gastro

Question 1

A 35-year-old woman with Crohn’s disease started azathioprine therapy.
After one week, she developed pancytopenia.
Which of the following is the most likely underlying mechanism?

Answer 1

Thiopurine methyltransferase deficiency
Thiopurine methyltransferase (TPMT) deficiency leads to accumulation of toxic metabolites of azathioprine, increasing the risk of bone marrow suppression.

Question 2

H pylori therapy

Answer 2

amoxicillin, clarithromycin and a PPI twice daily for seven days - so-called triple therapy.

metronidazole in penicillin allergic

Question 3

previous surgery to the terminal ileum can lead to

Answer 3

bile acid malabsorption

Question 4

type of anaemia in celiac vs crohns

Answer 4

celiac - microcytic

Patients with vitamin B12 deficiency have megaloblastic anaemia, which is a macrocytic, in crohns (duodenum)

Question 5

weird crohns symptom

Answer 5

Peripheral neuropathy
The patient likely has Crohn’s disease, which frequently affects the terminal ileum, the site of vitamin B12 absorption. A deficiency in B12 leads to various neurological conditions such as subacute combined degeneration of the spinal cord and peripheral neuropathy.

Question 6

medication induced constipaiotn common cause

Answer 6

Amlodipine, a calcium channel blocker used for hypertension, is known to decrease intestinal motility, leading to constipation, and ibuprofen can exacerbate this through effects on the gastrointestinal tract.

Question 7

Diarrhoea
Dementia
Dermatitis
Death (if untreated)

alcoholic

diagnosis?

Answer 7

Vitamin B3 (niacin) deficiency causes pellagra, a condition which classically presents with the 4 Ds:
Diarrhoea
Dementia
Dermatitis
Death (if untreated)
The hyperpigmented band around the neck seen in this patient is known as “Casal’s necklace”. Chronic alcohol excess and malnutrition significantly increase the risk of niacin deficiency, making this the correct answer.

Question 8

dermatitis herpetiformis treatment

Answer 8

Dapsone

Question 9

UC inflammation

Answer 9

colon and rectum

Question 10

mild UC mx

Answer 10

Mesalazine suppository

Question 11

crypt abscesses?

Answer 11

UC

Question 12

what is often used in perianal Crohn’s disease

Answer 12

Metronidazole is often used in perianal Crohn’s disease

Question 13

epigastric pain improved on eating?

Answer 13

duodenal ulcer, Duodenal improves after Dinner - most likely H pylori !

Question 14

C diff risk increased by

Answer 14

PPI

Question 15

A 56-year-old female presents with recurrent indigestion, nausea and weight loss over the past few months. She has no history of dyspepsia or peptic ulcer disease in the past. She is not currently taking any medications.
What is the most appropriate initial diagnostic test?

Answer 15

Upper GI endoscopy
Patients over the age of 55 with weight loss in addition to reflux, dyspepsia or abdominal pain require an urgent referral for an endoscopy (2-week wait). This allows direct visualisation and biopsy of the upper gastrointestinal tract, which can provide a definitive diagnosis.

Question 16

Infliximab

Answer 16

induced crohns remission

Question 17

first line to maintain remission in crohns after steroids

Answer 17

Azathioprine

Question 18

oesophageal webs, dysphagia and iron deficiency anaemia

dx?

Answer 18

Plummer-Vinson syndrome
The history and examination findings are suggestive of iron deficiency anaemia, which, together with the dysphagia, are suggestive of this rare syndrome that is characterised by oesophageal webs, dysphagia and iron deficiency anaemia

Question 19

food poisoning from chicken abx treatment

Answer 19

This patient has developed gastroenteritis, and infection due to Campylobacter jejuni is one of the commonest causes after exposure to poultry. This should normally be managed with supportive treatment, but more severe symptoms should be treated with a macrolide antibiotic such as Clarithromycin

Question 20

IBS treatment

Answer 20

Mebeverine is an antispasmodic

Question 21

Ank spond and IBD flare mx

Answer 21

The symptom of bloody diarrhoea and past medical history of ankylosing spondylitis make ulcerative colitis (UC) more likely than Crohn’s disease in this scenario

rectal mesalazine

Question 22

A 19 year old man with oedema and feeling generally unwell. On examination he is pale, thin and has evidence of angular stomatitis and oral ulcers. It is noted that his albumin is 15 g/L (normal range 35-50 g/L).
Which of the following is the most likely cause?

Answer 22

crohns malabsoprtion

Question 23

oral thrush tx

Answer 23

oral fluconazole

Question 24

Ix for perianal abscess causing sepsis

Answer 24

This patient has sepsis secondary to a perianal abscess, which is likely due to underlying Crohn’s disease. The priority is to delineate the extent of the abscess and potential fistula by an urgent MRI pelvis before draining it via EUA

urgent MRI pelvis

Question 25

In ulcerative colitis, a severe exacerbation is characterised by

Answer 25

the presence of six or more bloody stools per day and anaemia (haemoglobin <10 g/dL).

Question 26

anterior uveitis tx

Answer 26

cyclopentolate

Question 27

fatigue, easy bruising, and gingival swelling, - what is deficient

Answer 27

Vitamin C deficiency can lead to symptoms like fatigue, easy bruising, and gingival swelling, necessitating prompt vitamin C replacement therapy.

Question 28

rockall score

Answer 28

Question 29

"rice-water" stool suggest dx and mx

Answer 29

orał doxycycline The travel history and the pathognomonic "rice-water" stool suggest a diagnosis of cholera in this case, which is caused by Vibrio cholerae.

Question 30

first line for gastroparesis

Answer 30

Domperidone is a peripherally selective dopamine D2 antagonist and is used as the first line treatment in gastroparesis to promote gastric emptying with a prokinetic effect. It should be avoided in patients at risk of a prolonged QT interval. Diabetic patients are at increased risk of developing gastroparesis secondary to autonomic neuropathy.

Question 31

cyclising moa

Answer 31

Histamine H1 receptor antagonist

Question 32

painful shin ulcers in IBD

Answer 32

pyoderma gangrenosum

Question 33

what type of beta blocker for varices

Answer 33

non selective

Question 34

PSC associated with

Answer 34

UC

Question 35

Blood film shows Howell-Jolly bodies and target cells, young man

Answer 35

In a young man with a protracted history, the most likely cause of malabsorption and hyposplenism is coeliac disease.