Corrections 2

Question 1

What is pseudomembranous colitis?

Answer 1

A severe, potentially life-threatening infection of the colon caused by C. difficile.

Question 2

What is pseudomembranous colitis most commonly associated with?

Answer 2

Broad-spectrum antibiotics, particularly cephalosporins such as Cefaclor.

Question 3

What is hepatorenal syndrome?

Answer 3

A type of functional kidney impairment that occurs in patients with advanced liver disease.

Key features:
1) ascites
2) low urine output
3) significant increase in serum creatinine

Question 4

1st line mx of hepatorenal syndrome?

Answer 4

Terlipressin –> induces splanchnic vasoconstriction which reduces portal pressure and improves renal blood flow.

Question 5

What is the 1st line investigation for diagnosis of small bowel overgrowth syndrome?

Answer 5

Hydrogen breath test

Question 6

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

Answer 6

Antibiotic prophylaxis –> ciprofloxacin

Question 7

What is the prophylactic antibiotic of choice in SBP?

Answer 7

Ciprofloxacin or norfloxacin

Question 8

What can the causes of ascites be grouped into?

Answer 8

1) Those with a SAAG <11g/L

2) Those with a SAAG >11g/L

Question 9

What does a SAAG >11g/L indicate?

Answer 9

Portal HTN

Question 10

What are the causes of an ascites with SAAG >11g/L?

Answer 10

1) Liver disorders are most common:
- cirrhosis/alcoholic liver disease
- acute liver failure
- liver metastases

2) Cardiac:
- RHF
- constrictive pericarditis

3) Other:
- Budd-Chiari syndrome
- portal vein thrombosis
- veno-occlusive disease
- myxoedema

Question 11

What are some causes of an ascites with SAAG <11g/L?

Answer 11

1) Hypoalbuminaemia:
- nephrotic syndrome
- severe malnutrition (e.g. Kwashiorkor)

2) Other:
- pancreatitis
- bowel obstruction
- biliary ascites
- postoperative lymphatic leak
- serositis in connective tissue diseases

Question 12

Mx of ascites?

Answer 12

1) Reducing dietary sodium

2) Aldosterone antagonists: e.g. spironolactone (N.B. can add loop diuretics)

3) Drainage if tense ascites (therapeutic abdominal paracentesis)

4) Prophylactic abx to reduce risk of SBP (ciprofloxacin): offer to those with cirrhosis and ascites with an ascitic protein of 15 g/litre or less

5) Can consider TIPS

Question 12

What ascitic protein level should prophylactic abx be given to prevent SBP?

Answer 12

<15 g/L

Question 13

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

Answer 13

Albumin cover –> reduces paracentesis-induced circulatory dysfunction and mortality

Question 14

What 2 electrolyte disturbances can cause torsades de pointes?

Answer 14

1) hypokalaemia
2) hypomagnesaemia

Question 15

ECG changes in hypomagnesaemia?

Answer 15

Same as hypokalaemia:

• U waves
• small T waves
• PR prolongation
• ST depression
• long QT

Question 16

What condition is most strongly associated Helicobacter pylori infection?

Answer 16

Duodenal ulceration

Question 17

What is carcinoid syndrome?

Answer 17

usually occurs when metastases are present in the liver and release serotonin into the systemic circulation

Question 18

What is often the earliest feature of carcinoid syndrome?

Answer 18

flushing

Question 19

Features of carcinoid sydnrome?

Answer 19

• flushing
• diarrhoea
• bronchospasm
• hypotension
• right heart valvular stenosis
• other molecules such as ACTH and GHRH may also be secreted resulting in, for example, Cushing’s syndrome

Question 20

Mx of carcinoid syndrome?

Answer 20

somatostatin analogues e.g. octreotide

Question 21

What can be used to help with diarrhoea in carcinoid syndrome?

Answer 21

cyproheptadine

Question 22

What does a high SAAG gradient (>11 g/L) indicate?

Answer 22

Portal HTN

Question 23

What is mx if a severe flare of UC has not responded to IV steroids after 72 hours?

Answer 23

Add IV ciclosporin, or surgery

Question 24

What triad is seen in liver failure?

Answer 24

1) coagulopathy 2) encephalopathy 3) jaundice

Question 25

What are signet ring cells?

Answer 25

A type of cell that can be seen in certain types of cancer, most commonly gastric adenocarcinoma

Question 26

Mx of H. pylori?

Answer 26

PPI + amoxicillin + clarithromycin, or PPI + metronidazole + clarithromycin

Question 27

Mx of a liver abscess?

Answer 27

IV abx & drainage

Question 28

What may be used to stop an uncontrolled variceal haemorrhage?

Answer 28

Insertion of a Sengstaken-Blakemore tube

Question 29

What is a small hard swelling lateral to the umbilicus suggestive of?

Answer 29

A periumbilical lymph node (AKA a Sister Mary Joseph nodule).

Question 30

What is a periumbilical lymph node (AKA a Sister Mary Joseph nodule) classically associated with?

Answer 30

Gastric carcinoma

Question 31

Mechanism of loperamide?

Answer 31

Stimulation of opioid receptors in the submucosal neural plexus of the intestinal wall --> reduces gastric motility.

Question 32

Mx of a mild-moderate flare of UC that does not respond to topical or oral aminosalicylates?

Answer 32

Add oral steroids

Question 33

1st line vs gold standard investigation in diagnosis of coeliac disease?

Answer 33

1st line --> IgA-tTG test Gold standard --> endoscopy and biopsy

Question 34

Why should anti-motility and anti-peristaltic medications (e.g. morphine) be stopped in C. diff infection?

Answer 34

As these can predispose to toxic megacolon by slowing the clearance of C. diff toxin.

Question 35

You wish to screen a patient for hepatitis B infection. What is the most suitable test to perform?

Answer 35

HBsAg A positive HBsAg implies either acute or chronic hepatitis B.

Question 36

What doe a positive anti-HBs imply?

Answer 36

immunity through either previous immunisation or disease

Question 37

Anti-HBs vs anti-HBc?

Answer 37

Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease. Anti-HBc implies previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists.

Question 38

How long prior to an upper GI endoscopy should PPIs be stopped?

Answer 38

2 weeks

Question 39

Mx of a severe flare of UC?

Answer 39

IV corticosteroids

Question 40

What is cause of itching in gallstones?

Answer 40

Hyperbilirubinaemia

Question 41

Mx of a pharyngeal pouch?

Answer 41

Surgical repair (myotomy) & resection

Question 42

What is used to assess the severity of an UC flare?

Answer 42

The Truelove and Witts' severity index

Question 43

According to the Truelove and Witts' severity index, what indicates a 'severe' UC flare?

Answer 43

When the patient has blood in their stool, or is passing more than 6 stools per day plus at least one of the following features: 1) Temperature greater than 37.8°C 2) Heart rate greater than 90 beats per minute 3) Anaemia (Hb less than 105g/ L) 4) ESR greater than 30 mm/hour

Question 44

Diarrhoea, fatigue, osteomalacia →?

Answer 44

Coeliac disease

Question 45

How can severe iron deficiency anaemia cause dysphagia?

Answer 45

due to post-cricoid webs (part of Plummer-Vinson syndrome)

Question 46

Features of a peri-anal abscess?

Answer 46

Swollen, tender, fluctuant lump next to anus

Question 47

Mx of a peri-anal abscess?

Answer 47

Incision & drainage