Gastro

Question 1

Valvulae conniventes vs haustra

Answer 1

Haustra dont go all the way across bowel on xray

Question 2

Where can ALP be released from

Answer 2

Bone
Biliary tree
Placenta

Question 3

Where is ALT released from

Answer 3

Hepatocytes, Kidneys, Heart

Question 4

Where is AST released from

Answer 4

Hepatocytes, Muscle + others

Question 5

If AST in thousands

Answer 5

Acute presentation, viral/drug induced hepetitis

Question 6

What is NILS

Answer 6

Non-invasive liver screen
1. EBv, CMV, Hepatitis ABC
2. ANA, AMA, ASMA (autoimmune hep)
3. Ferritin, Cu, a-antitrypsin (haemochromatosis, wilsons)

Question 7

Hep A transmission

Answer 7

Faecal-oral

Question 8

Commonest viral hepatitis

Answer 8

A, can vaccinate

Question 9

Diagnosis of Hep A

Answer 9

Hep A IgM

Question 10

Hep E transmissino

Answer 10

Faecal-oral

Question 11

Diagnosis Hep E

Answer 11

IgG & IgM

Question 12

Hep B transmission

Answer 12

Parental, sexual, & IVDU. Self limiting disease

Question 13

Hep B diagnosis

Answer 13

Raised ALT + Bili in acute phase

Question 14

Hep C transmission

Answer 14

Bloos exposure

Question 15

Hep C presentation

Answer 15

Mostly asymptomatic, most develop chronic liver disease

Question 16

Diagnosis Hep C

Answer 16

ALT high, HCV screen

Question 17

Alcoholic Liver disease mx

Answer 17

Withdrawal, chlordiazeperoxide, Pabrinex, Alcohol abstinence, Steroids, NUTRITION

Question 18

Refeeding blood markers

Answer 18

Magnesium & Phosphate

Question 19

Most common causative organisms in SBP

Answer 19

E. Coli, Klebsiella pneumoniae or gram +ve cocci

Question 20

Gallstones made from

Answer 20

Cholesterol from concentrated bile

Question 21

Biliary colic vs cholecystitis vs cholangitis

Answer 21

BC (RUQ pain), cystitis (RUQ pain +fever), cholangitis, (RUQ pain + fever + jaundice)

Question 22

Causes of pancreatitis

Answer 22

I - Idiopathic
G - Gallstones
E - Ethanol
T - Trauma
S - Steroid Use
M - Mumps
A - Autoimmune
S - Scorpion stings
H - Hypercalcaemia/Hypertriglycerideaemia
E - ERCP
D - Drugs/Meds

Question 23

Replacement of pancreatic enzymes

Answer 23

Creon

Question 24

Main complication of pancreatitis

Answer 24

ARDS

Question 25

H.Pylori Triple therapy

Answer 25

PPI, Clari, Amox (or Metro)

Question 26

Key pt advice for h pylori test

Answer 26

Stop PPI for at least 2 weeks (avoids false negatives)

Question 27

In dysphagia who gets 2ww for oesophageal ca

Answer 27

All dysphasia Over 55 AND reflux

Question 28

GI Bleed Scoring system

Answer 28

Glasgow-Blanchford Score

Question 29

Post-endoscopy prognosis scoring system

Answer 29

Rockall Score

Question 30

All Gi bleeds get what in 24hrs

Answer 30

Endoscopy

Question 31

Mx variceal bleeding

Answer 31

IV terlipressin & IV abx TIPS, Carvedilol, Elastic band ligation, Injection of sclerosis, Sangsten-Blakemore (last line)

Question 32

Significant weight loss?

Answer 32

10% up to 6 months. Must be unintentional

Question 33

Risk of FAP

Answer 33

90% get colorectal cancer by 45

Question 34

3 genetic conditions that predispose to colorectal cancer

Answer 34

HNPCC FAP Peutz-Jegher's

Question 35

ALARM symptoms

Answer 35

Anaemia Loss weight Anorexia Rectal Bleeding Malaena

Question 36

Colorectal cancer tumour marker

Answer 36

CEA

Question 37

Courvoisiers law

Answer 37

Palpable gallbladder in abscence of pain, pancreatic cancer until proven otherwise.

Question 38

Staging for colonic cancer

Answer 38

Duke's A - Confined to mucosa B - Invading bowel wall C - Lymph node mets D - Distant Mets

Question 39

Dyspepsia Mx (NICE)

Answer 39

1mo trial of PPI before H. Pylori test (if uncomplicated)

Question 40

Zollinger ellison syndrome

Answer 40

Tumour that secretes gastrin, stomach produces more acid. Tumours common in duodenum/pancreas.

Question 41

MEN1 affects

Answer 41

Parathyroid, Pituitary, Pancreas

Question 42

MEN2 affects

Answer 42

Parathyroid, Phaechromocytoma

Question 43

Initial investigation for IBD

Answer 43

Stool culture & faecal calprotectin

Question 44

Gold standard ix for IBD

Answer 44

Endoscopy

Question 45

First line inducing remission of Crohns

Answer 45

Prednisolone 40mg (then reducing dose 5mg weekly till 0mg)

Question 46

Maintainence of remission of crohns

Answer 46

Azathioprine, (check its working with TPMT enzyme)

Question 47

Induction of remission of NON-extensive UC

Answer 47

Rectal mesalazine

Question 48

Definition of extensive vs non-extensive UC

Answer 48

Extends beyond splenic flexure

Question 49

Induction of remission of extensice UC

Answer 49

Oral mesalazine

Question 50

Scoring system for severity of IBD

Answer 50

Truelove and Witts Severity Index

Question 51

Symptomatic relief of IBS

Answer 51

Loperamide (anti diahorreal) + Mebeverine (antispasmodic)

Question 52

Viral vs non-viral gastroenteritis symtpoms differentiation

Answer 52

More vomiting in viral

Question 53

If in doubt for diahorrea abx mx say...

Answer 53

Metronidazole

Question 54

C diff investigations

Answer 54

1. Screening test - GDH waste product, can just isolate + supportive 2. Toxin test - c. diff toxin, needs treatment

Question 55

C. Diff mx

Answer 55

Vancomycin orally 125mg QDS If severe add metronidazole IV 500mg TDS

Question 56

All new cases of coeliac disease test for what...?

Answer 56

T1DM

Question 57

Derm condition linked to coeliac

Answer 57

Dermatitis herpetiformis (itchy knee/elbow rash)

Question 58

Investigation for Coeliac disease + gold standard to 'confirm'

Answer 58

Anti TTG antibodies (raised) + Total IgA. Biopsy to confirm1

Question 59

Refeeding syndrome U&Es

Answer 59

Low K, Mg + P

Question 60

Gold standard Ix for Achalasia + initial ix

Answer 60

Oesophageal Manometry (pressure testing at junction) Barium swallow (birds beak) usually done first but manometry golden boi

Question 61

Mx of achalasia

Answer 61

Heller's myotomy