Diagnosis- Gastro Flashcards
- In the condition Barrett’s oesophagus, a cell change of squamous to columnar cells occurs (One differentiated cell type replaced with another differentiated cell type). What is this an example of?
- Hyperplasia
- Metaplasia
- Neoplasia
- Dysplasia
Metaplasia is defined as replacement of one differentiated cell type with another differentiated cell type – This is what is happening in this case as the more differentiated cell type is more suited to function (not getting damaged by stomach acid)
- In the case of a man with suspected Inflammatory Bowel Disease (IBD) a barium swallow is conducted to identify any anatomical abnormalities. It is found that the bowel looks very thin almost string like, highlighting a stricture. The man is diagnosed with Crohn’s disease. What area is most likely affected?
- The sigmoid colon
- The right colonic flexure
- The rectum
- The distal ileum
- The distal ileum is the most commonly affected area in Crohn’s disease accounting for ∼40%
- In the diagnosis of H. Pylori which of the following is the most accurate diagnostic tool in an active H. Pylori infection?
- Faecal antigen testing
- Blood antigen testing
- Gastroscopy
- Urea breath test
Urea breath test – Gold standard as most accurate
A 42-year-old woman presents to A&E with a 2-day history nausea and vomiting and acute fever and jaundice. She describes an epigastric pain radiating to the back. After some investigations her tests come back showing slightly abnormal LFT’s and an extremely elevated serum amylase. What is the underlying pathology?
- Pancreatitis
- Gall Stones
- Primary Biliary Cholangitis
- Renal Calculi
- Pancreatitis is the correct answer as the 2 features that make this clear are the extremely elevated serum amylase and the epigastric pain radiating to the back
67-year-old man who is a known alcoholic presents to the GP. For a while now he has been feeling fatigued, a loss of appetite and had a slight abdominal pain which has recently worsened. More acutely he is feeling quite itchy and has a slight yellow tinge which is hard to make out due to his olive-coloured skin. After referring him for some blood tests (LFTs) his results come back showing a moderately elevated ALT and an extremely elevated AST (in a 1:2 ratio respectively). What is the most likely diagnosis?
- Paracetamol overdose
- Alcoholic steatohepatitis
- Gall Stones
- Viral Hepatitis
Alcoholic steatohepatitis
Alcoholic steatohepatitis is the correct answer, while it may be reasonable to assume is AFLD which accounts for many of the symptoms it would not cause the jaundice this man has gotten more acutely unwell (pain worsened and jaundice). His LFTs are supportive of this as AST higher than ALT (roughly 2:1 ratio respectively) Think alcoholic steatohepatitis
A woman in her 40s presents to A&E with colicky right upper quadrant pain and jaundice. After Observations she is found to have normal HR, BP, RR, SpO2 and no fever. After examination she has RUQ pain, but no palpable gall bladder or liver edge. She also has a raised BMI of 36 and the pain is worse after eating and she reportedly has a high fat diet. What condition does she have?
- Non-Alcoholic Fatty Liver Disease (NAFLD)
- Ascending cholangitis
- Gall Stones
- Cholecystitis
Gall Stones
Gall Stones is the correct answer, women are more at risk of cholesterol gall stones than men are, and her risk factor are is she is female, over 40, overweight and eating a high fat diet
A 35-year-old man presents to his GP with lethargy, bloating and a new rash which is comprised of severely itchy blisters and raised red skin lesions (shown to the right). After a blood test he is revealed to have iron deficiency anaemia. What is the most likely cause of his symptoms?
- Coeliac’s disease
- Crohn’s disease
- Alcoholic Fatty Liver Disease (AFLD)
- Cervical Cancer
- Coeliac’s disease is the correct answer as this is a cause of iron deficiency anaemia as the duodenum is commonly affected which is where iron is absorbed, also the rash present is dermatitis herpetiformis, an extraintestinal manifestation commonly seen in Coeliac’s disease. The bloating, lethargy and abdominal pain are slightly more vague and non-specific symptoms, however they are still symptoms or Coeliac’s
A 78-year-old woman presents to hospital after referral from the GP. On examination she has a palpable gall bladder with no right upper quadrant pain, mild jaundice and no fever. Which of the following definitions is met by her combination of signs and symptoms?
- Charcot’s Triad
- Grey-Turners sign
- Courvoisier’s law
- Murphy’s sign
Courvoisier’s law
Is that a palpable gall bladder accompanied by mild jaundice in the absence of RUQ pain is unlikely to be gallstones (THINK PANCREAIC CANCER – IN THE HEAD OF THE PANCREAS)
A 32-year-old man presents to his GP with weakness and tingling in his peripherals and some shortness of breath. It is note he had a bout of gastroenteritis 3 weeks earlier due to what he though was eating undercooked chicken. The man is diagnosed with Guillain-Barre-Syndrome, what is the most likely causative agent?
- Campylobacter Jejuni
- Clostridium Difficile
- Yesinia enterocolitica
- Salmonella
- Campylobacter Jejuni is the correct answer as it meets all the criteria is caught from undercooked poultry, causes gastroenteritis and about 3 weeks later you might get Guillain-Barre-Syndrome which is a neurological autoimmune condition usually presenting days or weeks after gastroenteritis where you get destruction of peripheral nerves and it can affect your phrenic nerve causing breathing problems such as in this case
A neonate is taken home by his mother after birth completely fit and well. She becomes concerned as after 4 days the baby has still not passed the meconium (its first poo) she takes the baby to A&E who do an abdominal X-ray, finding the colon to be very dilated. A rectal biopsy is then taken. What condition is suspected and being tested for in this case?
- Meckel’s diverticulum
- Hirschsprung’s disease
- Colonic Atresia
- Omphalocele
Hirschsprung’s disease is the correct answer in this case as not passing the meconium would make you think of a bowel obstruction however you would see a dilated colon on AXR and the rectal biopsy would confirm as you are checking for the presence of the myenteric and submucosal plexuses – which are absent in Hirschsprung’s
Which of the following would indicate a diagnosis for Wilsons Disease
- Reduced Serum Ceruplasmin
- Increased Serum Ceruplasmin
- Increase total serum copper
- Recued 24hr urinary copper
-Reduced Serum Ceruplasmin
Which of the following vasoactive agents are most likely given in treatment for Oesophageal Haemorrhage?
- Terlipressin
- Octreotide
- Propanalol
- Adrenaline
•Terlipressin
Which of the following features would you not observe in a duodenal biopsy for coeliac disease
- Villous atropy
- Crypt Hyperplasia
- Decreased intraepithelial lymphocytes
- Lamina Propria infiltration with lymphocytes
•Decreased intraepithelial lymphocytes
First line management for AI Hepatitis?
- Steroids
- Immunosuppressants
- Antibiotics
- Monoclonal Antibodies
•Steroids
Steroids and immunosuppressants are both correct. However, steroids would be the best answer. As per studies steroids are preferred over azathioprine for the management of AI hepatitis
What is the first line management for C Diff?
- 7 days Metronidazole
- 10 days Vancomycin
- 7 days Vancomycin
- 10 days Metronidazole
•10 days Vancomycin
A 65-year-old woman presents to A and E with a single episode of haematemesis.
Over the past few months, they describe worsening abdominal pain which is particularly bad after eating. They also report a history of black tarry stools which ‘smell awful’. They have noticed they feel quite fatigued and short of breath as of late.
On examination they are noted to have conjunctival pallor and they are very tender in the epigastric region.
They are haemodynamically stable.
Which of these blood tests is most useful in differentiating between an upper or lower GI bleed?
A)Hb 72g/L
B)Na+ 144mmol/L
C)CRP 7mg/L
D)Urea 23.3 mmol/L
E)Lactate 2.0mmol/L
A)Urea 23.3 mmol/L
