Gastroenterology 1

Question 1

Ix achalasia
Diagnostic test (1)
Other tests (2)

Answer 1

Oesophageal manometry
Barium swallow - birds beak appearance
CXR - wide mediastinum, fluid level

Question 2

Birds beak barium swallow =

Answer 2

Achalasia

Question 3

Treatment of achalasia
1st line
If recurrent or persistent
If high risk for surgery (1)
Medical therapy (2)

Answer 3

Pneumatic balloon dilatation

Surgical cardiomyotomy if recurrent or persistent
botox if high risk for surgery
Nitrates/ CCB

Question 4

What is the psoas sign?

Answer 4

Pain on extending hip if retrocaecal appendix (appendicitis)

Question 5

Small volume of fresh blood, often streaking vomit. Malena rare. Often ceases spontaneously. Usually history of antecedent GORD type symptoms.

Answer 5

Oesophagitis

Question 6

Pain after eating and haematemesis =
Pain during eating and haematemesis =

Answer 6

Duodenal
Gastric

Question 7

What is the Glasgow Blatchford score?
Interpretation

Answer 7

Used in determining whether patients can be managed as outpt or inpatient with UGI bleeding
0 = consider early discharge

Question 8

Mx GI bleeds:
Platelet transfusion if less than?
FFP if PT >? or fibrinogen <?
What to give in those taking warfarin and actively bleeding?

Answer 8

ABC
Platelet transfusion if <50
FFP if PT 1.5x > normal
Fibrinogen <1
Prothrombin complex concentrate

Question 9

When should endoscopy be done for GI bleed?

Answer 9

Within 24 hours

Question 10

Mx of non-variceal bleeding
When to give a PPI

Answer 10

If non-variceal upper GI bleeding and stigmata of recent haemorrhage shown at endoscopy

Question 11

Mx of variceal bleeding (4)

Answer 11

Terlipressin
Prophylactic abx
Band ligation
TIPS

Question 12

AUDIT interpretation
Range of scores
Hazardous/ harmful scores
Dependency scores

Answer 12

0-40
7> F > 13
8> M >15
= Hazardous/ harmful alcohol consumption

Question 13

FAST score interpretation
Score range
Hazardous drinking score

Answer 13

0-16
Hazardous drinking =>3

Question 14

CAGE explained

Answer 14

Have you ever felt you should cut down?
Have people been annoying by your drinking?
Have you ever felt guilty?
Eye opener

Question 15

Recommendation drinking

Answer 15

14 units spread thinly over 3 days or more

Question 16

How to calculate units

Answer 16

Mls X ABV / 1000

Question 17

Mx ETOH hepatitis
Acute (1)

Answer 17

Prednisolone - acute episodes

Question 18

Bloods strongly suggestive of acute alcoholic hepatitis
(2)

Answer 18

AST:ALT ratio >3
GGT raised

Question 19

5-ASA example

Answer 19

Sulphasalazine

Question 20

Name five side effects of sulphasalazine

Answer 20

Lung fibrosis
Heinz body anaemia/ megaloblastic
Oligospermia
Rashes
Headaches

Question 21

Mesalazine side effects (5)

Answer 21

GI upset
Headache
Agranulocytosis
Pancreatitis
Interstitial nephritis

Question 22

Autoimmune hepatitis is seen in which population?

Answer 22

Young females

Question 23

Autoimmune hepatitis types
I, II, III
Antibodies and age affected

Answer 23

I - ANA/ SMA adults and children

II - LKM1 antibodies affects children only

III - soluble liver kidney antigen adults middle age

Question 24

Common presentation for auto-immune hepatitis?
Mx (3)

Answer 24

Amenorrhoea
Mx steroids, AZT, liver transplant

Question 25

Inflammation extending beyond limiting plate Piecemeal necrosis Bridging necrosis

Answer 25

Autoimmune hepatitis biopsy

Question 26

Barrett's Cell change Classification

Answer 26

Squamous to columnar Short <3cm and long >3cm

Question 27

RF Barretts (4)

Answer 27

Central obesity GORD Male Smoker

Question 28

Mx Barrett's (2) Mx if dysplasia of any grade (2)

Answer 28

Endoscopy surveillance every 3-5 years High dose PPI Mucosal resection/ ablation

Question 29

Bile acid malabsorption can cause a deficiency in what vitamins? What other symptom?

Answer 29

KADE Steatorrhoea

Question 30

Investigation of choice for bile acid malabsorption Mx Name three causes of bile acid malabsorption

Answer 30

SeHCAT Mx cholestyramine Coeliac's, cholecystectomy, small intestine bacterial overgrowth

Question 31

What is Budd Chiari? Triad symptoms

Answer 31

Hepatic vein thrombosis AP, sudden onset, severe Ascites Tender hepatomegaly

Question 32

Causes of Budd Chiari (4)

Answer 32

Polycythaemia rubra vera Thrombophillia Pregnancy COCP

Question 33

Budd Chiari Ix

Answer 33

US with dopplers

Question 33

Budd Chiari Ix

Answer 33

US with dopplers

Question 34

Carcinoid tumours What is it? Symptoms (6)

Answer 34

Tumour of neuroendocrine cells usually from bowel or lung 1. SOB/ bronchospasm 2. Diarrhoea 3. Flushing 4. Hypotension 5. Pellagra 6. Right heart valvular stenosis

Question 35

Carcinoid tumour Ix (2) Mx (1) Metastases to?

Answer 35

Urinary 5-HIAA Plasma chromogranin Mx Somatostatin analogues (octreotide) Liver

Question 36

Cholestyramine is used in the management of which two conditions?

Answer 36

Bile acid malabsorption Hyperlipidaemia - reduced LDL

Question 37

Mx c. diff First line Second line Third line

Answer 37

Vancomycin 10/7 PO fidaxomicin PO vanc +/- IV metro

Question 38

Recurrent c. diff Mx <12 weeks of symptoms resolution >12 weeks

Answer 38

PO fidaxomicin PO vanc or fidax

Question 39

Classification of c. diff (4)

Answer 39

Mild normal WCC Mod <15 WCC 3-5 loose stools Severe >15 WCC/ increased creatinine/ T>38.5/ severe colitis Life threatening hypotension/ toxic megacolon

Question 40

Conditions associated with Coeliac's (3)

Answer 40

Dermatitis herpetiformis (vesicular, pruritic skin eruption) T1DM Autoimmune hepatitis

Question 41

Coeliac's complications (6)

Answer 41

Iron/folate/B12 deficiency (folate more common than B12) Hyposplenism Osteoporosis Lactose intolerance T cell lymphoma Subfertility

Question 42

Ix Coeliac (3)

Answer 42

Re-introduce gluten for 6 weeks TTG antibodies IgA (endomyseal) antibodies

Question 43

Gold standard diagnosis for Coeliac's

Answer 43

Endoscopic intestinal biopsy

Question 43

Gold standard diagnosis for Coeliac's

Answer 43

Endoscopic intestinal biopsy

Question 44

Coeliacs are offered which vaccine?

Answer 44

Pneumococcal - booster every 5 years