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Flashcards in Exam Deck (67):
1

Functions of bile salts? (2)

Excretion of cholesterol
Emulsification of fat

2

Commonest causes of gallstones? (2)

Excess of cholesterol excretion
Chronic haemolysis (pigment stones)

3

Signs associated with cholecystitis?

RUQ tenderness and rigidity
Murphy's sign- catching of breath at maximal inspiration while RUQ is being palpated

4

Antibiotic therapy for biliary tree infection?

Amox met gent

5

Investigations in suspected gallstones?

Ultrasound
MRCP

6

Surgical treatment of gallstones? (2)

Laparoscopic or open cholecystectomy if causing cholecystitis;
ERCP if impacted in the CBD

7

Acute abdomen:
a) sudden pain that is constant
b) pain on coughing/moving
c) helped by drawing knees up to chest; patient writhes around

a) suggests perforation of a viscus
b) peritonism
c) colicky pain

8

Higher volume, frequency and pitch of bowel sounds?

Obstruction

9

Absence of bowel sounds?

Ileus

10

Clinical signs:
a) Bruising around the umbilicus
b) bruising in the left flank
c) LIF palpation producing RIF pain

a) Cullen's sign (pancreatitis)
b) Grey Turners sign (pancreatitis)
c) Rosving's sign appendicits

11

Condition which presents similarly to appendicitis and may follow an URTI?

Mesenteric adenitis

12

Inflammatory bowel disease: cobblestoning, fissures, transmural inflammation

Crohn's disease

13

Inflammatory bowel disease: rose-thorn ulcers, non-caseating granulomas, mucosal inflammation

Ulcerative colitis

14

Systemic manifestations of IBD? (4)

Anterior uveitis
Ankylosing spondylitis
Erythema nodosum
Pyoderma gangrenosum

15

Investigation of suspected IBD? (3)

Faecal calprotectin
CRP
Colonscopy and biopsy

16

Scoring system used to assess the severity of a flare of UC?

Truelove and Witt's

17

Treatment of perianal fistula?

Seton suture

18

Medical management of IBD?

Induction of remission (steroids, mesalamine)
Maintenance of remission (AZT, mercaptopurine, mesalamine)

19

Transverse colon diameter greater than 6cm indicates...

Toxic megacolon

20

The levels of which enzyme should be assayed before commencing azathioprine?

TPMT

21

What are haemorrhoids?

Prolapsed and enlarged anal cushions containing AV communications

22

How are haemorrhoids clinically classified? (4)

I- don't prolapse
II- prolapse during defaecation, reduce spontaneously
III- always prolapsed, manually reducible
IV- irreducible

23

Management of haemorrhoids?
a) conservative
b) surgical

a) fluids, stool softener, dietary fibre
c) haemorrhoidectomy

24

Management of anal fissure? (3)

Conservative management of constipation
GTN/diltiazem cream to relax sphincter
Lateral sphincterotomy

25

Rectal bleeding + abnormal vessels on colonoscopy?

Angiodysplasia of the colon

26

Causes of acute pancreatitis (6)

Gallstones
Alcohol
ERCP
Trauma
Hypercalcaemia
Cancer

27

Radiological investigation in suspected pancreatitis?

Contrast enhanced CT abdomen

28

Management of acute pancreatitis? (3)

Opiate pain relief
Fluids
Enteral feeding if unable to eat/drink within 48-72 hrs

29

Complications of acute pancreatitis? (3)

Infected necrosis
Pseudocyst
Abscess

30

Epigastric pain worsened by eating + steatorrhoea + diabetes in an alcoholic

Chronic pancreatitis

31

CT finding in chronic pancreatitis?

Speckles of calcification

32

Diameter cut-off for surgery in AAA?

5.5cm

33

Investigation of AAA? (3)

Ultrasound
CT
MR angiography

34

Surgical options for AAA repair? (2)

Open aneurysm repair
EVAR

35

Jaundice with elevated ALP, moderately elevated ALT/AST

Obstructive jaundice

36

Pyrexia + rigors + jaundice + tender liver

Pyogenic liver abscess

37

How can chronic liver disease cause anaemia, thrombocytopenia and leucopenia?

Portal hypertension leading to splenomegaly

38

Definitive management of bleeding oeseophageal varices (3)

Terlipressin
Endoscopic variceal band ligation
(Sengstaken-Blakemore tube as a temporary holding measure)

39

Procedure which can be used to decompress the portal system?

Transjugular intrahepatic portosystemic shunt (TIPSS)

40

Prevention of variceal bleeding (3)

Beta blockers
Sclerotherapy
Band ligation

41

Herniation of mucosa through the circular colon wall at the sites of arterial penetration

Diverticular disease

42

Complications of diverticular disease? (4)

Diverticulitis/pericolic abscess
Obstruction
Fistula formation
Bowel perforation

43

Dysuria + cloudy urine + pneumaturia

Colovesical fistula

44

Definitive treatment of diverticular haemorrhage?

Angiographic embolization
or surgical resection

45

Solitary thyroid nodule- DDx? (3)

Cyst
Adenoma
Cancer

46

Four types of thyroid cancer in order of prevalence?

Epithelial: Papillary and Follicular
Anaplastic
Medullary

47

Rapidly-growing, highly malignant thyroid cancer

Anaplastic

48

Which thyroid cancer has the highest cure rate?

Papillary

49

Thyroid tumour arising from parafollicular cells, secretes calcitonin?

Medullary cancer

50

Medullary cancer and pharochromocytoma often arises as part of what syndrome?

MEN 2

51

Primary hyperparathyroidism is usually due to...

Solitary adenoma of the parathyroid gland

52

Psammoma calcification is diagnostic of...

Papillary thyroid cancer

53

Chovstek and Trosseau are signs of...

Hypocalcaemia

54

Parathyroid, pancreatic and pituitary adenomas- which MEN?

MEN 1

55

Waterhosue-Friderichsen syndrome

Diffuse adrenal haemorrhage

56

AXR- central gas shadows with valvulae conniventes

Small bowel obstruction

57

AXR- peripheral gas shadows with haustra (do not cross lumen)

Large bowel obstruction

58

Management of bowel obstruction?

Keep NBM, NG tube and IV fluids

59

"Coffee bean" sign

Sigmoid volvulus

60

Commonest locations of colorectal Ca? (2)

Rectum (45%) and sigmoid (25%)

61

Staging for confirmed colon Ca?

Contrast enhanced CT chest, abdo pelvis

62

Colorectal cancer- surgery for low sigmoid or high rectal cancer?

Anterior resection

63

Colorectal cancer- surgery for tumours low in the rectum?

Abdominoperineal resection + permanent colostomy

64

Numerous hamartmaous polyps in GI tract + pigmented lesions on lips, oral mucosa, face, palm and soles

Peutz Jeugher syndrome

65

Abd pain + bloody diarrhoea + fever in a known vasculopath

Mesenteric ischaemia

66

Adhesions usually cause obstruction of which segment of bowel?

Small bowel

67

Which is the only thyroid cancer that spreads haematogenously?

Follicular