2. BAMS Gastro/Endo/Renal/Rheum

Question 1

GI Drugs

1. What do antacids do
2. What do H receptor pumps do
3. What do PPIs do

Answer 1

1. Eliminate formed acids/neutralise stomach acids
2. Reduce acid production by preventing histamine activation of acid production
3. Reduce acid secretion by blocking all 3 parietal cell pathways

Question 2

Coeliac and IBDs

1. What is it
2. 3 systemic features
3. 3 oral features
4. Dx and Mx
5. Define Crohn’s
6. Where does it affect/how does it present
7. How does it appear IO
8. 4 symptoms
9. Define UC
10. Where does it affect/how does it present
11. Does it appear IO
12. 4 symptoms
13. IBD Mx options

Answer 2

1. Sensitivity to alpha-gliaden in gluten
2. Weight loss, lassitude (weakness), abode pain/swelling, diarrhoea
3. Glossitis, RAS (OU), angular cheilitis, xerostomia
4. Jejunal biopsy. GF diet
5. Chronic granulomatous inflammatory disease involving non-caveating granulomas
6. Any/all of GIT, discontinuous, primarily terminal third of ileum
7. Buccal mucosa cobblestoning, angular cheilitis, lip and tongue swelling, fistula formation, aphthous-type ulceration, full thickness gingivitis
8. Diarrhoea, abdo pain, PR bleeding, obstruction, anaemia (deficiency states)
9. Chronic granulomatous inflammatory disease
10. Continuous along colon
11. NA
12. Diarrhoea, abdo pain, PR bleeding, obstruction, anaemia (deficiency states)
13. Medically - steroids, 5ASAs, DMDs, biologics
    Surgery - stoma bag

Question 3

GORD and PUD

1. 3 causes of GORD
2. 3 systemic features
3. 3 oral features
4. Mx
5. 3 causes of PUD
6. Associated bacteria
7. 3 consequences
8. Rx

Answer 3

1. Defective lower oesophageal sphincter, impaired lower clearing, impaired gastric emptying
2. Heartburn, dysphagia, GI bleed, severe abdo pain
3. Palatal/lingual erosion, reflux, dysphagia,
4. Smoking cessation, weight loss, PPIs, increase GI motility
5. High duodenal acid secretion, reduced protective stomach barrier, drugs (NSAIDs, steroids)
6. H. pylori
7. Perforation, stricture, haemorrhage, malignancy, anaemia
8. Triple therapy (PPI, amoxicillin, metro), smoking cessation, stop NSAIDs/steroids, better diet, smoking cessation

Question 4

Liver

1. Define jaundice
2. Describe 3 types
3. Describe 3 symptoms
4. Describe triad of cirrhosis
5. 3 causes
6. 3 symptoms

Answer 4

1. Accumulation of bilirubin in skin
2. Pre-hepatic (increase in RBC breakdown), intra-hepatic (liver cell failure), post-hepatic (bile duct damage, inflammation, obstruction)
3. Yellow skin, sclera, mouth, itch, increased bleeding tendency
4. Damage, fibrosis (scarring), regenerated (reduced) function
5. Alcohol, CF, hepatitis, haemachromatosis
6. Reduced clotting, jaundice, oedema, ascites, spider nave, palmar erythema

Question 5

Steroids

1. 8 adverse effects of therapeutic steroids

Answer 5

1. HTN, T2DM, osteoporosis, immunosuppression, peptic ulceration, infection risk, thinning of skin, increased bruising, cataracts, glaucoma, hyperlipidaemia, cancer risk, psychiatric disturbances

Question 6

Cushing’s and Addisons

1. What causes Cushing’s
2. 3 features
3. What causes Addisons
4. 3 features
5. 3 features of hyperthyroidism
6. 3 features of hypothyroidism

Answer 6

1. Excess cortisol production. Due to use of therapeutic steroids or overproduction of ACTH (pituitary adenoma, lung tumour) increasing cortisol production
2. Centripetal obesity, moon face, buffalo hump, HTN, thin skin, easy bruising, muscle weakness, mucosal pigmentation
3. Reduced production of cortisol (gland failure or reduced production of ACTH). Commonly due to autoimmune adrenalitis
4. Postural hypotension, weight loss, lethargy, hyperpigmentation, loss of body hair
5. HTN, weight loss, heat intolerance, tachycardia
6. Hypotension, weight gain, cold intolerance, bradycardia

Question 7

Diabetes

1. Define DM
2. Dx
3. T1 definition and usual affected population
4. T1 key symptoms and Mx
5. T2 definition and usual affected population
6. T2 Mx
7. 4 oral effects of DM
8. 2 ways to measure glucose levels and normal scores for these
9. How does DKA occur

Answer 7

1. Persistent hyperglycaemia due to relative deficiency of insulin
2. GTT - fast for 8hrs, 75g glucose load, measure blood glucose (RPG). Diabetes if 2 tests >11.1mmol/l
3. Autoimmune disease caused by destruction of pancreatic B cells. Insulin deficient/dependent. Younger, thinner
4. Polydipsia, polyuria, unexplained weight loss, tiredness, increased appetite. Mx insulin injections
5. Insulin resistant
6. Diet modification, oral hypoglycaemic (metformin, azones, glicazides, sulfonyureas, etc)
7. Perio disease, fungal infections, xerostomia, poor wound healing, caries, infection risk
8. Blood glucose - 4-7mmol/l fasting; <9mmol/l after meals
   Hb1Ac - <48mmol/mol (<6.5%)
9. Hyperglycaemia unnoticed. Cells cannot metabolise glucose, so fat used for energy, build-up of acidic ketones

Question 8

Rheum 1

1. Define osteoporosis
2. 3 risk factors
3. 3 symptoms
4. How to prevent
5. How to treat
6. What is OI
7. 3 symptoms
8. 1 associated dental problem

Answer 8

1. Loss of bone matrix with secondary loss of mineral. Reduced bone mass and density
2. Age, gender, endocrine problems, steroids, post-menopausal hormone changes, smoke, anticonvulsants
3. Height loss, bone fracture, scoliosis
4. Build max bone mass, reduce rate of bone loss
5. Bisphosphonates
6. Collagen type 1 defect - brittle bone disease
7. Blue sclera, deafness, easy fracture
8. DI

Question 9

Rheum 2

1. Define OA
2. 3 clinical features
3. 2 radiographic features
4. Mx
5. Define RA
6. 2 types
7. 3 clinical features
8. 3 associated diseases
9. Mx
10. What are seronegative spondyloarthropathies associated with
11. 3 types and features of each

Answer 9

1. Degenerative bone disease due to primary degeneration of articular cartilage
2. Pain, stiffness, joint swelling and deformity, progressive loss of PIPJ/DIPJ space
3. Osteophute lipping and joint edges, subchondral sclerosis
4. NSAIDs, prosthetic replacement, physio, weight loss
5. LT autoimmune disease primarily affecting joints by systemic CT disease. Disease of synovial that starts as state of persistent cellular activation
6. Sero-positive - RF, peripheral joints
   Sero-negative - no RF, central joints
7. Symmetrical synovitis of MCPJ, PIPJ, wrist joint, ulnar deviation of fingers at MCPJ, PIPJ hyperextension, MCPJ hyeprflexion, wrist subluxation, pains stiffness
8. Sjogren’s, anaemia, vasculitis, amyloidosis, Raynaud’s
9. NSAIDs, steroids, DMARDs, biologics, physio
10. HLA-B27
11. AS - spinal joint arthritis, limited back movement, neck flexion, lower back pain
    Reactive arthritis - Reiter’s disease - conjunctivitis, arthritis, uveitis
    EnA - chronic inflammatory arthritis associated with IBDs