Corrections

Question 1

Can a brisk upper GI bleed present with fresh blood PR rather than malaena?

Answer 1

Yes

Question 2

If constipation doesn’t respond to a bulk-forming laxative such as isphagula husk, what should you try next?

Answer 2

Osmotic laxative e.g. macrogol

Question 3

What triad of features is seen in liver failure?

Answer 3

1) encephalopathy
2) jaundice
3) coagulopathy

Question 4

Triad of symptoms in Budd-Chiari syndrome?

Answer 4

1) sudden onset abdo pain
2) ascites
3) tender hepatomegaly

Question 5

What is Budd-Chiari syndrome?

Answer 5

Hepatic vein thrombosis - usually seen in the context of underlying haematological disease or another procoagulant condition.

Question 6

Transferrin saturation in haemochromatosis?

Answer 6

Raised

Question 7

What is required during large-volume paracentesis for the treatment of ascites?

Answer 7

IV human albumin solution to avoid avoid paracentesis-induced circulatory dysfunction (PICD).

Question 8

Mx of bile acid malabsorption causing diarrhoea?

Answer 8

Cholestyramine (bile acid sequestrant)

Question 9

What liver disease is sudden weight loss associatged with?

Answer 9

NAFLD

Question 10

What is the investigation of choice for suspected carcinoid tumours?

Answer 10

Urinary 5-HIAA

Question 11

1st line mx for NAFLD?

Answer 11

Weight loss

Question 12

What cancer does achalasia increase the risk of ?

Answer 12

Squamous cell carcinoma of the oesophagus

Question 13

What is Plummer-Vinson syndrome?

Answer 13

Triad of:

1) iron def anaemia

2) dysphagia

3) atrophic glossitis

Question 14

What type of duodenal ulcers are most likely to cause major upper GI haemorrhage?

Answer 14

Posteriorly sited ulcers –> gastroduodenal artery

Question 15

What is used to monitor treatment in haemochromatosis?

Answer 15

Ferritin + transferrin saturation

Question 16

1st line mx for achalasia?

Answer 16

Pneumatic (balloon) dilatation

Question 17

Mx of achalasia if recurrent or persistent symptoms?

Answer 17

surgical intervention with a Heller cardiomyotomy should be considered

Question 18

What is primary sclerosing cholangitis?

Answer 18

A biliary disease characterised by inflammation and fibrosis of intra and extra-hepatic bile ducts.

Question 19

Most common association of PSC?

Answer 19

UC

Question 20

Features of PSC?

Answer 20

1) cholestasis
- jaundice, pruritus
- raised bilirubin + ALP

2) RUQ pain

3) fatigue

Question 21

Investigations of choice in PSC?

Answer 21

ERCP/MRCP

Question 22

What are the 3 characteristic electrolyte disturbances seen in patients with refeeding syndrome?

Answer 22

1) Hypophosphataemia

2) Hypokalaemia

3) Hypomagnesaemia

Question 23

What does an ‘apple core’ sign on barium swallow indicate?

Answer 23

Oesophageal carcinoma

Question 24

What is primary biliary cholangitis (PBC)?

Answer 24

A chronic liver disorder, thought to be an autoimmune condition.

Interlobular bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis which may eventually progress to cirrhosis.

Question 25

Classic presentation of PBC?

Answer 25

Itching in a middle-aged woman

Question 26

Give 4 associations with PBC

Answer 26

1) Sjogren's (seen in up to 80%) 2) RA 3) Systemic sclerosis 4) Thyroid disease

Question 27

What antibdies are present in PBC?

Answer 27

AMA M2 subtype

Question 28

Mx of PBC?

Answer 28

first-line: ursodeoxycholic acid

Question 29

Mx of pruritus in PBC?

Answer 29

cholestyramine

Question 30

Complications of PBC?

Answer 30

1) Cirrhosis --> portal HTN --> ascites, variceal haemorrhage 2) Osteomalacia & osteoporosis 3) significantly increased risk of HCC

Question 31

What cancer are those with PBC at an increased risk of?

Answer 31

HCC

Question 32

What is Sister Mary Joseph node?

Answer 32

A palpable nodule in the umbilicus due to metastasis of malignant cancer within the pelvis or abdomen

Question 33

What are the investigations of choice in primary sclerosing cholangitis? (PSC)

Answer 33

ERCP/MRCP

Question 34

What do patients who have had an episode of SBP require?

Answer 34

Antibiotic prophylaxis (e.g. ciprofloxacin)

Question 35

Mx of pharyngeal pouch?

Answer 35

Surgical repair

Question 36

What is the typical diagnostic investigation in primary sclerosing cholangitis?

Answer 36

MRCP --> this usually shows typical beaded appearance of the bile duct

Question 37

During infection, ferritin is an unreliable indicator of iron stored in the body as it is an acute phase protein. What should be used instead?

Answer 37

Transferrin saturation

Question 38

What is Courvoisier's law?

Answer 38

A palpable, non tender, enlarged gallbladder accompanied with painless jaundice is unlikely to be due to gallstones. Instead consider malignancy

Question 39

1st line mx of primary biliary cholangitis?

Answer 39

Ursodeoxycholic acid

Question 40

What is PBC?

Answer 40

An autoimmune liver disease. Interlobular bile ducts become damaged by a chronic inflammatory process causing progressive cholestasis which may eventually progress to cirrhosis.

Question 41

What is the classic presentation of PBC?

Answer 41

itching in a middle-aged woman

Question 42

What condition is most associated with PBC?

Answer 42

Sjogren's syndrome

Question 43

Mx of patients with upper GI bleeding that has shown resistance to multiple endoscopic interventions?

Answer 43

Referral to general surgery

Question 44

What antibodies are seen in autoimmune hepatitis?

Answer 44

ANAs

Question 45

What antibodies are seen in PBC?

Answer 45

AMAs

Question 46

What is the diagnostic investigation of choice for pancreatic cancer?

Answer 46

High resolution CT scanning

Question 47

What is the investigation of choice for suspected carcinoid tumours?

Answer 47

Urinary 5-HIAA

Question 48

Mx of dysplasia on biopsy in Barrett's oesophagus?

Answer 48

Requires endoscopic intervention

Question 49

What is used to monitor treatment response in haemochromatosis?

Answer 49

Ferritin & transferrin saturation

Question 50

What is most likely to be identified if a colonoscopy were performed in Peutz Jeghers?

Answer 50

Hamartomas

Question 51

1st line mx of Wilson's?

Answer 51

Penicillamine

Question 52

How can a TIPS result in confusion?

Answer 52

Cn cause hepatic encephalopathy (due to inadequate metabolism of nitrogenous waste products by the liver)

Question 53

What investigation may be useful for diagnosing and monitoring the severity of liver cirrhosis?

Answer 53

Transient elastography (fibroscan)

Question 54

1st line investigation in acute mesenteric ischaemia?

Answer 54

Serum lactate

Question 55

Mx of asymptomatic gallstones?

Answer 55

Observation, lifestyle measures & diet

Question 56

What is the investigation of choice for a suspected pharyngeal pouch?

Answer 56

Barium swallow with fluoroscopy

Question 57

1st line mx of acute constipation?

Answer 57

Bulk forming laxative e.g. ispagula husk

Question 58

1st & 2nd line mx of haemochromatosis?

Answer 58

1st line --> venesection 2nd line --> desferrioxamine

Question 59

Mx of achalasia?

Answer 59

Heller cardiomyotomy

Question 60

What investigation is most likely to provide diagnostic information in an acute abdomen following abdo surgery?

Answer 60

CT abdomen with IV contrast

Question 61

What is the most important intervention to reduce the chance of further episodes of Crohn's disease?

Answer 61

Stop smoking

Question 62

Mx of a pancreatic pseudocyst?

Answer 62

Conservative mx initially

Question 63

What is globus pharyngis?

Answer 63

The persistent sensation of having a 'lump in the throat' when there is none. Symptoms are often intermittent and relieved by swallowing food or drink. Swallowing of saliva is often more difficult.