Gastroenterology

Question 1

What serology is present in acute Hep B infection?

Answer 1

HbsAg (hep B surface antigen)

Question 2

What does anti HBs?

Answer 2

Implies immunity to hep B either by infection or vaccination - it is negative in chronic disease

Question 3

What does anti-HBc imply

Answer 3

previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists

Question 4

what does amylase do

Answer 4

breaks down starch to sugars

Question 5

what does maltase do

Answer 5

cleaves disaccharide maltose to glucose + glucose

Question 6

what does sucrase do

Answer 6

cleaves sucrose to fructose and glucose

Question 7

what does lactase do

Answer 7

cleaves disaccharide lactose to glucose + galactose

Question 8

what is the inheritance of haemochromatosis

Answer 8

autosomal recessive

Question 9

what antibiotics is most strongly associate with c diff

Answer 9

cephalosporins

Question 10

what is the second line treatment of hepatic encephalopathy

Answer 10

rifaximin

Question 11

what drug can help prevent recurrent c.diff

Answer 11

Bezlotoxumab

Question 12

what drugs can cause a hepatocellular picture

Answer 12

paracetamol
sodium valproate, phenytoin
MAOIs
halothane
anti-tuberculosis: isoniazid, rifampicin, pyrazinamide
statins
alcohol
amiodarone
methyldopa
nitrofurantoin

Question 13

what drugs cause a cholestatic picture

Answer 13

combined oral contraceptive pill
antibiotics: flucloxacillin, co-amoxiclav, erythromycin*
anabolic steroids, testosterones
phenothiazines: chlorpromazine, prochlorperazine
sulphonylureas
fibrates
rare reported causes: nifedipine

Question 14

name medications that cause cirrhosis

Answer 14

methotrexate
methyldopa
amiodarone

Question 15

what HLA is associated with coeliac disease

Answer 15

HLA DQ2

Question 16

what supplementation will likely be required following gastric bypass surgery

Answer 16

iron - as most surpass the duodenum where iron is absordbed

Question 17

when is prophylaxis for SBP given

Answer 17

if ascited with protein level less than 15

choice is cipro

Question 18

what is a rare complication of pancreatitis causing cotton wool spots on fundoscopy

Answer 18

ischaemic (Purtscher) retinopathy

Question 19

what causes carcinoid synrome

Answer 19

release of serotinin

usually once carcinoid tumours have metastasised to liver

Question 20

how can u treat carcinoid syndrome

Answer 20

ocreatide

Question 21

what is used to treat SBBOS

Answer 21

rifaximin is now the treatment of choice due to relatively low resistance. Co-amoxiclav or metronidazole are also effective in the majority of patients.

Question 22

what is whipple’s disease

Answer 22

rare multi-system disorder caused by Tropheryma whippelii infection. It is more common in those who are HLA-B27 positive and in middle-aged men.

Question 23

jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules is diagnostic of

Answer 23

whipples disease

Question 24

how is whipples disease treated

Answer 24

co-trimox

Question 25

how does teripressen work

Answer 25

causes contriction of the splanchnic vessels

Question 26

older person, diarrhea, lots of mucus, hypokalaemia

Answer 26

villous adenoma

Question 27

where is most likely affected in ischaemic colitis

Answer 27

splenic flexure

Question 28

what rheumatological disease is most commonly associated with primary bilary cirrhosis

Answer 28

sjrogens

Question 29

what is the triad of budd chairi

Answer 29

abdo pain ascites hepatomegaly

Question 30

give causes of budd chiari

Answer 30

polycythaemia rubra vera thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies pregnancy oral contraceptive pil

Question 31

describe the difference between type 1 and type 2 hepatorenal syndrome

Answer 31

type 1 -fast onset | type 2 - slower onset (slightly better prognosis)

Question 32

what scoring system can be uses to estimate the likelihood of someone having appendictis

Answer 32

alvarado

Question 33

what primary prevention is given for oesophageal varices

Answer 33

propranolol: reduced rebleeding and mortality compared to placebo endoscopic variceal band ligation (EVL)

Question 34

what is the risk of endosopic variceal band ligation

Answer 34

ulcers - PPI given to prevent

Question 35

what is dubin johnson syndrome

Answer 35

benign autosomal recessive disorder resulting in hyperbilirubinaemia (conjugated, therefore present in urine). It is due to a defect in the canillicular multispecific organic anion transporter (cMOAT) protein. This causes defective hepatic bilirubin excretion

Question 36

what heart problem is angiodysplasia assoiciate with

Answer 36

aortic stenosis

Question 37

what are the chances of having bowel cancer from a positive FOB test

Answer 37

5-15 percent | about 40 percent chance of having an adenoma

Question 38

what gene mutations are most common in HNPCC

Answer 38

MSH2 (60 percent) MLH1 they are DNA mismatch repair genes

Question 39

what other cancer is most commonly associated with HNPCC

Answer 39

endometrial cancer

Question 40

how is vertical tranmission of hep B in pregncnay prevented

Answer 40

give newborn hep B vaccine AND immunoglobulin

Question 41

what is the mode of inheritance of peutz jehgers

Answer 41

autosomal dominant

Question 42

what blood group is associated with gastric cancer

Answer 42

A

Question 43

what needs to be checked before commencing azathioprine

Answer 43

TPMT activity if deficient cannot metalobise azathioprine well and more prone to side effects

Question 44

what can be used for resitant c diff

Answer 44

fidaxomicin

Question 45

what are cardiac complications of carcidnoid

Answer 45

tricuspid insufficiency and pulmonary stenosis.

Question 46

what is zollinger ellson syndrome

Answer 46

is condition characterised by excessive levels of gastrin, usually from a gastrin secreting tumour usually of the duodenum or pancreas. Around 30% occur as part of MEN type I syndrome

Question 47

what is the diagnostic test for zollinger ellson syndrome

Answer 47

gastrin levels (fasting)

Question 48

what is associated with gastric cancer on a pathology vlevel

Answer 48

signet ring cells

Question 49

what blood test can be used to assess for chronic pancreatitis

Answer 49

faecal elastase

Question 50

what conditions are associate with primary sclerosisng chonlangitis

Answer 50

UC HIV (also crohns)

Question 51

what is the diagnostic investigation for PSC

Answer 51

ERCP

Question 52

what cancers are you at increased risk from in PSC

Answer 52

cholangiocarcinoma (10 percent) | colon cancer

Question 53

at what BMI can u be referred for bariatric surgery

Answer 53

``` no risk factors (>40) rish factors (>35) ```

Question 54

what antibody is associated with primary biliary cholangitis

Answer 54

antimitochondrial

Question 55

what is the gold standard investigation for GORD

Answer 55

24 hour oesophageal pH monitoring

Question 56

what can be seen on imaging in pancreatic cancer

Answer 56

'double duct' sign - dilation of both the pancreatic and CBD

Question 57

what biochemical marker is used to monitor efficacy of treatment in haemochromatosis

Answer 57

ferritin and transferin saturation

Question 58

what investigation can confirm a diagnosis of gilberts syndrome

Answer 58

investigation: rise in bilirubin following prolonged fasting or IV nicotinic acid

Question 59

for oesophageal/gastric cancer - what is the best method to assess for mural invasiion

Answer 59

endoscopic ultrasound

Question 60

what is the carrier rate of CF

Answer 60

1 in 25

Question 61

what clotting factor is paradoxically raised in liver failure

Answer 61

factor 8

Question 62

what is the investigation of choice for bile acid malabsoption

Answer 62

the test of choice is SeHCAT nuclear medicine test using a gamma-emitting selenium molecule in selenium homocholic acid taurine or tauroselcholic acid (SeHCAT) scans are done 7 days apart to assess the retention/loss of radiolabelled 75SeHCAT

Question 63

where do VIPomas usually originate

Answer 63

pancreas

Question 64

which type of colonic polyps are more strongly associate with malignancy

Answer 64

flat or 'sessile' polyps

Question 65

what medical therapy can help prevent cancer in lynch syndrome

Answer 65

apirin 600mg