Gastro Management

Question 1

A patient with acute upper GI bleeding , whats your first step in management as a doctor ?

Answer 1

Gain IV Access

Question 2

A patient with a high risk of ulcer after endoscopy , what will you do ?

Answer 2

Intravenous ppi infusion

Question 3

What is the first line step in Diverticular disease ?

Answer 3

Endoscopic clipping ( Either alone or after the injection of dilute adrenaline ( Epinephrine )

Question 4

What is the treatment of choice in Angiodysplasia?

Answer 4

Endoscopic thermal ablation

Question 5

What is the next step in management in Angiodysplasia if it bleeds even after endoscopic thermal ablation?

Answer 5

Resection of the affected segment of bowel

Question 6

Fluid of choice in case of upper GI bleeding in hameodynamically unstable patients ?

Answer 6

IV crystalloid fluid should be given to raise the blood pressure ,with a 500 ml bolus is recommended over less than 15 minutes.

Question 7

What is the scoring system to assess Acute upper GI bleeding ?

Answer 7

Modified blatchford score

Question 8

What clue you may found in CBC report that indicates hypersplenism in CLD ?

Answer 8

Thrombocytopenia

Question 9

How ppi works in upper GI bleeding ?

Answer 9

1. Reduce gastric acid secretion
2. Neutralise intragastric pH
3. Promoting clot stability by reducing pepsin induced clot lysis & increasing platelet aggregation

Question 10

How will you confirm successful eradication of H.pylori following treatment ?

Answer 10

Urea breath test or faecal antigen test

Question 11

A patient with profuse red or maroon diarrhoea & Hypovolaemic shock . CT angiography is done & bleeding point is identified . What is your next step?

Answer 11

Catheter angiography with embolisation .

Question 12

A patient with profuse red or maroon diarrhoea & Hypovolaemic shock . CT angiography is done & source of bleeding is not identified . What is your next step?

Answer 12

Colonoscopy

Question 13

Most common site of Angiodysplasia in older people ?

Answer 13

Caecum

Question 14

What is the investigation algorithm in case of GI bleeding ?

Answer 14

Endoscopy , Colonoscopy , CT angiography > Wireless capsule endoscopy > Enteroscopy > Laparotomy with on table endoscopy

Question 15

Rx option for Aphthous ulcer ?

Answer 15

Topical glucocorticoid ( such as 0.1% triamcinolone in orabase ) or choline Salicylate (8.7%) gel .

Question 16

Rx option for oral thrush ?

Answer 16

Topical miconazole or nystatin . Resistant case requires oral fluconazole

Question 17

A patient came with painful parotid swelling with abscess . How will you manage?

Answer 17

Surgical drainage + Broad spectrum antibiotics

Question 18

First line drug in case of GERD ?

Answer 18

Antacids / Alginates

Question 19

Treatment option for high grade dysplasia or intramucosal carcinoma of esophagus ?

Answer 19

Oesophagectomy or endoscopic therapy, with a combination of endoscopic resection of any visibly abnormal areas and radiofrequency ablation (RFA) of the remaining barret’s mucosa ,as an organ preserving alternative to surgery .

Question 20

Treatment of choice for esophageal carcinoma ?

Answer 20

Oesophagectomy

Question 21

Mainstay of treatment of esophageal perforation ?

Answer 21

Surgery

Question 22

Treatment of pharyngeal pouch?

Answer 22

Cricopharyngeus myotomy (Diverticulotomy) with or without resection of the pouch.

Question 23

Treatment of Achalasia ?

Answer 23

Surgical myotomy ( Heller’s operation ) accompanied by partial fundoplication anti reflux procedure .

Question 24

Advanced endoscopic technique for the mx of Achalasia ?

Answer 24

POEM (Peroral endoscopic myotomy)

Question 25

Treatment of Menetrier's disease ?

Answer 25

Antisecretory drugs ,such as PPI with or without or octreotide may reduce protein loss , H. pylori eradication may be effective but unresponsive patients need partial gastrectomy .

Question 26

Mx option for Z-E syndrome ?

Answer 26

Unifocal tumour : Resection Multifocal tumor / Metastasis : Continuous therapy with PPI in high dose / Somatostatin analogue

Question 27

Gold standard treatment for Gastric carcinoma ?

Answer 27

Surgery is the gold standard and total gastrectomy with lymphadenectomy is the operation of choice.

Question 28

Treatment of Gastroparesis ?

Answer 28

Small ,frequent, low fat meals and the use of metoclopramide and domperidone. In severe case , long term jejunostomy feeding or TPN is required .

Question 29

Aim of mx of Coeliac disease ?

Answer 29

Aims are to correct existing deficiency of micronutrients, such as iron, folate, calcium/vitamin D and to achieve mucosal healing through life long gluten free diet.

Question 30

Most common cause of treatment failure in Coeliac disease ?

Answer 30

Accidental or Unrecognized gluten ingestion

Question 31

Treatment of Dermatitis herpetiformis?

Answer 31

Rash usually responds to gluten free diet , but some patients require additional treatment with dapsone .

Question 32

Treatment of choice for Tropical sprue?

Answer 32

Tetracycline 250mg 4 times for 28 days.

Question 33

First line treatment for Small intestinal bacterial overgrowth ?

Answer 33

A course of broad spectrum antibiotic for 2 weeks . Example : Rifampicin ( which is not absorbed from the gut after oral administration ), as well as systemic antibiotics such as ciprofloxacin, Metronidazole and Amoxicillin .

Question 34

Initial treatment of Whipple's disease ?

Answer 34

Intravenous ceftriaxone (2 gm daily for 2 weeks ) followed by co-trimoxazole for at least 1 year.

Question 35

Treatment of Bile acid diarrhoea ?

Answer 35

Bile acid sequestrant , such as Cholestyramine or colesevelam , which binds bile salt in intestinal lumen .

Question 36

Treatment of Radiation enteropathy ?

Answer 36

Sucralfate enema and hyperbaric oxygen. Diarrhoea in acute phase is treated with codeine phosphate, diphenoxylate or loperamide. Antibiotic for bacterial overgrowth .

Question 37

Treatment of intestinal lymphangiectasia?

Answer 37

Low fat diet with medium chain triglyceride supplement .

Question 38

Intitial strategy in mx of Eosinophilic gastroenteritis ?

Answer 38

Dietary manipulation

Question 39

Cornerstone of treatment for Colorectal cancer ?

Answer 39

Surgery

Question 40

Treatment of Hirschsprung disease ?

Answer 40

Resection of the affected segment

Question 41

Treatment of anal fissure ?

Answer 41

1. Bulk forming laxative and increased fluid intake 2. Nitric oxide and 0.2% glyceryl trinitrate to relax the internal sphincter 3. In resistant case : Botulinum toxin injection 4. If all above measures fail , then lateral internal anal sphincterotomy or advancement anoplasty.

Question 42

Initial treatment of active ulcerative colitis ?

Answer 42

Topical or oral 5-aminosalicylic acis ( 5-ASA) therapy

Question 43

Mainstay of treatment of Active crohn's disease ?

Answer 43

Glucocorticoid

Question 44

Drug of first choice in patients with ileal disease ?

Answer 44

Budesonide

Question 45

Maintenance therapy in crohn's disease ?

Answer 45

Immunosuppression treatment with thiopurine (Azathioprine and mercaptopurine )

Question 46

Drug that must be stopped 6 months before conception in IBD?

Answer 46

Methotrexate

Question 47

Drugs that are,safe in pregnancy in a patient with IBD ?

Answer 47

Aminosalicylate and Azathioprine

Question 48

Most important step in mx of IBS ?

Answer 48

To make a positive diagnosis as well as educating and reassuring the patient.

Question 49

Treatment of Autoimmune pancreatitis ?

Answer 49

Glucocorticoid

Question 50

Only method of effective cure in case of Adenocarcinoma of pancreas?

Answer 50

Surgical resection