Gastro

Question 1

severe colitis flare management?

Answer 1

hospital admission
IV steroids
if no improvement after 72h - consider adding IV ciclosporin or surgery

Question 2

pt with blood results showing macrocytic anaemia and low b12, next test?

Answer 2

intrinsic factor antibodies for pernicious anaemia

Question 3

first, second and third line management for c.diff?

Answer 3

1. oral vanc 10d
2. oral fidaxomycin
3. oral vanc +/- IV metronidazole

Question 4

which vitamin is teratogenic in high doses?

Answer 4

vitamin A
(retinol)

Question 5

which blood test are useful to monitor the function of the liver in liver failure?

Answer 5

prothrombin time
(coagulation and albumin generally)

Question 6

which part of the colon is most likely to be affected by ischaemic colitis?

Answer 6

splenic flexure

Question 7

which biliary disease is associated with UC?

Answer 7

primary sclerosis cholangitis

Question 8

tx for haemachromatosis?

Answer 8

first line - venesection
second line - desferrrioxamine

Question 9

mgt of barrett’s oesophagus?

Answer 9

high dose PPI
+ endoscopic surveillance

Question 10

management when dysplasia is seen on upper GI endoscopy in barretts oesophagus?

Answer 10

endoscopic intervention ie endoscopic mucosal resection

Question 11

triggers for UC flares?

Answer 11

stress
medx - NSAIDs, abx
cessation of smoking

Question 12

features of vitamin C deficiency (scurvy)?

Answer 12

gingivitis, loose teeth
poor wound healing
bleeding from gums, haematuria, epistaxis
general malaise

Question 13

management of variceal haemorrhage?

Answer 13

ABC
prophylactic IV abx and terlipressin
then endoscopy

Question 14

painful palpable umbilical nodule associated with advanced malignancy in the pelvis or abdomen?

Answer 14

sister mary joseph’s node

Question 15

most common bacteria in SBP?

Answer 15

e.coli
then klebsiella

Question 16

sign on MRCP in pancreatic cancer?

Answer 16

double duct sign (dilatation of pancreatic and common bile ducts)

Question 17

M rule in PBC?

Answer 17

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

Question 18

management for wilsons disease?

Answer 18

penicillamine

Question 19

features of carcinoid syndrome ?

Answer 19

abdo pain
diarrhoea
flushing
also bronchospasm

Question 20

prophylaxis of oesophageal bleeding?

Answer 20

non cardioselective beta blocker eg propranolol

Question 21

mild UC flare?

Answer 21

<4 stools daily with or without blood
no systemic disturbance
normal ESR and CRP

Question 22

moderate UC flare?

Answer 22

4-6 stools a day, minimal systemic disturbance

Question 23

severe UC flare?

Answer 23

> 6 stools a day, cont blood
evidence of systemic disturbance
eg fever, tachycardia, abdo tenderness, distention or dec BSs
anaemia
hypoalbuminaemia

Question 24

management of PBC?

Answer 24

ursodeoxycholic acid

Question 25

management of pruritus in PBC?

Answer 25

cholestyramine

Question 26

mgt for liver abscess?

Answer 26

IV abx and image guided percutaneous drainage

Question 27

monitoring bloods in haemochromatosis?

Answer 27

ferritin and transferrin saturation

Question 28

investigation of choice for carcinoid tumours?

Answer 28

urinary 5-hydroxyindoleacetic acid
(5-HIAA)

Question 29

alcohol intake advice?

Answer 29

max 14 units per week
if you drink as much as 14 units it is best to spread it evenly over 3 days or more

Question 30

findings on AXR in ischaemic colitis?

Answer 30

thumb printing of the small bowel

Question 31

features of crohns that are diff from UC?

Answer 31

mouth to anus
skip lesions
inflam all layers
goblet cells
granulomas
bowel obstruction, fistulae
typically more weight loss, abdo pain, non bloody diarrhoea

Question 32

complications of PSC?

Answer 32

cholangiocarcinoma (10%)
inc risk of colorectal cancer

Question 33

management of perianal abscess in crohn’s pts?

Answer 33

incision and drainage

Question 34

what is peutz-jeghers syndrome?

Answer 34

AD condition
-> numerous hamartomatous polyps in GI tract
- also pigmented freckles on the lips, face, palms and soles
» often intussusception
associated with gastrointestinal cancers

Question 35

which malignancy is associated with barrett’s oesophagus?

Answer 35

adenocarcinoma

Question 36

dx: young man with retrosternal chest pain and dysphagia to liquids and solids

Answer 36

achalasia (LES doesn’t relax)

Question 37

which autoantibody is positive in PSC?

Answer 37

p-ANCA

Question 38

symptoms of congestive hepatomegaly?

Answer 38

persistent dull ache
-» mild elevation of ALT

Question 39

typical blood results in haemochromatosis?

Answer 39

raised ferritin and transferrin saturation
low TIBC