Gastro

Question 1

dysphagia of both liquids and solids

Answer 1

achalasia

Question 2

failure of oesophageal sphincter to close due to degenerative loss of ganglia from the myenteric plexus

Answer 2

achalasia

Question 3

diagnostic test of achalasia

Answer 3

oesophageal manometry- LOS which doesn’t relax on swallowing

Question 4

first line for achalasia

Answer 4

pneumatic (balloon) dialtion

Question 5

surgery for recurrent achalasia

Answer 5

Heller cardiomytomy

Question 6

is jaundice present in cholecystitis or ascending cholangitis

Answer 6

ascending

Question 7

roving sign in appendicitis

Answer 7

more pain in RIF than LIF when palpating LIF

Question 8

loin pain and fever

Answer 8

acute pyelonephritis

Question 9

loin pain radiating to groin

Answer 9

renal colic

Question 10

ectopic preg presetns with amenorrhoea the past 6-9 weeks

Question 11

central abdo pain and history of fib and may get diarrhoea and metabolic acidosis is often seen

Answer 11

mesenteric ishaemia

Question 12

*remember that ‘liver function tests’ do not always accurately reflect the synthetic function of the liver. This is best assessed by looking at the —and — level.

Answer 12

prothrombin time and albumin

Question 13

what can indicate an upper vs lower Gi bleed

Answer 13

upper - high urea

Question 14

as duodenal ulcers are posteriorly sited they can erode the

Answer 14

gastroduodenal artery

Question 15

GI bleed what risk assessment

Answer 15

Glasgow blatchfrod at first assessment
Rockall used after endoscopy

Question 16

fresh frozen plasma replaces

Answer 16

fibrinogen

Question 17

give what if taking warfarin and actively bleeding

Answer 17

prothrombin complex concentrate

Question 17

what should be done in GI bleed within 24hrs after resus

Answer 17

endoscopy

Question 18

bind ligation is done for oesophageal varices what is done for gastric

Answer 18

injections of N-butyl-2-cyanoacrylate

Question 19

if do drink more than 14 units of alcohol a days best to

Answer 19

spread this evenly over 3 days or more

Question 20

1 unit of alcohol is

Answer 20

half a glass of wine
1/3 of a pint of beer
25ml of a spirit

Question 21

mx of alcoholic ketoacidossi

Answer 21

saline and thiamine

Question 22

findings in alcoholic liver disease

Answer 22

AST:ALT >2, greater than 3 is strongly suggestive of acute alcoholic hepatitis

Question 23

mx for alcoholic liver disease

Answer 23

steroids and may give pentoxyphylline

Question 24

madders discriminant function use in alcoholic liver disease

Answer 24

determines whether would benefit from steroids

Question 25

the aminosalicyclate drugs eg =sulphasalazine and mesalazine associated with haematoligcal adverse effects including agranulocytosis so

Answer 25

FBC is a key ix

Question 26

side effect of sulphasalazine is -- mesalazine s/e is ---

Answer 26

headache, pancreatitis

Question 27

loperamide is a

Answer 27

anti diarrhoea

Question 28

for ascites, in contrast to pleural efussuin where the high one is malignancy, infection

Answer 28

is opposite for ascites. infection, malign saag <11

Question 29

mx of ascites

Answer 29

salt restrict spironolactone paracentesis

Question 30

when doing paracetensis for ascites need cover of what

Answer 30

albumin

Question 31

what might be given in ascites as prophylaxis for spontaneous bacterial peritonitis

Answer 31

ciprofloxacin

Question 32

anti nucleus anti smooth liver/kidney microsmal antibodie s

Answer 32

autoimmune hepatit s

Question 33

what is common in autoimmune hepatitis

Answer 33

amenorrhoea

Question 34

more what epithelium in barrets

Answer 34

columnar

Question 35

increased risk of what carcinoma in barrets

Answer 35

adeno

Question 36

what is not a rf for barrets

Answer 36

alcohol

Question 37

mx of barrerts

Answer 37

PPI &endoscopy every 3-5 years

Question 38

if barrets causing dysphasia then what is first line

Answer 38

radio frequency ablation

Question 39

strongest rf or barrets

Answer 39

gord

Question 40

bile acid malabsorption is a cause of

Answer 40

chronic diarrhoea

Question 41

test of choice in bile acid malabsorption

Answer 41

SeHCAT

Question 42

bile acid amalsprotion may be treated With

Answer 42

cholesytramine

Question 43

unconjugated bilirubin raised is a result of

Answer 43

haemolysis

Question 44

A mild glucuronyl transferase deficiency results in Gilbert's Syndrome

Answer 44

more severe def in CRIGLER najjar syndrome

Question 45

triad of Budd chairi syndrome

Answer 45

abdo pain ascites tender hepatomegaly

Question 46

ix for Budd chairi

Answer 46

US with doppler flow studies

Question 47

budd chairi syndrom eis

Answer 47

hepatic vein thrombosis

Question 48

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

Answer 48

carcinoid syndrome

Question 49

flushing and diarrhoea can be seen in

Answer 49

carcinoid syndrome

Question 50

ix for carcinoid syndrome

Answer 50

urinary 5-HIAA

Question 51

drugs for carcinoid syndrome

Answer 51

somatostatin analogue eg ocreotide

Question 52

what can be sued for hyperlipidaemia as it reduces LDL cholesterol

Answer 52

Cholestyramine

Question 53

cholestryramine can be sued for ongoing diarrhoea after

Answer 53

bowel resection in crohns

Question 54

other risk factor for c diff

Answer 54

PPI

Question 55

antibiotic class that are leading cause of c. diff

Answer 55

cephalosporins

Question 56

what is characteristic of c diff

Answer 56

raised WCC

Question 57

C. difficile antigen positivity only shows exposure to the bacteria, rather than current infection

Answer 57

First episode of C. difficile infection first-line therapy is oral vancomycin for 10 days second-line therapy: oral fidaxomicin third-line therapy: oral vancomycin +/- IV metronidazole

Question 58

recurrent c diff

Answer 58

fidaxomicin

Question 59

life threatening c diff

Answer 59

oral Vanc and Iv metr

Question 60

dermatitis herpetiformis

Answer 60

blistering itchy rash

Question 61

villas atrophy

Answer 61

coeliac

Question 62

features of coeliac

Answer 62

diarrhoea persistent nausea and vomit tired all the time abdo pain,crampign

Question 63

coeliac effect on fertility

Answer 63

subfertility

Question 64

in coeliac what happens to villous atrophy when on gluten free diet

Answer 64

reverses

Question 65

ix for coeliac -

Answer 65

tissue transglutimate antibodies (bloods) & IgA level

Question 66

if IgA deficiency test for IgG endomyseal antibodies, IgG deamidated gliadin peptide (DGP) or IgG transglutaminase antibodies

Answer 66

need to introduce gluten into diet how long before testing - 6 weeks

Question 67

gold standard for coeliac dx

Answer 67

endoscopic intestinal biopsy

Question 68

villous atrophy crypt hyperplasia increase in intraepithelial lymphocytes lamina propria infiltration with lymphocytes

Answer 68

findings of coeliac

Question 69

gluten foods

Answer 69

bread past, beer, rye oats

Question 70

gluten free bu can drink

Answer 70

whiskey rice potatoes

Question 71

Tissue transglutaminase antibodies may be checked to check--- with a gluten-free diet.

Answer 71

compliance

Question 72

Patients with coeliac disease often have a degree of functional hyposplenism For this reason, all patients with coeliac disease are offered the pneumococcal vaccine Coeliac UK recommends that everyone with coeliac disease is vaccinated against pneumococcal infection and has a booster every 5 years

Question 73

most common form of inherited colon cancer

Answer 73

Lynch syndrome

Question 74

pts with lych syndrome also at risk of

Answer 74

endometrial cancer

Question 75

Lynch syndrome naem is

Answer 75

hereditary non polyposis colorectal carcinoma

Question 76

osteomalacia of skull and mandible

Answer 76

gardner syndrome

Question 77

Amsterdam criteria for

Answer 77

hereditary non polyposis colorectal cancer

Question 78

cosntiaption if under

Answer 78

3 stools weekly

Question 79

first line laxative in consipation

Answer 79

bulk forming eg ispaghula

Question 80

weight loss, diarrhoea

Answer 80

crohns

Question 81

most common extra intestinal manifestation in crohns and UC

Answer 81

arthritis

Question 82

episcelrisi is more common I crohns

Answer 82

uveitis is more common in UC

Question 83

goblet cells and granulomas strictures - kantor string sign rose thorn ulcers fistulae

Answer 83

crohns

Question 84

ix of choice in crohns

Answer 84

colonoscopy

Question 85

second lien to steroids in crohns

Answer 85

5ASA drugs eg mesalazine

Question 86

azathioprine or mercaptopurine* may be used as an add-on medication to induce remission but is not used as monotherapy. Methotrexate is an alternative to azathioprine

Answer 86

crohns

Question 87

what is used in refractory crohns and fistualting crohns

Answer 87

inflixamb

Question 88

what is a priority in crohns dx

Answer 88

stopping smoking

Question 89

what is used first line to maintain remission in crohns

Answer 89

Azathioprine or mercaptopurine

Question 90

what acitivty should be assess before starting azathioprine or mercaptopurine in crohns

Answer 90

TMPT activity

Question 91

ix of choice for perianal fistula in crohns

Answer 91

MRI

Question 92

what is given for perianal fistula incrohns

Answer 92

metronidazole

Question 93

diarrhoea greater than how many water stools per day

Answer 93

3

Question 94

mouth ulcers

Answer 94

crohns

Question 95

diverticulosis is most commonly in

Answer 95

sigmoid colon

Question 96

2 drugs that can cause a cholestatic liver disease

Answer 96

COC and co -amox