2 - PM

Question 1

Primary biliary cirrhosis - the M rule

Answer 1

gM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

Question 2

anti-mitochondrial antibodies

Answer 2

primary biliary cholangitis/cirrhosis

Question 3

what is primary biliary cholangitis

Answer 3

auto immune Ab (anti mitochondrial) against cell that line bile ducts in liver = fibrosis and cirrhosis

Question 4

Primary biliary cholangitis diagnosis

Answer 4

anti-mitochondrial antibodies (AMA) M2 subtype are present in 98% of patients and are highly specific
smooth muscle antibodies in 30% of patients
raised serum IgM

Question 5

Primary biliary cholangitis treatment

Answer 5

pruritus: cholestyramine
fat-soluble vitamin supplementation
ursodeoxycholic acid
liver transplantation e.g. if bilirubin > 100 (PBC is a major indication) - recurrence in graft can occur but is not usually a problem

Question 6

the major copper-carrying protein in the blood that will be low in wilsons disease

Answer 6

ceruloplasmin

Question 7

why low serum copper levels in wilsons

Answer 7

Ceruloplasmin is copper binding protein in blood, these levels are low in wilsons and therefore serum copper levels will be low

Question 8

Obese T2DM with abnormal LFTs

Answer 8

non alcoholic fatty liver disease

Question 9

Non alcoholic fatty liver disease diagnosis

Answer 9

Liver US

Question 10

most common cause of travellers’ diarrhoea

Answer 10

E. Coli

Question 11

Hep B serology: Anti-HBs

Answer 11

implies immunity

Question 12

Hep B serology: Anti-HBc

Answer 12

implies previous (or current) infection

Question 13

Hep B serology: IgM anti-HBc

Answer 13

acute or recent hepatitis B infection and is present for about 6 months

Question 14

Hep B serology: HbeAg

Answer 14

core antigen break down so a marker of infectivity

Question 15

Hep B serology: HBsAg

Answer 15

acute disease (present for 1-6 months)

Question 16

H1 anti-emetic (1)

Answer 16

cyclizine

Question 17

D2 ant-emetic (3)

Answer 17

metaclopramide, haloperidol, domperidone

Question 18

5HT3 ant-emetic (1)

Answer 18

ondansetron

Question 19

“other” type of ant-emetic

Answer 19

dexamethasone, midazolam

Question 20

achalasia treatment

Answer 20

endoscopic balloon dilation

Question 21

apple core appearance on barium swallow

Answer 21

achalasia

Question 22

what is ranitidine

Answer 22

H2 blocker

Question 23

what is odynophagia

Answer 23

painful swallowing

Question 24

C. diff treatment

Answer 24

metronidazole and oral vancomycin if severe

Question 25

wilsons treatment

Answer 25

pencillamine

Question 26

diagnosis: speech issues, behavioural changes, clumsy, liver disease

Answer 26

wilsons

Question 27

crohns flare up treatment

Answer 27

glucocorticosteroids > mésalazinè > + methotrexate orazathioprine or mercaptopurine > infliximab

Question 28

crohns maintenance therapy

Answer 28

azathioprine or mercaptopurine is used first-line to maintain remission methotrexate is used second-line 5-ASA drugs (e.g. mesalazine) should be considered if a patient has had previous surgery

Question 29

Diagnosis: dysphagia occurs to both solids and fluids equally, barium swallow shows a dilated oesophagus that tapers at the lower oesophageal sphincter.

Answer 29

achalasia

Question 30

'bird's beak' appearance on barium swallow

Answer 30

achalasia

Question 31

Prophylaxis of variceal haemorrhage

Answer 31

propanalol

Question 32

weekly alcohol intake recommendations

Answer 32

both genders: no more than 14 units a week, spread over 3 or more days

Question 33

what is cholangiocarcinoma

Answer 33

cancer of bile duct

Question 34

what will suggest cholestasis

Answer 34

dark urine, pale stool (conjugated bilirubin, so water soluble, blockage means less excreted into faeces)

Question 35

what is uribilogen

Answer 35

conjugated bilirubin excreted via bile > turn into urobilogen by gut bacteria

Question 36

where does conjugation occur

Answer 36

in liver

Question 37

which type of bilirubin is water soluble (seen in urine)

Answer 37

conjugated

Question 38

when will bilirubin urine test be negative

Answer 38

if pre-hepatic jaundice (bilirubin is unconjugated and therefore not water soluble)

Question 39

when will urine urobilogen be absent

Answer 39

In obstructive jaundice because bilirubin hasn't made it to gut to get turned into urobiligen by gut flora

Question 40

direct coombs test test for what?

Answer 40

autoimmune haemolytic anaemia - take RBCs

Question 41

indirect coombs test is for what?

Answer 41

pregnant woman and prior to blood transfusion. take a patients plasma looking for certain antibodies

Question 42

test for wilsons

Answer 42

caeroplasmin (will be low coz this is mopping up excess copper)

Question 43

Investigations you wanna do in liver disease and why

Answer 43

FBC, U & E, LFTs, clotting (have inc PT and INR), glucose, paracetamol level, hepatitis screen, CMV and EBV, ferritin levels (haeochromatosis - ferritin in the 1000's), caeroplasmin (wilsons - levels will be low due to copper mop up), autoantibodies (ant mitochondrial - primary biliary cirrhosis, anti smooth muscle - autoimmune hepatitis)

Question 44

clotting factors made in liver

Answer 44

2, 7, 9, 10

Question 45

normal number of spider naevi

Answer 45

up to 5 is normal. >5 think liver cirrhosis

Question 46

which condition do you get loss of bowel houstra

Answer 46

UC

Question 47

positive murphy sign =

Answer 47

cholecystitis

Question 48

type of antibiotics associated with C. diff

Answer 48

Cephalosporins, not just clindamycin and cefaclor, are strongly linked to Clostridium difficile

Question 49

Pre hepatic: Bilirubin, ALT/ AST, alk phosphatase

Answer 49

Bilirubin: normal/high ALT/ AST: Normal alk phosphatase: normal

Question 50

Intra hepatic: Bilirubin, ALT/ AST, alk phosphatase

Answer 50

Bilirubin: high ALT/ AST: Very high alk phosphatase: slightly high

Question 51

Extra hepatic: Bilirubin, ALT/ AST, alk phosphatase

Answer 51

Bilirubin: very high ALT/ AST: slightly high alk phosphatase: very high

Question 52

Bloody diarrhoea | Vomiting and abdominal pain

Answer 52

shigella

Question 53

Prolonged, non-bloody diarrhoea

Answer 53

giardia

Question 54

Gradual onset bloody diarrhoea, abdominal pain and tenderness which may last for several weeks

Answer 54

amoebiasis

Question 55

diarrhoea following rice meal

Answer 55

Bacillus cereus

Question 56

A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody

Answer 56

campylobacter

Question 57

hep C treatment

Answer 57

urrently a combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used