Extra

Question 1

Vomiting that relieves pain

Answer 1

Peptic ulcer

Question 2

Vomiting preceeded by loud gurgling

Answer 2

GI obstruction

Question 3

Constipation + menorrhagia

Answer 3

Hypothyroidism

Question 4

Constipation + blood PR

Answer 4

Cancer

Question 5

Constipation, distension and active bowel sounds

Answer 5

Obstruction

Question 6

Poor prognostic factors for GI bleeding

Answer 6

Older
Low systolic BP
Tachycardic 
Co-morbidities 
Above = Rockall score 
Post-endoscopy Rockall score - diagnosis of upper GI malignancy (2), Malory Weiss or no lesion (0), all other diagnoses (1) 
If signs of recent haemorrhage 

Poor urine output
Peripherally shut down
Low GCS

Question 7

Stain for iron loading

Answer 7

Perls stain

Question 8

Anti mitochondrial antibodies

Answer 8

PBC

Question 9

Anti smooth muscle antibodies

Answer 9

Autoimmune hepatitis

Question 10

Anti nuclear antibody

Answer 10

Autoimmune hepatitis

Question 11

Anti endomysial

Answer 11

Coeliacs disease

Question 12

Transglutaminase

Answer 12

Coeliacs disease

Question 13

Alpha gliadin

Answer 13

Coeliacs disease

Question 14

What is beri beri?

Answer 14

Thiamine - b1 deficiency

Heart failure with oedema (wet) or neuropathy (dry)

Question 15

What is pellagra?

Answer 15

Lack of nicotinic acid
3 d’s - dementia, diarrhoea and dermatitis

Also neuropathy, depression, insomnia, other Neuro symptoms

Endemic in China and Africa

Question 16

ALT higher than AST

Answer 16

ALTernative diagnosis to alcoholic liver dies as

Question 17

AST higher then ALT

Answer 17

Alcoholic liver disease

Question 18

Pabrinex

Answer 18

High dose vitamin b’s - including thiamine

Question 19

What is acute abdomen?

Answer 19

Severe sudden abdominal pain of unknown aetiology

Question 20

What is the cough test

Answer 20

Ask patient to cough - if in pain, flinching or a protective movement of hands to abdomen
Suspect peritonitis

Question 21

Blunt or penetrating trauma + acute abdomen

Answer 21

Blunt - splenic rupture (can be delayed)

Penetrating - liver rupture

Question 22

Signs of peritonitis

Answer 22

Shock, lying still, cough test, rigid abdomen, guarding, no bowel sounds

Question 23

DDX of peritonitis

Answer 23

Acute pancreatitis has similar signs but doesn’t need laparotomy
Therefore always check amylase and can do erect X-ray - gas under diaphragm in peritonitis

Question 24

Best way of assessing shock from hypovolaemia

Answer 24

Assess perfusion of organs
Skin - cap refill
Brain - GCS
Kidney - urine output

Also do BP, pulse and RR

Question 25

Pain of appendicitis

Answer 25

Starts mid-abdomen, peri-umbilical - referred pain | Then lateralises and settles at McBurney's point

Question 26

What is Rosvings sign

Answer 26

Pain in RIF when LIF is pressed - sign of acute appendicitis

Question 27

What is Psoas sign

Answer 27

Pain on extending hip if retrocaecal appendix

Question 28

Cope sign

Answer 28

Pain on flexion and internal rotation of hip if appendix in close relation to obturator internus

Question 29

Antibiotics in appendicitis

Answer 29

Cefuroxime and metronidazole

Question 30

Type of pain in intestinal obstruction

Answer 30

Colicky pain

Question 31

Signs of ileus aka functional obstruction

Answer 31

Bowel sounds absent - no pain

Question 32

Indications for gastric surgery

Answer 32

Cancer and pyloric or duodenal peptic ulcers

Question 33

What is murphys sign?

Answer 33

Lay two fingers over RUQ - ask patient to breathe in Causes pain and arrest of inspiration due to inflammation Sign of acute cholecystitis Only +ve if same test in LUQ doesn't cause pain

Question 34

Jaundice and RUQ pain - and fever

Answer 34

Cholangitis | No jaundice if biliary colic or acute cholecystitis

Question 35

Assessment of severity of pancreatitis

Answer 35

``` PANCREAS PaO2 55 Neutrophilia WBC >15 x109 Calcium 16 Enzymes - LDH and AST Albumin 10 ```

Question 36

Raised bilirubin but normal liver enzymes

Answer 36

Gilberts syndrome - enzyme which conjugates bilirubin is dysfunctional therefore high levels or serum bilirubin - Unconjugated therefore can't go into urine - no bilirubin in urine

Question 37

Raised ALP but normal GGT

Answer 37

Suspect bone cause of raised ALP

Question 38

Burning retrosternal pain and dysphagia

Answer 38

Erosive oesophagitis

Question 39

What drug reduces the pressure of blood coming from the liver

Answer 39

Somatostatin

Question 40

How does terlopressin work?

Answer 40

Narrows blood vessels to small intestine

Question 41

What is crigler-Najjar syndrome?

Answer 41

More extreme form of gilberts syndrome - enzyme which conjugates bilirubin is dysfunctioning - usually presents neonatally and requires transfusion

Question 42

What can exacerbate gilberts syndrome?

Answer 42

enzyme deficit is heightened in intercurrent illness (viral infection) and fasting

Question 43

What are coryzal symptoms?

Answer 43

Common cold viral infection symptoms

Question 44

Rotor syndrome

Answer 44

Rise in conjugated bilirubin - in urine | Not itchy

Question 45

Helicobacter pylori treatment

Answer 45

First line PAC or PMC for a week | Then add bismuth subcitrate for 2 weeks

Question 46

Cyclizine side effects

Answer 46

Antihistamine causes dry mouth and drowsiness

Question 47

Hyoscine butylbromide

Answer 47

Anti spasmodic | Anti muscarinic side effects eg. Dry mouth and blurred vision

Question 48

Metoclopramide side effects

Answer 48

Anti-emetic Causes oculogyric crisis caused by blockade of central D2 receptors - uncontrollable rolling back of the eyes - also lateral neck flexion, open mouth and protruding tongue

Question 49

Side effects of omeprazole

Answer 49

Headache and GI upset

Question 50

Side effects of ondansetron

Answer 50

Anti emetic - headache and constipation

Question 51

What is Paul bunnell monospot test

Answer 51

Tests for heterophil antibodies | Develop in 90% of patients with mononucleosis

Question 52

What can giving glucose (for hypoglycaemia or dehydration) cause in an alcoholic

Answer 52

Potentially thiamine deficient therefore can precipitate encephalopathy Therefore give pabrinex ampoules - vitamin c and b - 3x day

Question 53

Test correct position of NG tube

Answer 53

Test ph of aspirate | If

Question 54

Arthritis and conjunctivitis in setting of abdominal pain and diarrhoea

Answer 54

IBD

Question 55

What can rapid correction of hyponatraemia lead to?

Answer 55

Bulbar palsy (speech and swallowing) and central pontine myelinolysis (limb weakness)

Question 56

Coffee ground vomit

Answer 56

GI bleeding