gastro

Question 1

What markers are used in the modified glasgow score for pancreatitis severity?

Answer 1

PANCREAS
PaO2 <8
Age >55
Neutrophilia
Calcium
Renal function (urea>16)
Enzymes(LDH and AST)
Albumin
Sugar (>10)

Question 2

in UC: which of these other features are realted to uc disease activity?
- erythema nodosum
- psc
- arthropathy
- sacroiliitis/ank spon

Answer 2

Erythema nodosum - related
PSC - unrelated
Arthropathy - related
Ank spon - unrelated

Question 3

Diagnosis?
- middle aged
- jaundiced
- pruritic
- hepatosplenomegaly + RUQ discomfort

Answer 3

primary biliary cirrhosis

Question 4

diagnostic blood test in PBC?

Answer 4

antimitochondrial antibodies

Question 5

Vomiting of undigested food
diagnosis?

Answer 5

gastric outlet obstruction

Question 6

Key test for hiatus hernia? why?

Answer 6

contrast upper GI series
- delineates anatomy

Question 7

2ww referrals for colorectal cancer.
At what age group would you refer for the following presentations?

• weight loss + abdo pain
• unexplained PR bleeding
• positive FOB test
• new iron deficiency anaemia in man or post menopausal woman
• persistent CIBH

Answer 7

Weight loss and abdo pain >40yo

Unexplained PR bleeding >50yo

Positive FOB test - any age

New IDA - >60yo

Peristent CIBH >60yo

Question 8

location inguinal vs femoral hernia in relation to pubic tubercle

Answer 8

Inguinal - superior and medial
Femoral - inferior and lateral

Question 9

how many units in a pint of weaker 4% beer

Answer 9

2

Question 10

how many units in a small glass of wine

Answer 10

2

Question 11

guideline for alcohol intake in UK?

Answer 11

14 units, spread out over >3 days of the week

Question 12

zenker diverticulum, aka…

Answer 12

pharyngeal pouch

Question 13

Incarcerated hernias are more likely to cause large or small bowel obstruction?

Answer 13

Small bowel obtruction

Question 14

Causative organism?

bloody diarrhoea and RUQ pain

Answer 14

Entamoeba
RUQ pain due to amoebic liver abscess

Question 15

Bloody diarrhoea and joint pain

2 possible causative organisms?

Answer 15

Campylobacter
Yersinia

Question 16

Most common presentation of portal hypertension?

Answer 16

Haematemesis from varices

Question 17

What is budd chiari syndrome

Answer 17

hepatic vein obstruction - may be thrombotic or non thrombotic

Question 18

Common vitamin deficiency secondary to carcinoid tumour? How?

Answer 18

NIacin (pellagra - dementia, dermatitis, diarrhoea)

Carcinoid tumours –> tryptophan metabolism increased –> increased serotonin

Question 19

Features of chronic mesenteric ischemia?
Management?

Answer 19

Post prandial pain in a pt with CVD , esp smokers
Weight loss and fear of eating
Unremarkable abdo exam

Revascularisation

Question 20

Most commonly affected part of GIT in crohns disease

Answer 20

Terminal ileum

Question 21

Anatomical landmark used to differentiate between internal and external haemorrhoids

Answer 21

dentate line

Question 22

Egs of :
bulk forming laxative
osmotic laxative
stimulant laxative

Answer 22

Bulk - fybogel
osmoti - lactulose, movicol
stimulant - senna

Question 23

Isolated raised ALP
- what are the 2 likely sources? how to differentiate between them?

Answer 23

liver vs bone

measure GGT - if rasied, do USS and antimitochondrial antibodies (PBC)

if not raised, need vit D, calcium, phosphate

Question 24

oral ocular genital syndrome = deficiency?

Answer 24

B2 deficiency-

Question 25

Haemochromatosis - which blood test is useful for diagnosis

Answer 25

High transferrin saturation

Question 26

Features of haemochromatosis (apart from bronzed skin)

Answer 26

liver
diabetes
arthralgia
cardiomyopathy = reversible with treatment

Question 27

Features of Wilsons disease

Answer 27

copper deposition ++
neurological and liver involvement
kayser fleischer rings

Question 28

Wilson’s disease - which blood test is useful for diagnosis

Answer 28

low caeruloplasmin

Question 29

In a pt with IBD with worsening bowel sx, what is the most specific blood test to rule out/in a diagnosis of IBD exacerbation

Answer 29

faecal calprotectin

Question 30

Triad of sx in plummer vinson syndrome

Answer 30

beefy red tongue
dysphagia
IRON DEFICIENCY

Question 31

a well patient with isolated raised bilirubin. what do you do next?

Answer 31

repeat unconjug and conjug bilirubin in 1-3 months time

if unconjug bili is increasing –> think haemolysis

Question 32

middle aged woman with diarrhoea, DVT, depression and rash and weight loss
diagnosis?

Answer 32

glucagonoma

Question 33

at what age would you refer 2ww a pt with new onset dyspepsia

Answer 33

55yo

Question 34

relationship btw calcium and pancreatitis

Answer 34

HIGH ca –> pancreatitis

but low Ca = worse prognosis

Question 35

2 organisms which cause dysentry + joint pain?

Answer 35

campylobacter + yersinia

Question 36

when are abx indicated in diarrhoea? which one?

Answer 36

clarithromycin - if systemically unwell or campylobacter is suspected

Question 37

how do HCC and cholangiocarcinoma present differently?

Answer 37

HCC is usually painful RUQ, cholangiocarcinoma is typically painless