Gastro

Question 1

Three most common causes of chronic liver disease

Answer 1

Alcohol

Viral hepatitis

Non-alcoholic fatty liver disease

Question 2

What are the abdominal causes of finger clubbing?

Answer 2

IBD
Cirrhosis
Coeliac Disease
Hepatocellular carcinoma

Question 3

Sx of IBD

Answer 3

RIF Mass
Abdo tenderness

Aphthous ulcers in the mouth
Enteropathic arthropathy
Conjunctivitis/episcleritis/anterior uveitis

Question 4

Tx of UC vs Crohn’s

Answer 4

Crohns:
induce remission with glucocorticoids
maintain remission with azathioprine or mercaptopurine

UC:
Induce remission with topical aminosalicylate (then oral)
maintain remission with topical aminosalicylate

Question 5

Name some side effects and complications of immunosuppressants?

Answer 5

Gum hypertrophy – ciclosporin
Hirsutism – ciclosporin
Hypertension – ciclosporin
Cushingoid features – steroids
Purpura – steroids

Question 6

What causes unilateral/bilateral palpable native kidneys

Answer 6

Polycystic kidney disease

Question 7

What could an AV fistula indicate

Answer 7

Renal transplant/dialysis

Question 8

What to do to complete an examination in a renal failure patient

Answer 8

Perform fundoscopy to assess for either diabetic or hypertensive retinopathy

Question 9

Extrarenal mainfestations of PKD

Answer 9

Cysts in liver, pancreas, spleen, thyroid and lungs
Intracranial Berry Aneurysm and rupture causing SAH
Polycythaemia
Anaemia
Hypertension
Mitral valve prolapse

Question 10

Signs of chronic liver disease

Answer 10

Palmar erythema
Dupuytrens contracture
Leuconychia
Spider naevi
Gynaecomastia

Question 11

What is the usual cause of ascites without features of chronic liver disease

Answer 11

Malignancy

Question 12

Causes of massive splenomegaly

Answer 12

CML, AML, myelofibrosis

Malaria, HIV

Question 13

Inguinal hernia reappears when you cough

Answer 13

Direct inguinal hernia

Question 14

indications for stomas

Answer 14

temporary exteriorisation: perforated or contaminated bowel e.g. hartmann’s

protection of distal anastomosis

bypass of distal obstructing lesion

Feeding: gastrostomy/jejunostomy

Question 15

Differences between ileostomy and colostomy stoma

Answer 15

Ileostomy: RIF, spout, watery contents

Colostomy: LIF, flush, formed faeces

Question 16

Sx for loop or end colostomy

Answer 16

End colostomy: AP resection, Hartmann’s

Loop colostomy: Anterior resection

Question 17

Complications of stoma

Answer 17

ischaemia
High output (can lead to hypokalaemia)
parastomal abscess

parastomal hernia
obstruction; adhesions
stoma prolapse
stenosis or stricture

Question 18

Anatomical order of structures in midline laparotomy

Answer 18

skin
camper’s fascia
scarpa’s fascia
linea alba
transversalis fascia
pre-peritoneal fat
peritoneum

Question 19

Cause of Kocher’s scar

Answer 19

Top right of abdomen - cholecystectomy

Question 20

Use of mercedes-benz scar (other name)

Answer 20

Rooftop

Liver transplant
Liver resection

Question 21

Scar used for caesarian

Answer 21

Pfannenstiel

Question 22

Complications og CLD

Answer 22

Ascites
Coagulopathy
Encephalopathy
Sepsis/SBP

Question 23

Tx of encephalopathy

Answer 23

Lactulose
Rifaximin

Question 24

Causes of hepatomegaly

Answer 24

Hepatitis
CLD
Congestion secondary to heart failure

Malignancy, lymphoma

Question 25

Causes of splenomegaly

Answer 25

CML, CLL, Lymphoma
myelofibrosis
Amyloidosis
malaria

Question 26

Causes of small spleen

Answer 26

Portal hypertension (secondary to cirrhosis)
EBV

Question 27

CML Mx

Answer 27

Imatinib

Question 28

dDx of enlarged kidneys

Answer 28

ADPKD
RCC
Cysts
Amyloidosis

Question 29

Mx of ADPKD

Answer 29

↑ water intake, ↓ Na, ↓ caffeine (may ↓ cyst formation)
Monitor U+E and BP
Genetic counselling
50% chance of transmission

Question 30

Induce remission in crohn’s

Answer 30

Steroids