finals gastro

Question 1

what sign is seen on imaging in pancreatic cancer?

Answer 1

double duct sign (CT, MRI, ERCP)
> dilatation of pancreatic and common bile duct

Question 2

which tumour marker is associated with pancreatic cancer?

Answer 2

Ca 19-9 (think pancreas shaped like a 9)

Question 3

what treatment is offered for dysplasia on biopsy in barrett’s oesophagus?

Answer 3

endoscopic mucosal therapy (radiofrequency ablation/endoscopic resection)

Question 4

what is the management for wilson’s disease?

Answer 4

penicillamine (?tridentine now)
> chelates copper

Question 5

anti-HBs -
anti-HBc +
HBs antigen +
IgM anti-HBc -

Answer 5

chronic hep B (prev acute infection still a carrier)

Question 6

anti-HBs +
anti-HBc -
HBs antigen -
IgM anti-HBc -

Answer 6

prev immunisation

Question 7

anti-HBs -
anti-HBc +
HBs antigen -
IgM anti-HBc -

Answer 7

prev hep B not a carrier

Question 8

common side effect of metaclopramide?

Answer 8

diarrhoea (prokinetic)

Question 9

what is the management for recurrence of c.diff within 12 weeks of symptom resolution?

Answer 9

oral fidaxomicin

Question 10

what marker is positive in PSC?

Answer 10

pANCA

Question 11

what bowel disease is PSC associated with?

Answer 11

ulcerative colitis

Question 12

what is the management for life-threatening C-diff?

Answer 12

• ORAL vancomycin
• IV metronidazole

Question 13

how is alcoholic ketoacidosis managed?

Answer 13

IV thiamine and saline

Question 14

what is the mechanism of action of loperamide?

Answer 14

Reduction in gastric motility through stimulation of opioid receptors

Question 15

what is the diagnostic investigation for PSC?

Answer 15

MRCP (sensitive and non-invasive)

Question 16

what is grade I HE?

Answer 16

irritability

Question 17

what is grade II HE?

Answer 17

confusion, inappropriate behaviour

Question 18

what is grade III HE?

Answer 18

incoherent, restless

Question 19

what is grade IV HE?

Answer 19

coma

Question 20

what type of cancer is barrett’s oesophagus associated with?

Answer 20

oesophageal carcinoma

Question 21

what type of cancer is achalasia associated with?

Answer 21

squamous cell carcinoma of the oesophagus

Question 22

what score assesses risk of rebleeding after upper GI bleed (post endoscopy)?

Answer 22

rockall score

Question 23

what does the child-pugh score assess?

Answer 23

severity of liver cirrhosis

Question 24

what medication is given post-resuscitation for variceal haemorrhage?

Answer 24

terlipressin

Question 25

what is the triad of features in intestinal angina?

Answer 25

1. severe colicky post-prandial abdo pain 2. weight loss 3. abdominal bruit

Question 26

what bloods are used to monitor treatment in haemochromatosis?

Answer 26

ferritin transferrin

Question 27

how does PBC present?

Answer 27

may be asymptomatic, or fatigue, pruritus cholestatic jaundice, hyperpigmentation > raised ALP on routine LFTs

Question 28

how is PBC diagnosed?

Answer 28

AMA (highly specific) raised serum IgM

Question 29

how do you treat PBC?

Answer 29

ursodeoxycholic acid

Question 30

which drugs should be stopped before 13C-urea breath test?

Answer 30

no abx last 4 weeks no PPIs last 2 weeks

Question 31

what drugs are used first line in patients with ascites secondary to liver cirrhosis?

Answer 31

aldosterone antagonist - spironolactone

Question 32

what is carcinoid syndrome?

Answer 32

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

Question 33

what are the features of carcinoid syndrome?

Answer 33

- flushing - diarrhoea - bronchospasm - hypotension - RH valvular stenosis

Question 34

how is carcinoid syndrome investigated?

Answer 34

urinary 5-HIAA plasma chromogranin A y

Question 35

how is carcinoid syndrome managed?

Answer 35

somatostatin analogues eg octreotide for diarrhoea cyproheptadine may help

Question 36

what does metabolic alkalosis + hypokalaemia suggest?

Answer 36

? prolonged vomiting

Question 37

why do people with coeliac disease receive the pneumococcal vaccine?

Answer 37

hyposplenism

Question 38

what lifestyle factors are used in mgt of ascites?

Answer 38

- reducing dietary sodium - fluid restriction is sodium is >125mmol/L

Question 39

what is a disadvantage of using a PPI long-term?

Answer 39

inc risk fractures + osteoporosis

Question 40

what type of cancer does pernicious anaemia predispose to?

Answer 40

gastric carcinoma

Question 41

what does dysphagia to both solids and liquids from the outset of symptoms suggest?

Answer 41

achalasia

Question 42

what is the AST/ALT ratio in alcoholic hepatitis?

Answer 42

AST:ALT 2:1 toAST

Question 43

which bowel condition is associated with gallstones?

Answer 43

crohn's

Question 44

how does pharyngeal pouch present?

Answer 44

- dysphagia - regurgitation - aspiration - neck swelling which gurgles on palpation - halitosis

Question 45

What is the management for C. difficile?

Answer 45

Oral vancomycin

Question 46

What are the key features of Peutz-Jeghers syndrome?

Answer 46

- autosomal dominant - hamartomatous polyps in GI tract > small bowel obstruction, GI bleeding - pigmented lesions on lips, oral mucosa, face, palms and soles

Question 47

What is the most commonly affected part of the bowel in UC?

Answer 47

Rectum

Question 48

Which malignancy is associated with coeliac disease?

Answer 48

EATL (enteropathy-associated T cell lymphoma)

Question 49

What test is used for H.pylori post-eradication therapy?

Answer 49

Urea breath test