Gastro Flashcards
(83 cards)
1
Q
Name 2 or more drugs/ drug classes which are risk factors for getting peptic ulcers.
A
- NSAIDs
- Steroids
- Bisphosphonates
- SSRIs
2
Q
Zollinger Ellison syndrome is a condition characterised by excess levels of _____ being secreted from a tumour.
Histamine
Stomach acid
Gastrin
A
Gastrin
3
Q
Name 3 or more conditions which can cause dyspepsia (Indigestion).
A
- Peptic ulcers (duodenal or gastric)
- Gastritis/ Duodenitis
- H. pylori infection
- Malignancy
- GORD
4
Q
Bloody diarrhoea is more common in which type of IBD?
A
Ulcerative Collitis
5
Q
Do rotavirus, norovirus, Giardia and Cholera usually cause bloody or non-bloody diarrhoea?
A
Non bloody diarrhoea (enteritis)
6
Q
What antibiotic is first line for treating C. difficile infection?
A
Metronidazole 10-14 days
7
Q
What antibiotic is second line for treating C. difficile infection?
Metronidazole
Amoxicillin
Vancomycin
A
Vancomycin
8
Q
What antibiotic is used for treating recurrent C. difficile infection?
Amoxicillin
Fidaxomycin
Penicillin
A
Fidaxomycin
9
Q
What class of laxative are Senna, Castor oil and Sodium Picosulfate?
A
Stimulants
10
Q
Lactulose, Magnesium salts and Movicol are all in which class of laxatives?
Stimulant
Bulk forming
Osmotic
A
Osmotic
11
Q
Docusate sodium is from which class of laxatives?
Stool softener
Bulk forming
Osmotic
A
Stool softener
12
Q
Name 4 or more causes of PRE-hepatic jaundice.
A
- Drugs- Paracetamol, Rifampicin
- Hereditary Haemolysis eg. G6PD deficiency, Sickle Cell, Thalassaemia
- Acquired Haemolysis eg. Malaria, Autoimmune haemolysis
- Impaired conjugation- Gilbert’s disease
13
Q
Name 4 or more causes of HEPATIC jaundice.
A
- Drugs- Alcohol, paracetamol, Rifampicin, Isoniazid, Pyrazinamide, Sodium Valproate, MAOIs
- Hepatitis-B, C, Autoimmune
- Cirrhosis
- Malignancy- hepatocellular carcinoma
- Haemochromatosis
- Wilson’s disease
- Alpha 1 antitrypsin deficiency
- Right sided HF
- Viruses- CMV, EBV
14
Q
Penicillamine is used primarily for the treatment of which disease?
Haemochromatosis
Wilson’s disease
Gilbert’s syndrome
A
Wilson’s disease
15
Q
Primary sclerosing cholangitis is more commonly associated with which type of IBD?
A
Ulcerative collitis
16
Q
Which of these drugs is NOT used to treat Ulcerative Colitis?
Mesalazine
Prednisolone
Azathioprine
Methotrexate
A
Methotrexate
17
Q
What are the 3 most common causes of malabsorption in the UK? (3 C’s)
A
Crohn’s
Coealiac
Chronic Pancreatitis
18
Q
Oral Dapsone is used to treat which complication/ association of Coeliac disease?
A
Dermatitis Herpetiformis
19
Q
What are the ABC symptoms for suspecting Irritable Bowel Syndrome?
A
A- Abdo discomfort/ pain
B- Bloating
C- Change in bowel habit
Need to be for >6 months
20
Q
Is a colonoscopy needed to diagnose IBS?
A
No- unless red flags are present
21
Q
Which blood tests should be done when diagnosing IBS to rule out other differentials?
A
FBC
CRP
ESR
Anti TTG
22
Q
Name 4 or more causes of diarrhoea.
A
- Gastroenteritis
- Irritable bowel syndrome
- IBD: Crohn’s, UC
- Coeliac disease
- Drugs- laxatics, antibiotics, cytotoxics, propanolol
- Colorectal cancer
- Clostridium difficile
23
Q
Which area of the bowel is most likely to be affected by ishaemic collitis?
Rectum
Descending colon
Splenic flexure
A
Splenic flexure
24
Q
What medication should be given first for a severe flare up of UC?
Mesalazine
Mercaptopurine
IV Hydrocortisone
A
IV Hydrocortisone
25
Name 4 or more causes of upper GI bleeding.
1. Peptic ulcers (duoedenal or gastric)
2. Mallory Weiss tears
3. Gastro-oesophageal varices
4. Malignancy
5. Oesophagitis
6. Drugs- NSAIDs, Aspirin, Steroids, Anticoagulatio n
26
The Rockall score is used to assess the risk of rebleed and death following an acute upper GI bleed. What factors are considered in the scoring?
1. Age
2. Shock- Systolic BP, Pulse
3. Comorbidities
4. Endoscopic diagnosis for cause of tear
5. Signs of recent haemorrhage on endoscopy
27
If a patient aged 61yrs presents with weight loss and new onset diabetes, which cancer should be suspected and hence an urgent referral done?
Pancreatic cancer
28
Which imaging technique is gold standard for investigating suspected gall bladder cancers via the 2 week wait referral?
AXR
CT
USS
USS
29
Which imaging technique is gold standard for investigating suspected pancreatic cancers via the 2 week wait referral?
CT scan
30
For which of these chemotherapy drugs must a patient with bowel cancer be tested for the RAS wild type gene before they are given it?
Folfox
Folfiri
Capox
Cetuximab
Cetuximab
31
Where do T3 bowel cancers reach?
Muscularis propria
Serosa
Submucosa
Serosa
32
Capectiabine can be given for colorectal cancer and is which type of chemotherapy?
Alkylating agent
Antimetabolite
Topoisomerase inhibitor
Antimetabolite
33
Deficiency of which Vitamin can lead to macrocytic anaemia AND neuropathy?
```
Vitamin B1 (Thiamine)
Vitamin B6 (Pyridoxine)
Vitamin B12
```
Vitamin B12
34
Deficiency of which Vitamin can lead to peripheral neuropathy?
```
Vitamin B1 (Thiamine)
Vitamin B6 (Pyridoxine)
Vitamin A
```
Vitamin B6 (Pyridoxine)
35
Deficiency of which Vitamin can lead to Wenicke's encephalopathy, Korsakoff's syndrome or Beriberi?
```
Vitamin B1 (Thiamine)
Vitamin B6 (Pyridoxine)
Vitamin B12
```
Vitamin B1 (Thiamine)
36
If a patient presents with right upper quadrant abdominal pain, yellow sclera and a temperature of 38.2, which of the following conditions are they most likely to have?
Biliary colic
Acute cholecystitis
Cholangitis
Cholangitis
37
A patient presents with a history of colicky abdominal pain followed by abdominal distension and they are now unable to pass stools. AXR shows a small bowel fluid level, pneumobilia and a radiolucent gallstone. What is the most likely diagnosis?
Acute cholecystitis
Mirizzi syndrome
Acute pancreatitis
Gallstone ileus
Gallstone ileus
38
What does the mnemonic PANCREAS stand for in the modified glasgow score?
```
P- PaO2
A- Age
N- Neutrophil count
C- Calcium
R- Renal function (urea)
E- Enzymes (LDH/AST)
A- Albumin
S- Sugar (glucose)
```
39
Name 5 or more complications of acute pancreatitis.
1. Sepsis
2. ARDS
3. Pleural effusion
4. Peripancreatic fluid collection
5. Abscess
6. Pancreatic necrosis
7. Pseudocyst
8. Haemorrhage
9. DIC
10. Renal failure
11. Chronic pancreatitis
40
Which autoimmune liver disorder often presents asymptotically or with chronic fatigue, and is associated with raised IgM antibodies?
Primary Biliary Cholangitis
41
Which autoimmune liver disorder is associated with Ulcerative Colitis and may present with multiple biliary strictures on ERCP/ MRCP?
Primary Sclerosing Cholangitis
42
Which autoimmune disorder predominantly affects young women and is associated with amenorrhoea?
Autoimmune hepatitis
43
Do HIGH urea levels indicate an upper or lower GI bleed?
Upper GI bleed
44
If a patient is in a coma, what Grade encephalopathy is this?
Grade 2
Grade 3
Grade 4
Grade 4
45
If a patient is droswy, with slurred speech and behaving inappropriately, what grade of encephalopathy are they likely to have?
Grade 1
Grade 2
Grade 4
Grade 2
46
Which of these drugs are used to treat hepatic encephalopathy in acute liver failure?
1. Lactulose and Rifaximin
2. Tazocin and Fluconazole
3. Thiamine and Benzodiazepines
1. Lactulose and Rifaximin
(Tazocin and Fluconazole are used as antibiotic prophylaxis in Acute Liver Failure; Thiamine and Benzodiazepines are used to treat Wernicke's encephalopathy)
47
Name 3 or more causes of acute liver failure.
1. Alcohol
2. Drugs- Paracetamol overdose, Isoniazid
3. Ischaemic hepatitis
4. Infections: Viral hepatitis (A, B), CMV, EBV
5. Acute fatty liver of pregnancy
6. Wilson's disease
7. Budd Chiari syndrome
8. Seronegative hepatitis
9. Autoimmune hepatitis
48
What is the risk of transmitting Hepatitis B via needlestick injury?
0.3%
2%
20-30%
20-30%
49
What is the risk of transmitting HIV via needlestick injury?
0.3%
2%
20-30%
0.3%
50
What is the risk of transmitting Hepatitis C via needlestick injury?
0.3%
2%
20-30%
2%
51
In NAFLD, which is usually greater; ALT or AST?
ALT
52
Which imaging technique can be used to diagnose NAFLD?
USS
53
What is the ELF blood test used for?
Testing for enhanced/ advanced liver fibrosis in people who have been diagnosed with NAFLD.
Is a blood test with 3 serum markers.
54
What is the main treatment for NAFLD?
Lifestyle modification
55
What is the Child Pugh classification used for?
Assessing prognosis of patients with chronic liver disease (cirrhosis).
56
Which of these factors is NOT considered in the Child Pugh score for cirrhosis prognosis?
```
Total bilirubin
Albumin
AST
INR
Ascites
Encephalopathy
```
AST
57
Which technique is recommended at 1st line by NICE for diagnosing liver cirrhosis?
CT scan
Fibroscan (transient elastrography)
Liver biopsy
Fibroscan (transient elastrography)
58
Budd Chiari syndrome is a cause of acute or chronic liver disease, and is caused by occlusion of what?
The hepatic veins
59
Which of these drugs is NOT associated with causing hepatic cirrhosis?
Methotrexate
Azathioprine
Amiodarone
Methyldopa
Azathioprine
60
Name 2 or more causes of ascites with a SAAG of >11g/l.
1. Portal hypertension
2. Cirrhosis
3. Alcoholic hepatitis
4. Portal vein thrombosis
5. Budd Chiari syndrome
6. Fatty liver of pregnancy
7. Large liver mets
8. Cardiac ascites: RHF or constrictive pericarditis
9. Fulminant hepatic failure
61
Name 2 or more causes of ascites with a SAAG of <11g/l.
1. Malignancy eg. Peritoneal caricinomatosis
2. Infection eg. Peritoneal TB
3. Pancreatitis
4. Nephrotic syndrome
5. Bowel obstruction
6. Biliary ascites
7. Connective tissue disease
62
If a patient with cirrhosis and ascites has an ascitic neutrophil count of >250cells/ul what does this suggest?
Spontaneous bacterial peritonitis
63
Chronic liver disease is hepatic injury for > __ months.
6 monhts.
64
Name 1 cause of portal hypertension other than cirrhosis.
1. Pre-hepatic causes: Portal Vein Thrombi
2. Hepatic: Sarcoidosis, Schistosomiasis
3. Post hepatic: Right heart failure, Budd Chiari Syndrome
65
Hyper acute onset of liver failure is onset in __ or less days.
7 days or less
66
According to NICE, how frequently should patients with cirrhosis be screened for Hepatocellular carcinoma (HCC)?
Every 6 months- with USS and AFP bloods
67
Which enzyme is more specific to the liver, ALT or AST?
ALT
68
1 unit of alcohol = ___ml of pure ethanol
10ml
69
1 unit of alcohol = ___g of pure ethanol
8g
70
NAFLD and viral hepatitis cause which rise in LFTs?
ALT>AST
AST>ALT
ALT> AST
71
Cirrhosis, alcoholic hepatitis and liver metastases cause which rise in LFTs?
ALT>AST
AST>ALT
AST> ALT
72
Which 5 factors are used to calculate the Child Pugh Score for disease severity in cirrhosis?
```
Bilirubin
Albumin
INR/PT
Ascites
Encephalopathy
```
73
Which diuretic is used 1st line for managing ascites?
Furosemide
Spironalactone
Acetazolamide
Spironalactone
74
Which 3 drugs can be used for pharmacological management of alcohol abstinence?
1. Acamprosate, Naltrexone and Disulfiram
2. Naltrexone, Disulfiram and Lorazepam
3. 2. Naltrexone, Disulfiram and SSRIs
Acamprosate, Naltrexone and Disulfiram
Acamprosate- GABA analog, reduces cravings
Naltrexone- Partial opiod agonist
Disulfiram- Inhibits aldehyde dehydrogenase so unpleasant taste if drinking alcohol
75
Suggest 1 or more drugs which affect the lower oesophagael sphincter/ oesophageal motility and can lead to GORD.
1. Nitrates eg. GTN
2. TCAs- Tricyclic antidepressants
3. Anticholinergics
76
Which type of hiatus hernia is most common?
Sliding hiatus hernia
Rolling hiatus hernis
Sliding hiatus hernia (80%)
Gastro-oesophageal sphincter moves above the diaphragm- LOS becomes less competent so can lead to GORD
77
Whipple's procedure is used in the management of which cancer?
Oesophageal
Gastric
Pancreatic
Pancreatic
In particular head of pancreas tumours, cholangiocarcinomas or duodenal cancers.
78
Which cancer does Primary Sclerosing Cholangitis increase the risk of?
Gastric adenocarcinoma
Hepatocellular carcinoma
Cholangiocarcinoma
Cholangiocarcinoma
79
What is the first line treatment for Haemochromatosis?
Iron chelation
Penicillamine
Regular venesection
Regular venesection
80
5-ASA (Mesalazine) used for Ulcerative Collitis increased the risk of what?
Hepatitis
Pancreatitis
Seizure
Pancreatitis
81
What are the 2 main causes of small bowel obstruction?
1. Adhesions
| 2. Hernias
82
Name 2 or more causes of large bowel obstruction.
1. Colorectal malignancy
2. Diverticular disease
3. Volvulus
4. Constipation
83
Which of these drugs cause a cholestatic picture?
```
Combined oral contraceptive pill
Steroids
Co-Amoxiclav
Sodium valproate
Chlorpromazine
MAOIs
```
Combined oral contraceptive pill
Steroids
Co-Amoxiclav
Chlorpromazine
