Gastroenterology and HPB Flashcards
(30 cards)
60Y M presents to ED with sudden onset severe central abdominal pan, vomiting and diarrhoea. It is a constant pain, no radiation and he has never had this before. PMH is significant for MI; no other problems except the mentions increasing heartburn after eating. O/E: initially extremely unwell with tachycardia and resistant hypotension despite fluid treatment. Abdominal examination revealed slight central and epigastric pain but no guarding or rebound tenderness. Which is the most likely diagnosis?
a) Perforated viscera
b) Pancreatitis
c) Gastric ulcer
d) Small bowel ischaemia
E) Intussusception
D - Small bowel ischaemia
Patient is a known arteriopath (past MI).
Likely to have developed a thrombus in the mesenteric circulation.
Triad of severe acute abdominal pain, severe shock and a lack of significant abdominal findings.
A 32 year old housewife is referred to the gastroenterology clinic with a 2 year history of gastroenterological complaints. Which of the following is the most useful in her history in establishing an organic diagnosis?
a) Tenesmus
b) Mucus PR
c) Dyspareunia
d) Abdominal bloating
e) Weight loss
E - Weight loss
IBS is a complex disease and all of the answers A-D can be associated. However, weightless is not and is therefore most suggestive of an underlying organic cause.
A 45 year old patient presents to you with a few weeks’ history of odynophagia and dysphagia. O/E, he is noted to have white plaques at the back of his throat, but no ulcers. On endoscopy, these white plaques extend into the oesophagus. He does not take any prescription drugs or over the counter remedies or illegal drugs. There is nothing of note in his PMH. What is the single most useful test in diagnosing the underlying pathology in this patient?
a) Monospot test
b) Oral glucose tolerance test
c) Blood tests
d) Viral markers
e) Bacterial MC+S
D - Viral markers
This patient appears to be suffering from oral and oesophageal candidiasis.
The most likely cause is immunosuppression. Oesophageal candidiasis is an AIDS-defining condition.
Therefore, testing for HIV is a necessity.
Which one of the following is least likely to cause pruritis ani?
a) Threadworm
b) Incontinence
c) Anxiety
d) Perianal haematoma
e) Contact dermatitis
D - Perianal haematoma
A clotted venous sacule, can affect patients suffering from haemorrhoids.
Typically painful, but responds to topical gels and does not cause pruritis ani.
A 70 year old is brought into the ED with severe abdominal pain worsening over the past 2 days - associated with a fever at home. Some blood diarrhoea at the same time. Attended a birthday party at a Chinese restaurant a few days a go, unwell since.
O/E he is febrile, tachycardia and in obvious discomfort. Abdomen examination reveals a tender mass in the left iliac fossa with some guarding. Rectal examination reveals normal coloured stool with some blood on glove, no malaena or masses. Erect CXR shows no evidence of sub diaphragmatic air.
Which one of the following is the most likely diagnosis?
a) Infective colitis
b) Ulcerative colitis
c) Malignant obstruction
d) Diverticulitis
e) Atypical appendicitis
D) Diverticulitis
Indicated by:
Age
Left-sided mass and tenderness
Increasingly common acute surgical presentation.
Requires IV fluids and ABx
CT abdo and pelvis
May represent a diverticular abscess
A 29 year old develops nausea, vomiting and diarrhoea, which appears to be due to gastroenteritis. Nearly everyone who attended the same conference 2 days a go has developed the same condition. Which of the following applies to this patient?
a) You do not need to contact the consultant in communicable disease
b) The timing is suggestive of salmonella gastroenteritis
c) Antimicrobial therapy is the main treatment option in this patient
d) Pathogen is likely to be campylobacter jejuni
e) The pathogen is likely to be bacillus cereus
D) Campylobacter jejuni
All cases of food poisoning should be reported to the consultant in communicable disease
(2hrs) Bacillus cereus: fried rice cooked and stored for hours
(4-8hrs) Salmonella gastroenteritis
(2-5days) Campylobacter jejuni
Fluid rehydration and ABx if required
Which one of the following statements best describes Charcot’s triad?
a) Pain, dilated common bile duct and jaundice
b) Pain, jaundice and fever
c) Gallstones, pain and fever
d) Gallstones, jaundice and hypoalbuminaemia
e) Hypoalbuminaemia, pain and jaundice
B) Pain, jaundice and fever
Charcot’s triad for ascending cholangitis.
Key differentials are: biliary colic and acute cholecystitis
Listed below are a number of familiar cancer syndromes. Which one has a different mode of inheritance compared with the others?
a) Xeroderma pigmentosa
b) Familial breast cancer
c) Familial adenomatous polyposis
d) Hereditary non-polyposis colon cancer
e) Wilm’s tumour
A) Xeroderma pigmentosa
Xeroderma pigmentosa is autosomal recessive
Familial breast cancer, adenomatous polyposis, hereditary non-polyposis colon cancer and Wilm’s tumour are all autosomal dominant
A patient in hospital develops constipation during his admission and asks you about the medications available for this condition. Which of these answers is the most correct?
a) Fybogel is a stimulant laxative which should be taken with plenty of fluids.
b) Magnesium containing antacids can relieve constipation
c) Lactulose is a stimulant laxative than can take up to 2 days to work
d) Co-danthramer is a widely used stimulant laxative
e) Hyperkalaemia is a risk with excessive use of laxatives
B)
A 54 year old patient complains of increasing difficulty swallowing over the past year. She reports no weight loss or sinister features suggestive of malignancy. She tells you food sticks to her throat. Which one of the following would you perform to investigate this complaint?
a) Endoscopy
b) Simple barium meal
c) Barium swallow
d) Double contrast barium meal
e) Small bowel follow through
92
You review a patient in clinic with a diagnosed oesophageal stricture. Which one of the following is the most common cause of oesophageal strictures?
a) Adenocarcinoma
b) Crohn’s disease
c) GORD
d) Caustic ingestion
e) Radiation induced stricture
98
A 32 year old presents to ED after being found by her husband with an empty bottle of tablets and a half finished bottle of vodka. O/E her pupils are dilated but responsive to light. Her mucous membranes and tongue appear dry and she is sinus tachy. Which one of the following is most useful in assessing the severity of the overdose?
a) Drug levels
b) LFTs
c) Activated charcoal
d) ECG
e) INR
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A 35 year old presents with a long history of diarrhoea and steatorrhoea. This has been accompanied by weight loss, fever and joint pains. O/E he has widespread peripheral lymphadenopathy with ophthalmoplegia and nystagmus. Which one of the following would be diagnostic for the above condition?
a) Small bowel biopsy
b) MRI head
c) Barium follow through
d) CT abdomen
e) Bone marrow biopsy
111
A patient with early gastric cancer is admitted for gastrectomy under the care of your consultant. Which one of the following is most suitable for post-operative pain relief?
a) Regular long acting oral morphine with oramorph prn
b) Epidural anesthesia
c) Spinal anaesthesia
d) Intercostal nerve block
e) Patient controlled analgaesia
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Mr Smith is a 58 year old gentleman presenting with trouble defecating and although he passes stool normally, over the past month he has noticed the uncomfortable feeling of still wanting to defecate after going. Over the past 2 weeks he has noticed mucus in the stool but denies any blood or change in colour. What is the next most appropriate step?
a) Colonoscopy
b) Barium enema
c) Faecal occult blood testing
d) Sigmoidoscopy
e) CT abdomen
116
A 30y student undergoes a flexi sig for diarrhoea that has been occurring on and off for the past few years. She reports bloating and abdominal cramps, but no other symptoms. The flexi sig shows melanosis coli. Which one of the following is most likely her diagnosis?
a) Hyperthyroidism
b) Laxative abuse
c) Coeliac disease
d) Microscopic colitis
e) Malignancy
128
You are an F1 admitting a patient with jaundice. Which one of the following with regards to this sign is true?
a) Jaundice is usually clinically detectable with bilirubin concentrations greater than 80umol/L
b) Gilbert syndrome and Crigler-Najjar syndrome lead to jaundice through defects in the same enzyme
c) An ALT:AST ration of 2 or more heavily suggests alcohol abuse
d) AMA are specific to PBC
e) Bilirubin is converted to urobilinogen by the liver
131
Which one of the following is true?
a) The leading cause of cirrhosis world wide is alcohol
b) In Budd-Chiari syndrome, there is obstruction of the portal vein
c) Schistosomiasis can lead to pre-hepatic portal hypertension
d) Patient with PBC typically have raised serum cholesterol levels
e) Non-alcoholic steatohepatitis is a benign condition
139
A patient who has taken an overdose is brought in by ambulance. You are considering administering activated charcoal’ which one of the following overdoses can be treated this way?
a) Iron
b) Methanol
c) Lithium
d) Aminophylline
e) Ethylene glycol
145
A 15yr girl presents with central abdominal pain, localising to the right lower quadrant. This is accompanied by decreased appetite, a pyrexia of 37.6 and nausea. Which one of the following statements is true?
a) Mortality is highest for patients between 10 and 20 years
b) Pain on palpation of the right iliac fossa but not the left iliac fossa is known as Rovsig’s sign
c) DKA is an important DDx
d) Lymphocytosis is present in between 80% and 90% of patients
e) A positive urine test for βhCG rules out the above condition
147
A 45 year old chef who recently underwent a laparotomy for resection of diseased small bowel, secondary to CD is complaining of not being able to move his legs. His obs are as follows: T = 37.0, HR = 50bpm, BP = 105/60mmHg, RR = 15 and sats on room air are 97%.
He is receiving bupivacaine through an epidural which is working well. When you go to see him he is pain free and on examination, both legs are completely paralysed.
Which of the following is true?
a) The on-call surgical registrar should be informed
b) The patient is at risk of metabolic alkalosis
c) Sitting the patient up is contraindicated
d) The epidural should be slowed but kept running
e) Naloxone would be helpful
152
A 22 year old male comes to see you because of pain and discharge near his anus. He tells you that it is extremely tender and is discharging pus. There are no other complains and systems review is unremarkable. Abdominal examination shows no abnormalities. Examination of the perianus shows a discharging sinus in the intergluteal cleft 5m from the anus, with an overlying erythema, most likely due to an abscess. Which one of the following statements is true?
a) There is a racial difference, with this condition being more common in africans and asians
b) Incision and drainage of the abscess is recommended
c) Women > Men
d) Obesity is a protective factor in developing this condition
e) Meticulous shaving and hygiene has no role in the control of this disease
154
A patient is referred to the ED for severe UC. Which one of the following is not a marker of severity?
a) Tachycardia
b) Stool consistency
c) Stool frequency
d) Fever >37.5
e) Albumin
166
Which of the following is true with regard to pernicious anaemia?
a) The presence of thyroid autoantibodies implies an alternative diagnosis
b) Patients are at a decreased risk of gastric cancer
c) It is associated with blood group A
d) Intrinsic factor antibodies are present in 90% of patients
e) Parietal cell antibodies are diagnostic
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