis

A

RUQ pain
palpable mass
fever
positive Murphy’s sign (sudden pause on insipiration during deep palpation of RUQ due to pain)
right shoulder pain
nausea
vomiting

351
Q

what is Murphy’s sign

A

sudden pause on insipiration during deep palpation of RUQ due to pain

352
Q

first lien investigations for cholecyitis if sepsis is and is not suspected

A

sepsis not suspected: US
sepsis suspected: MRI/CT

353
Q

what does US show in cholecystitis

A

thick gallbladder wall

354
Q

treatment/management for cholecystitis and how soon after diagnosis should it be done

A

IV ABx + laparoscopic cholecystectomy (+ IV fluids + analgesia + NBM)

IV ABx is supportive
laparoscopic cholecystectomy should be done 1 week after diagnosis

355
Q

risk factors for gallstones

A

5xFs
female
fat
forty
fertile
fair

OCP
rapid weight loss
sickle cell anameia (haemolytic conditions)

356
Q

what are the 2 types of gallstones and what are they made of

A

cholesterol gallstones: cholesterol + calcium carbonate

pigment gallstones: calcium billirubinate (due to increased unconjugated bilirubin, associated with haemolytic diseases eg SCA)

357
Q

what is the most common type of gallstone

A

cholesterol stones

358
Q

signs and symptoms of biliary colic/gallstones

A

colikcy RUQ pain
can radiate to right scapula
pain after eating fatty meal
Murphy’s sign egtauve
no fever
nausea and vomiting

359
Q

what is fever and LFT’s like in gallstones/biliary colic

A

no fever
normal LFTs

360
Q

what is Murphy’s sign in biliary colic

A

negative

361
Q

investigation for biliary colic

A

US (shows thin gallbladder wall)
if US negative but bile duct dilated or abnormal LFTs: MRCP

362
Q

what does US show in biliary colic vs cholecystitis

A

biliary colic: thin gallbladder wall
cholecystitis: thick gallbladder wall

363
Q

treatment for gallstones

A

analgesia
IV fluids
NBM

ERCP / electie laparoscopic cholecystectomy

if asymptomatic don’t need any treatment

364
Q

what is the site of damage in primary biliary cholangitis

A

intrahepatic bile ducts

365
Q

what do raised anti-michondrial antibodies indicate

A

primary biliary cholangitis

366
Q

which cancer does primary biliary cholangitis significantly increase the risk of developing

A

hepatocellular carcinoma

367
Q

which antibodies are see in sjogrens syndrome

A

anti Ro (SS-A)
ani La (SS-B)
rheumatoid factor
antinuclear

368
Q

which cancer does primary sclerosing cholangitis significantly increase the risk of developing

A

cholangiocarcinoma

369
Q

which antibodies are lily to be raised in primary scleroing cholangitis

A

anti-nuclear antibodies

370
Q

what is sjogrens syndrome

A

autoimmune condition affecting parts of the body that produce fluids
symptoms include dryness

371
Q

psc vs pbc

A

btw are autoimmune cholestatic liver diseases

psc:
- targets medium/large extra hepatic and intrahepatic bile ducts
- associated with IBD/colon cancer/bile duct cancer
- roughly equal M:F
- diagnosed by MRI of blue ducts
- usually not associated with smoking history
- itching, fatigue, abdo pain
- antibodies = ANA, ASMA

pbc:
- targets small intrahepatic bile ducts
- not associated with IBD/colon cancer/bile duct cancer
- F > M
- diagnosed by raised AMA / ALP
- associated with smoking history
- itching, fatigue abdo pain, dry eyes and mouth
- antibodies = AMA

372
Q

what is Whipple’s disease

A

chronic infectious disease - bacterial infection, affects joints and digestive system

373
Q

which pt demographic does Whipple’s disease mostly present in

A

middle aged white men

374
Q

triad of Whipple’s disease

A

dementia, ophthalmoplegia, myoclonus

375
Q

gold standard investigation for diagnosis of whipples disease

A

jejunal biopsy

376
Q

what does a jejunal biopsy for whipples disease show

A

stunted villi
deposition of macrophages in lamina proprietor
stains positive for PAS (period acid-Schiff)

377
Q

what is zollinger Ellison syndrome

A

gastric secreting tumour / hyperplasia of islet ells causes overproduction of gastric acid
–> results in recurrent peptic ulcers

378
Q

can pancreatic cancer present with abdominal pain

A

yes, if in body or tail of pancreas - head of pancreas presents as painless jaundice

379
Q

which syndrome causes a pancreatic cancer which presents with recurrent peptic ulcers and diarrhoea

A

zollinger Ellison syndrome

380
Q

presentation of cholangiocarcinoma

A

overt jaundice
no abdo pain

381
Q

how does typhoid fever present

A

abdo pain
weekness
headaches
rose spot rashes

382
Q

how is typhoid fever transmitted

A

faecal oral route

383
Q

what is the likely diagnosis of explosive non-bloody/mucus diarrhoea, ons 1 week after trying local food abroad

A

giardiasis

384
Q

what is the likely diagnosis of watery diarrhoea, abdominal cramps, dehydration after taking clindamycin

A

C diff infection

385
Q

3 risk factors for C diff infection

A

recent abx: clindamycin / penicillin
age over 65
prolonged stay in healthcare setting

386
Q

what is used to treat chemo-related nausea and vomiting

A

5HT3 antagonist

387
Q

what is functional dyspepsia

A

recurring symptoms of upset stomach with no obvious cause
- burning stomach pain
- bloating
- heartburn
- nausea
- vomiting
- burning

388
Q

which drug is sued for cytotoxic induced nausea and vomiting

A

Ondanestron ( 5HT antagonist)

389
Q

what is mirizzi’s syndrome

A

gallstone impacted at the neck/infundibulum of gallbladder

390
Q

what is a gallbladder muocoele

A

accumulate of bile in gallbladder due to blockage of cystic duct, usually by gallstone

391
Q

what is the calcium levels of pts with malignancies

A

hypercalcaemia

392
Q

what is the glucose level in pancreatic cancer

A

raised serum glucose (may present as impaired glucose tolerance or diabetes) as the endocrine function of the pancreas becomes damaged

393
Q

what causes achalasia

A

progressive degeneration of the ganglion cells in the myenteric Lexus - causes failure of relaxation of the LOS

394
Q

which 2 common meds can cause dyspepsia

A

NSAIDs and aspirin

395
Q

what is ‘multiple beaded biliary structures on MRCP’ seen in

A

primary sclerosis cholangitis

396
Q

which class of antibody is raised in serum of PBC pts

A

IgM

397
Q

what is portal hypertensive gastropathy

A

changes in the stomachs lining caused by elevated blood pressure in the portal vein

398
Q

what does biopsy show in PSC vs PBC

A

PSC: onion skin fibrosis

PBC: granulomas

399
Q

indications for TIPS

A

refractory ascites
budd-chiari syndrome
oesophageal variceal bleed

400
Q

first line treatment for giardiasis

A

metronidazole

401
Q

cholangiocarinoma vs pancreatico cancer symptoms

A

cholangiocarcinoma: biliary colic, jaundice
pancreatic cancer: painless jaundice

402
Q

what should painless jaundice raise a high suspicion of

A

pancreatic cancer

403
Q

if a pt has barrets oesophagus but no dysphasia, how often should they have endoscopic surveillance?

A

every 3-5 years

404
Q

what is it common for pts to expect for upto 6 weeks following treatment for giardiasis

A

lactose intolerance

405
Q

which condition does the triad of dysphagia, iron deficiency anaemia and glossitis indicate

A

Plummer vinson syndrome

406
Q

what is mallory Weiss syndrome

A

oesophageal tear secondary to severe vomiting which leads to haematemesis
common in alcoholics

407
Q

what type of stool does cholera vs giardiaisis cause

A

cholera: explosive ‘rice water’ stool
giardiasis: explosive fatty stool

408
Q

which condition should metoclopramide be avoided in

A

parkinsons

409
Q

which anti emetic should be avoided in bowel obstruction

A

metoclopramide

410
Q

what fluid rhesus is needed for a pt with acute pancreatitis

A

IV crystalloid given 4-6 hourly

411
Q

are colloid or crystalloid IV fluids used more

A

crystalloid
colloid fluids are generally not used bc of risk of anaphylaxis

412
Q

contrast dysphagia due to anatomical causes and oesophageal motility causes

A

anatomical causes: difficulty swallowing solids first and then liquids
oesophageal motility causes: difficulty swallowing liquids first and then solids

413
Q

what is a likely diagnosis of. apt with dysphagia first to solids and then to liquids, painful hands, telengiechtasia and positive anti-centromere antibodies

A

limited cutaneous systemic sclerosis (CREST syndrome)

414
Q

what is the cause of dysphagia with eosinophil infiltration of mucosa on oesophageal biopsy

A

eosinophilic oesophagitis

415
Q

what is the cause of dysphagia with upper oesophageal web on endoscopy, iron deficiency anaemia, glossitis, angular stomatitis

A

Plummer vinson syndrome

416
Q

what is a common side effect of canaglifozin

A

balanoposthitis

417
Q

what re-testing method is recommended for Hpylori after completing eradication therapy

A

urea breath test

418
Q

most likely diagnosis of pt with diarrhoea, weight loss hyperpigmentation of skin, polyarthralgia

A

whipple’s disease

419
Q

gold standard diagnosis of whipples disease

A

jejunal biopsy - stunted villi, deposition of macropjages in lamina propria which stain positive for PAS (period acid-schiff)

420
Q

Tx for Whipple’s disease

A

ABx - cotrimoxazole

421
Q

what is the criteria for urgent endoscopy

A

over 55 with weight loss
plus
reflux, dyspepsia or abdo pain

422
Q

what is a likely cause of dysphagia, regurgitation and halitosis

A

pharyngeal pouch (zenker’s diverticulum)

423
Q

which cancer is trousseau syndrome associated with

A

pancreatic cancer

424
Q

which cancer is Lambert eaton myasthenic syndrome (LAMS) associated with

A

small cell lung cancer

425
Q

what are acetylcholine receptor antibodies specific for

A

myasthenia gravis

426
Q

what antibodies are found in PBC

A

antimitochondrial antibodies (AMA)

427
Q

what antibodies are found in PSC

A

antineutrophil cytoplasmic antibodies (ANCA) (esp p-ANCA)
anti smooth muscle antibodies (SMA)

428
Q

what is the likely diagnosis if a sjogrens syndrome pt presents with fatigue and skin itchiness with raised ALP

A

primary biliary cholangitis

429
Q

drugs which induce pancreatitis

A

FAT SHEEP

F-Furosemide (lasix)
A-Asa, AZT, Asaparaginase
T-Tetracyclines
S-Statins, (sulfonamides), Steroids
H-HCTZ
E-Estrogens (OCP)
E-EtOH
P-Pentamidine

430
Q

what do you first need to rule out if a 15 year old girl comes in with abdominal pain

A

ectopic pregnancy

431
Q

what is Trousseau’s sign

A

migratory thrombophlebitis - associated with pancreatic cancer

432
Q

what 2 signs are associated with pancreatic cancer

A

Courvoisier’s sign: painless palatable gallbladder + jaundice
Trousseau’s sign: migratory thrombophlebitis

433
Q

which pt group does PBC most present in

A

women

434
Q

what is the first line treatment fro cholestatitic pruritus

A

cholestyramine

435
Q

most common type of oesophageal cancer in GORD pts

A

adenocarcinoma

436
Q

TIPSS procedure diverts some blood flow way from the liver parenchyma, what is a complication of this procedure?

A

hepatic encephalopathy

437
Q

what is a perineal abscess

A

a pus collection in the perineal region

438
Q

what is a perineal fistula

A

a chronically infected tract between the rectum and perineum

439
Q

at which stages do abscess and fistulas form in purulent perineal infections

A

abscess: acute manifestation
fistula: chronic manifestation

440
Q

main cause of perineal asbcesses and fistulas

A

flow obstruction and bacterial infection of the anal crypt glands

441
Q

contrast symptoms of perineal abscess and fistula

A

abscess: dull pain, pruritis
fistula: constant, throbbing pain

442
Q

best ix to visualise a perineal fistula’s course

A

MRI pelvis

443
Q

confirmatory tests for deeper perineal abscesses

A

MRI/CT
anal ultrasonography

444
Q

treatment and post operative care for perineal abscess

A

Tx:
surgical incision and drainage

post operative care:
sitz bath
analgesics
stool softeners
abx for immunocompromised

445
Q

treatment for normal perineal fistula

A

surgical fistulotomy (cut along the whole fistula to open and drain it)

446
Q

treatment for complex perineal fistula

A

seton placement (surgical thread placed through fistula to keep it open and allow it to be drained - stops pus forming and it healing around the pus, as that will cause other abscesses to form)

447
Q

which 2 classes of medications are risk factors for C diff

A

abx
PPIs

448
Q

which 4 antibiotics are risk factors for c diff

A

4 x C
clarithromycin
clindamycin
ciprofloxacin
cephalosporin

449
Q

what shows on a sigmoidoscopy for infectious colitis

A

yellow plaques

450
Q

if infectious colitis causes perforation what can this lead to

A

toxic megacolon

451
Q

symptoms for infectious colitis

A

possible mucus and blood in diarrhoea
fever
lower abdo pain
malaise

452
Q

what does a positive antigen stool sample for C diff indicate

A

indicates bacterial exposure but not necessarily current infection

453
Q

Tx for infectious colitis

A

hydration
loperamide (antidiarrhoeals)
Abx

454
Q

Tx for C diff

A

10 days course of oral vancomycin

455
Q

what are colonic diverticula

A

outpouchings of the colonic mucosa

456
Q

which meds can be risk factors for diverticulitis

A

NSAIDs and opioid

457
Q

Risk factors for diverticulitis

A

age > 50
low dietary fibre
constipation
diet rich in salt, meat, sugar
obesity
NSAID and opioid used
smoking

458
Q

symptoms for diverticulitis

A

LLQ pain
constipation / change in bowel habits
rectal bleeding
N & V
fever

459
Q

what does leukocytosis in someone with diverticula suggest

A

acute diverticulitis, if have symptoms too

460
Q

which scan is used for someone with suspected acute diverticulitis and raised inflammatory markers

A

contrast CT of abdo

461
Q

how does diverticulitis look on barium enema

A

saw tooth pattern

462
Q

what does riglers sign indicate on X-ray

A

(double walled gut is visible) - indicates air in the abdo (pneumoperitoneum) which could be due to gut perforation

463
Q

treatment for asymptomatic diverticulosis

A

dietary and lifestyle modifications

464
Q

treatment for acute and uncomplicated diverticulitis, and then what do u do if complications arise

A

oral abx and analgesia
if not responding after 72 hrs give IV abx (ceftriaxone + metranidazole)
if complications do Hartmanns procedure (resection of rectosigmoid colon and end colostomy is formed)

465
Q

what does pneumaturia and faecaluria indicate

A

colovesical fistula

466
Q

what does vaginal passage of faeces or flatus indicate

A

colovaginal fistula

467
Q

what are the 2 types of bowel obstruction

A

Functional ie no peristalsis - paralytic ileus

Mechanical ie a physical obstruction - SBO or LBO

468
Q

contrast the clinical and examination features of mechanical vs functional obstruction

A

mechanical:
- colicky pain
- tinkling bowel sounds, then absent
- peristalsis
- dilated bowel proximal to obstruction
- clear obstruction on scan
- no air in rectum - collapsed bowel and rectum distal to obstruction

functional:
- diffuse continuous pain
- no bowel sounds
- no peristalsis
- whole bowel is diffusely, equally dilated
- no obstruction on scan
- air in rectum

469
Q

what causes functional bowel obstruction

A

paralytic ileus, which can happen after bowel surgery

470
Q

what is the max the SB, LB and caecum can dilate to

A

3 cm
6 cm
9 cm

471
Q

contrast causes of SBO and LBO

A

SBO
hernias
adhesions
gallstones

LBO
tumour
volvulus
diverticulitis

472
Q

contrast the clinical signs of SBO vs LBO

A

SBO
early bilious vomiting
late constipation, esp if proximal obstruction
less severe abdo distention

LBO
late vomiting
faecal vomiting
early constipation
early and significant abdo distention

473
Q

what obstruction does faecal vomiting indicate

A

LBO

474
Q

contrast SBO and LBO on imaging

A

SBO
max 3cm dilated
valvular conniventes (lines go all way across)
central dilated loops

LBO
max 6cm dilated
haustra (lines don’t go all way across)
peripherally dilated loops

475
Q

1st line Ix for bowel obstruction

A

abdo xray

476
Q

gold standard diagnostic Ix for bowel obstruction

A

CTAP with IV contrast

477
Q

treatment for bowel obstruction

A

IV fluid resus
NBM
NGT decompression
analgesia
anti emetics
electrolyte replacement
surgery

478
Q

what should you monitor during post operative paralytic ileus

A

U&Es
(as electrolyte imbalance can contribute to ileus)

479
Q

acid base level in vomiting

A

hypokalaemia metabolic alkalosis

480
Q

acid base level in bowel ischameia

A

metabolic acidosis

481
Q

what 2 things in bloods indicate bowel ischameia

A

raised lactate
leukocytosis

482
Q

what are the most common sites of volvulus in adults

A

sigmoid colon
caecum

483
Q

contrast RFs for sigmoid volvulus and caecum volvulus

A

sigmoid:
older pts
chronic constipation
chagas disease
neurological conditions
psychiatric conditions

caceal:
all ages
adhesions
pregnancy

484
Q

which volvulus happen more in older pts

A

sigmoid

485
Q

where does volvulus happen in infants

A

midgut

486
Q

symptoms of volvulus

A

similar to bowel obstruction symptoms
abdo pain which decreases after explosive passage of stool or gas
distension
bililous vomiting

487
Q

what does failure to pass NG tube, epigastric pain and vomiting indicate

A

gastric volvulus

488
Q

what does bilious vomiting, haematochezia. haematomesis, hypotension and tachycardia in an infant indicate

A

midget volvulus

489
Q

how does sigmoid volvulus present on X-ray

A

coffee bean sign
2 dilated loops
LBO

490
Q

how does cecal volvulus present on X-ray

A

kidney bean/embryo sign
1 dilated loop
SBO

491
Q

how does volvulus present on CT

A

whirl sign

492
Q

how does volvulus present on barium enema

A

birds beak sign

493
Q

Surgery for sigmoid volvulus

A

rigid sigmoidoscopy with rectal tube insertion (detorsion)

494
Q

Surgery for sigmoid volvulus if peritonitis or decompression doesn’t work

A

sigmoid colectomy (take out sigmoid colon and anastamose with rectum
–> haemodynamically stable pt with viable bowel

Hartmanns procedure (signed is removed, end colectomy is formed)
–> haemodynamically unstable pt with ischaemic bowel

495
Q

surgery for cecal volvulus

A

right hemicolectomy

496
Q

Surgery for intestinal malrotation (midgut volvulus in infants)

A

Ladd procedure

497
Q

what type of cancer are the majority of colorectal tumours

A

adenocarcinomas

498
Q

contrast features/symptoms of right, left and rectal colorectal tumours

A

right sided
- melaena / occult
- iron deficiency anaemia
- diarrhoea

left sided
- changes in bowel habits
- streaks of blood
- colicky pain

rectal
- tenesumus
- flatulence
- faceal incontimnece
- haematochezia
- rectal pain

499
Q

what medication should pts take before colonoscopy

A

laxatives

500
Q

diagnostic Ix for colorectal tumours

A

colonoscopy and biopsy

501
Q

Ix to stage colorectal cancer via dukes staging

A

CT CAP

502
Q

what are Duke’s A-D of colorectal cancer

A

Dukes A - tumour confined to the mucosa
Dukes B - tumour invaded past the mucosa and thriough the bowel wall
Dukes C - lymph node metastases
Dukes D - distant metastases

503
Q

how does colorectal tumour look on barium enema

A

apple core lesion (due to stricturing)

504
Q

how to monitor disease progression for colorectal tumours

A

measure CEA - tumour marker

505
Q

screening for colorectal tumours

A

FIT test every 2 years for men and women aged 60-74

506
Q

criteria for 2 WW referral for colorectal tumour suspicion

A

60 years or older with
iron deficiency anaemia
or
change in bowel habit

507
Q

resection and anatomises for cecal, ascending or proximal transverse colon

A

right hemicolectomy
ileo-colic

508
Q

resection and anatomises for distal, transverse, descending colon

A

left hemicolectomy
colo-colon

509
Q

resection and anatomises for sigmoid colon

A

higher anterior resection
colo-rectal

510
Q

resection and anatomises for upper rectum

A

anterior resection (TME)
colo rectal

511
Q

resection and anatomises for low rectum

A

anterior resection (low TME)
colo rectal

512
Q

resection and anatomises for anal verge

A

abdomino perineal excision of rectum
none

513
Q

signs/symptoms of anastomotic leak?

A

diffuse abdo tenderness
tachycardia
rigidity
tachycardia
hypotensive

514
Q

contrast direct and indirect inguinal hernia

A

direct
- medial to inferior epigastric vessels
- through posterior wall of inguinal canal
- due to straining / weakness in abdo wall muscles
- older men

indirect
- lateral to inferior epigastric vessels
- through deep inguinal ring into inguinal canal
- due to abdo wall defects present from birth
- infants

515
Q

contrast inguinal and femoral Hernia

A

inguinal
- supermedial to pubic tubercle
- reducible
- cough impulse present

femoral
- inferolateral to pubic tubercle
- non reducible
- cough impulse absent

516
Q

what is hasselbachs triad and which hernia occurs here

A

between
- inferior epigastric vessels
- rectus border
- inguinal ligament

direct inguinal hernia

517
Q

investigations for hernia

A

groin ultrasound
Ct abdo - for obese pts

518
Q

what does raised lactate and leukocytosis indicate in context of hernia

A

strangulation
- ischaemia

519
Q

treatment of hernia if pt is medically fit

A

if pt is medically fit always do surgical mesh repair

520
Q

treatment for inguinal hernia if pt is not medically fit for surgery

A

Truss support belt

521
Q

what type of groin hernia should always be treated surgically due to strangulation

A

femoral hernia

522
Q

contrast an incarcerated and a strangulated hernia

A

incarcerated
- just trapped
- pain
- no systemic symptoms

strangulated
- blood supply cut off
- pain
- systemic symptoms eg absent bowel sounds, tender and distended abdo

523
Q

contrast a rolling and sliding hiatus hernia

A

sliding
- GOJ moves above diaphragm

rolling
- GOJ stays below diaphragm but another part of stomach eg fungus moves above diaphragm

524
Q

which hiatus hernia requires more urgent surgical intervention due to volvulus risk

A

rolling hiatus hernia

525
Q

symptoms for hiatus hernia

A

hiccups
GORD symptoms
heartburn
regurgitation
dysphagia
odnophagia
cough
chest pain
SOB

526
Q

medical and surgical treatment for hiatus hernia

A

weight loss and 4-8 weeks PPI
surgery (mainly for rolling hiatus hernia) : Nissens fundoplication and hiatoplasty

527
Q

most sensitive investigation for hiatus hernia

A

barium swallow

528
Q

first line investigation for hiatus hernia

A

upper GI endoscopy
- due to symptoms most pt have this endoscopy and the hernia is found incidentally

529
Q

what is seen on a CXR with hiatus hernia

A

retrocardiac bubble

530
Q

what are peptic ulcers caused by

A

gastric acid
pepsin

531
Q

which layer of the GI wall do peptic ulcers reach to

A

submucosa

532
Q

what is the most common peptic ulcer, gastric or duodenal

A

duodenal

533
Q

what are the most common causes of peptic ulcers

A

NSAIDs
H pylori

534
Q

which type of peptic ulcer is more common in older people (50+)

A

gastric

535
Q

which type of peptic ulcer is more common in young people (30)

A

duodenal

536
Q

contrast pain and weight changes in gastric and duodenal ulcers

A

gastric
- pain immediately after eating
- weight loss

duodenal
- pain a couple hours after eating
- eating may a make pain better
- weight gain

537
Q

what kind of pain is seen in peptic ulcers

A

epigastric “gnawing” pain

538
Q

what is gastritis

A

mucosal inflammation of GI tract

539
Q

symptoms of gastritis

A

nausea
vomiting
loss of appetite
weight losss

540
Q

gold standard diagnostic test for peptic ulcer disease

A

upper Gi endoscopy

541
Q

2 tests for H pylori

A

carbon 13 urea breath test
stool antigen tests

542
Q

which tests for H pylori can be used post eradication therapy

A

carbon 13 urea breath test

543
Q

what does CXR show in perforated gastric vs perforated duodenal ulcer

A

perforated gastric ulcer
- dome sign

perforated duodenal ucler
- pneumoperitoneum

544
Q

what does raised urea indicate

A

UPPER GI bleed as opposed to lower GI

545
Q

management plan for peptic ulcer disease in a H pylori positive vs negative pt

A

universal
- reduce smoking and alcohol

positive H pylori
- triple eradication therapy for 1 week, twice daily (omeprazole, clarithromycin, amoxicillin - or metranidazole if penicillin allergy)

negative H pylori
- stop drug causing ulcer eg NSAIDS
- omeprazole 20mg for 4-8 weeks
- gastric ulcer - repeat endoscopy 6-8 weeks later
- duodenal ulcer - repeat carbon 13 urea breath test for H pylori 6-8 weeks later

546
Q

what is the next step if a patient with peptic ulcer disease is H pylori positive and their symptoms don’t improve after triple eradication therapy

A

endoscopy

547
Q

contrast boerrhaves tear and mallory-weise tear

A

Boerrhaves tear - TEARS ALL THE WAY THROUGH
- transmural
- distal 1/3 of oesophagus
- severe sudden onset chest pain following repeated episodes of vomiting (and prolonged alcohol use)
- subcutaneous emphysema
- progresses to chest and neck pain and dysphagia

mallory weiss tear - VOMIT BLOOD, DOESNT TEAR ALL THE WAY THROUGH
- confined to mucosal membrane (mucosa and submucosa)
- haematemssis

548
Q

contrast the pain in gastroduodenal vs large bowel perforation

A

gastroduodenal
- epigatrsic pain
large bowel
- peritonitic abdo pain

549
Q

first line investigation for GI perforation

A

erect CXR
will see pneumoperitoenum

550
Q

gold standard investigation for bowel perforation

A

CT with Iv contrast

551
Q

what does riggler’s sign indicate on AXR

A

GI perforation
- double walled sign due to gas outlining both sides of the bowel

552
Q

what investigation is used specifically for oesophageal perforations

A

gastrograffin swallow

553
Q

surgical repair of large bowel perforation

A

hartmanns procedure - resection of the perforated section
peritoneal lavage

554
Q

surgical repair of gastroduodenal perforation

A

perforation is closed with omental patch

555
Q

do gastric or duodenal ulcers have higher morbidity / mortality

A

gastric

556
Q

most common pathogen cause of peritonitis

A

e coli

557
Q

most likely diagnosis if a pt with ascites secondary to liver failure presents with fever and abdo pain

A

SBP

558
Q

diagnostic test for SBP

A

paracentesis / ascitic tap
SBP if neutrophils > 250 / mm3

559
Q

2 investigations for peritonitis

A

paracentesis / ascitic tap - check neutrophil count for SBP

ascitic fluid culture - determine causative organism

560
Q

management for peritonitis

A

empirical IV antibiotics (cefotaxime)
IV albumin

561
Q

management for peritonitis if protein conc < 15 g/L or previous episode of SBP

A

continuous abx prophylaxis ( oral ciprofloxacin / norfloxacin)

562
Q

what is mesenteric adenitis

A

inflammation of lymph nodes in abdominal mesentery

563
Q

most common cause of mesenteric adenines

A

recent viral intestinal infection

564
Q

which condition can mesenteric adenitis mimic

A

appendicitis - usually has RLQ pain

565
Q

which pts does mesenteric adenines commonly affect

A

children and teenagers

566
Q

Ix for mesenteric adenitis

A

abdo ultrasound
bloods

567
Q

Tx for mesenteric adenitis

A

self limiting
fluids
paracetamol / ibuprofen
abx if caused by bacterial infection

568
Q

2 example causes of malabsorption

A

coeliac disease
IBD

569
Q

2 example causes of maldigestion

A

exocrine pancreatic insufficiency
orlistat use

570
Q

an example cause of global malabsorption

A

coeliac disease

571
Q

an example cause of partial malabsorption

A

vit B12 deficiency due to problems in terminal ileum

572
Q

deficiency of what causes alopecia and wound healing problems

A

zinc

573
Q

deficiency of what causes bleeding tendency

A

vit K

574
Q

deficiency of what causes oedema

A

protein

575
Q

deficiency of what causes muscle weakness

A

potassium

576
Q

deficiency of what causes tetany

A

calcium

577
Q

deficiency of what causes goitre

A

iodine

578
Q

what is a D-Xylose absorption test

A

tests absorptive ability of upper small intestine

579
Q

treatment for malabsorption

A

oral supplementation
calorie and protein enriched diet
Iv nutrition in severe cases

580
Q

define malnutrition

A

BMI < 18.5
or
weight loss of > 10% in 3-6 months
or
BMI < 20 and weight loss of > 5% in 3-6 months

581
Q

screening test for malnutrition and what does it measure

A

MUST
uses BMI, recent weight change and acute disease to categorise pts in high medium and low risk

582
Q

treatment for malnutrition

A

1st: ‘food-first diet’ (a nutrient dense diet)

then give ONS (oral nutritional supplements) - taken between meals

if that doesn’t work - feeding tube (enteral nutrition)

for more severe cases -parenteral nutrition (IV - doesn’t go through Gi tract)

583
Q

side effect of enteral nutrition

A

diarrhoea

584
Q

what is refeeding syndrome and how can it be avoided

A

effect of nutrition following starvation - electrolyte imbalances
hypophosphataemia, hypomagnaseamia (can cause torsades des pointes) , hypokalaemia

avoided by: if pt hasn’t eaten for 5+ days, give less than 50% of what they’re meant to receive for first 2 days

585
Q

which population has high incidence of gastric cancer

A

asia

586
Q

most common form and location of gastric cancer

A

adenocarcinoma
lesser curvature of stomach

587
Q

main 4 RF for gastric cancer

A

diet high in nitrates or salts
h pylori
smoking
pernicious anaemia

588
Q

what is pernicious anaemia

A

autoantibodies attack gastric parietal cells causing deficiency in If and vit B 12

589
Q

symptoms of gastric cancer

A

epigastric pain
dyspepsia
weight loss

590
Q

skin sign related to gastric cancer

A

acanthosis nigricans - smooth brown velvety symmetrical patches on skin

591
Q

sign of lymphadenopathy or metastases in gastric cancer

A

virchows node
- left supraclavicular region

saint Mary josephs nodule
- umbilical region

krukenberg tumour
- ovarian mass

592
Q

an ovarian mass is a rare presentation of which cancer metastases

A

gastric cancer

593
Q

1st line Ix for gastric cancer

A

upper Gi endoscopy with biopsy

594
Q

what is seen in biopsy for upper GI endoscopy of gastric cancer

A

signet ring cells

595
Q

Ix for gastric cancer staging

A

Ct CAP

endoscopic ultrasound with FNA is an alternative
MRI is used to see spread to liver

596
Q

what should you monitor after someone has gastrectomy for gastric cancer, and why

A

vit B12
can cause neurological symptoms

597
Q

2 situations which require 2 ww referral for OGD

A

dysphagia at any age

or

=> 55 yrs with weight loss + abdo pain / reflux / dyspepsia

598
Q

main 3 causes of viral gastroenteritis in order of how common

A

norovirus
sapovirus
rota virus

599
Q

main 3 causes of bacterial gastroenteritis

A

campylobacter
e coli
salmonella

600
Q

which ages does norovirus affect

A

all ages

601
Q

which viruses causing gastroenteritis affect younger children

A

rota virus
astrovirus
adenovirus

602
Q

which virus causing gastroenteritis has a longer incubation period (8-10 days) compared to others

A

adenovirus

603
Q

which virus causing gastroenteritis causes periodic diarrhoea that lasts over 10 days

A

adenovirus

604
Q

how does CMV present

A

colitis, ulceration

605
Q

which pts does CMV commonly affect

A

immunocompromised

606
Q

which virus causing gastroenteritis is spread via bodily fluids or transplanted organs/ transfused blood

A

CMV

607
Q

blood and mucus in stool
fever
malaise
dehydration
sudden onset diarrhoea
N& V
diagnosis ?

A

bacterial/viral gastroenteritis

608
Q

what can norovirus cause in frail pts (it is self limiting in healthy pts)

A

pre renal acute kidney injury

609
Q

meds for C diff

A

oral vancomycin
add metronidazole if severe

610
Q

what can campylobacter cause

A

Guillain barre syndrome

611
Q

what is Guillain barre syndrome

A

autoimmune demyelinating polyneuropathy affecting pns

612
Q

1st sign of Guillain barre syndrome

A

leg pain / weakness

613
Q

signs and symptoms of Guillain barre syndrome

A

leg pain / weakness
ascending weakness
AREFLEXIA
resp muscle weakness –> resp failure

614
Q

2 Ix for Guillain barre syndrome

A

lumbar puncture: CSF = high protein (autoantibodies), normal WCC
nerve conduction study: decreased motor nerve conduction

615
Q

Tx for Guillain barre syndrome

A

IV Ig (normal abs dilute auto abs)
plasmapheresis (filter auto abs from plasma)

616
Q

What is lynch syndrome also known as

A

Hereditary nonpolyposis colorectal cancer (HNPCC)

617
Q

Which bacteria causes gastroenteritis when food esp rice is not immediately refrigerated after cooking

A

Bacillus cereus

618
Q

Incubation. Period of campylobacter

A

2-5 days

619
Q

Most common cause of bacterial diarrhoea

A

Campylobacter

620
Q

Initial management for variceal bleeding

A

Antibiotics
Terlipressin / somatostatin (vasoconstrictors)

621
Q

Definitive management of variceal bleeding

A

Variceal band ligation

622
Q

What is given to reverse anticoagulant medication pre endoscopy

A

Prothrombin complex concentrates

623
Q

First line treatment for pt with haematemesis and melaena (ie acute non variceal upper GI bleed)

A

Endoscopic treatment

624
Q

Most definitive investigation for pharyngeal pouch

A

Barium swallow

625
Q

Likely diagnosis of a left sided mass in neck with gurgling sound on palpating, and pt experiences regurgitation

A

Pharyngeal pouch

626
Q

Which cancer is H pylori strongly associated with

A

MALT lymphoma

627
Q

Which condition causes freckles in lips, hands, soles of feet and increases risk of gastric cancer

A

Peutz Jeghers syndrome

628
Q

What is Rockall score used to measure

A

Severity of GI bleeding

629
Q

What is child Pugh score used to measure

A

Cirrhosis

630
Q

What is Glasgow score used to measure

A

Acute pancreatitis

631
Q

What is HAS-BLED score used to measure

A

risk of bleeding in pts taking anticoagulants for atrial fibrillation - score of 3+ suggests high risk of bleeding

632
Q

What should pts at high risk of refereeing syndrome be started on

A

Thiamine of pabrinex

633
Q

What are the 4 Ds of pellagra (vit B3 deficiency)

A

Dementia
Diarrhoea
Dermatitis
Death (if not treated promptly)

634
Q

What nutritional deficiency causes pellagra

A

Vit B3

635
Q

What nutritional deficiency causes beriberi

A

Thiamine

636
Q

What nutritional deficiency causes xerophthalmia

A

Vit A

637
Q

Contrast wet and dry Beriberi

A

Wet beriberi - Herat failure and peripheral oedema
Dry Berberi - peripheral neuropathy

638
Q

Tx from beri beri

A

IV pabrinex then oral thiamine

639
Q

Tx for scurvy

A

Absorbic acid

640
Q

Features of scurvy

A

Cachexia
Gingivitis
Halitosis
Gut / bladder / gum bleeding
Oedema

641
Q

Effect of grapefruit juice on cytochrome p450 enzymes

A

Inhibitor

642
Q

Effect of rifampicin on cytochrome p450 enzymes

A

Inducer

643
Q

Effect of clarithromycin on cytochrome p450 enzymes

A

Inhibitor

644
Q

Which condition requires regulate venesection / phlebotomy

A

Hereditary haemachromatosis

645
Q

Likely Diagnosis: fever, abdo pain, rash in trunk

A

Typhoid fever

646
Q

What is zollinger Ellison syndrome

A

Neuro endocrine tumour which secrets gastrin

647
Q

if a pt is having UC flare up and isn’t improving on topical and oral ASA what do you do

A

ADD oral prednisolone to the ASA

year 3 conditions (17 decks)

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